Heart Risks in Midlife Reduce Men's Life Expectancy

Study links baseline risk factors with a 10- to 15-year shorter life expectancy from age 50

19 sept 2009-- In middle-aged men with cardiovascular risk factors, long-term life expectancy is significantly shortened even if they subsequently modify those risk factors, according to a study published Sept. 17 in BMJ.

Robert Clarke, from the University of Oxford in the United Kingdom, and colleagues analyzed data on 18,863 male civil servants ages 40 to 69 years at first assessment. At the first assessment, in 1967 to 1970, subjects had high rates of current smoking, hypertension, and elevated cholesterol (42, 39, and 51 percent, respectively). At a second assessment in 1997, two thirds-of the surviving smokers had long since quit, and the mean differences between those with low or high blood pressure and cholesterol had been reduced by two-thirds.

The researchers found that the baseline presence of all three risk factors was associated with significantly shorter life expectancy from age 50 (23.7 years) than the absence of all three risk factors (33.3 years). They also found that men whose risk score was in the highest 5 percent for these risk factors combined with diabetes, high body mass index, and low pay grade had a significantly shorter life expectancy from age 50 (20.2 years) than those whose risk score was in the lowest 5 percent (35.4 years).

"Continued public health strategies to lower mean levels of the three main cardiovascular risk factors, together with more intensive medical treatment for 'high-risk' subgroups, including use of medication to lower blood pressure and cholesterol concentration, that have proved efficacy could result in further improvements in life expectancy," the authors write.

Abstract
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Studying the earliest brain changes that could lead to Alzheimer's disease

5 researchers receive grants to investigate biological, genetic, and environmental causes of AD

NEW YORK, 19 sept 2009-- Five early-career scientists were awarded The Rosalinde and Arthur Gilbert Foundation/AFAR New Investigator Awards in Alzheimer's Disease. The $75,000 awards provide a broad array of funding in the biological, genetic, and environmental causes of AD. By studying the early changes suggesting Alzheimer's disease from different but complementary angles, the awards seek to accelerate development of diagnostic, preventative interventions, and treatments. The program, now in its third year, has provided more than $1 million to 16 scientists in the U.S. and Israel.

Award recipients include:

Ehud Cohen, PhD, Lecturer, The Hebrew University of Jerusalem: Roles of Peptidylprolyl Cis/Trans Isomerases in the Regulation of Aging and Countering Alzheimer's Disease

Dr. Cohen's research will focus on the possible roles of cyclophilins – a group of proteins that help other proteins fold properly - in preventing Alzheimer's disease (AD) from emerging early in life and will test how this activity is affected by the aging process. His research could answer the question of whether the maintenance of cyclophilin activity through late life could protect against developing AD and will help unearth the mechanisms underlying the onset of some types of familial AD.

Raquel L. Lieberman, PhD, Assistant Professor, Georgia Tech: Crystal Structure of an Intramembrane Asparyl Protease

Over-production of beta amyloid peptides contribute to the pathogenesis of Alzheimer's disease.

The objective of this research is to understand the crystal structure of signal peptide peptidase (SPP). This protein is closely related to gamma secretase, the enzyme that participates in the generation of beta amyloids, species that are known to play roles in the development of Alzheimer's disease. Insights into these crystal structures could significantly further the development of structure-based designs for potential therapeutic agents.

Gad A. Marshall, MD, Instructor in Neurology, Associate Neurologist, Brigham and Women's Hospital: Amyloid Deposition and Frontally Mediated Symptoms in MCI

Although memory loss is the hallmark of Alzheimer's disease (AD), behavioral changes and executive dysfunction often play a major role in disability. Dr. Marshall will use state of the art imaging techniques to better understand the biological underpinnings of apathy and executive dysfunction in relation to mild cognitive impairment (MCI) and mild AD. This may provide the opportunity to differentiate between patients whose MCI will progress to AD and intervene with disease-modifying agents, attacking the disease at its earliest stages.

Esther Oh, MD, Assistant Professor, Johns Hopkins University: Oral Glucose Tolerance Test For Alzheimer's Disease Biomarker Development

The goal of Dr. Oh's research is to modify an amyloid blood test so that it may be able to determine whether someone has early forms of Alzheimer's disease (AD) or predict who may develop the disease among individuals who have certain forms of mild cognitive impairment (MCI). Since many cases of AD are diagnosed at more advanced stages, the diagnostic blood test, which could predict the likelihood of a person developing AD years in advance, could allow clinicians greater opportunity to intervene when drug therapy is likelier to be more effective.

Lucia Pastorino, PhD, Instructor in Medicine, Beth Israel Deaconess Medical Center: Role of the Prolyl Isomerase Pin1 in the Modulation of PS1 Activity

Dr. Pastorino will investigate how the regulation of protein conformation may be crucial in the development of Alzheimer's disease. Specifically, Dr. Pastorino will investigate whether Pin1, a protein that regulates the spatial conformation of other protein substrates, modifies the functional activity of another protein, presenilin 1, key to the generation of amyloid peptides typically seen in patients with AD.

Read more about these grant recipients at http://www.afar.org/gilbert09.html

According to the Alzheimer's Association, 5.3 million Americans are living with Alzheimer's disease. By 2010, it is estimated that there will be nearly half a million new cases of Alzheimer's disease diagnosed each year with that number doubling by 2050. There are currently no treatments to prevent AD or reverse its effects.

"Aging is by far the biggest risk factor for Alzheimer's disease. Researching the fundamental mechanisms that set the stage for Alzheimer's disease will help us get at the root of how this disease develops and progresses that could lead to a viable program of prevention and therapy, our ultimate goal," said George M. Martin, MD, Director Emeritus, Alzheimer's Disease Research Center at the University of Washington School of Medicine and Scientific Director of the American Federation for Aging Research. "The Rosalinde and Arthur Gilbert Foundation and an anonymous donor who supplemented each award are to be commended for their continued commitment to supporting these promising young scientists with innovative approaches to tackling our most pressing public health problem."

"The Rosalinde and Arthur Gilbert Foundation has invested in an outstanding group of U.S. and Israeli researchers who have the potential to make important and lasting contributions to Alzheimer's disease and aging science," said Martin H. Blank, Jr., co-director and Chief Operating Officer of the Foundation.

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The Rosalinde and Arthur Gilbert Foundation (www.thegilbertfoundation.org) invests in programs in the areas of College Access, Healthcare and Israel. In addition, The Foundation funds Arts Education & Culture in Los Angeles, Jewish Programs in Los Angeles, and Universities in California. In the area of Alzheimer's disease, The Rosalinde and Arthur Gilbert Foundation focuses its grantmaking on the advancement of research by junior investigators in the United States and Israel and investments in Alzheimer's disease caregiving.

Postmenopausal women, too, reap cardiovascular benefits from endurance training

Vigorous exercise as beneficial after menopause as for younger women

19 sept 2009--Marilyn Graham was 56 when she signed up for a grueling hour of cycling each morning for 12 weeks, occasionally decked out in a mask, a heart monitor and a bag of intravenous fluid and subjected to needle pricks to obtain blood samples.

"I was probably the biggest whiner of the group, complaining loudly about the seats and how my butt hurt," said Graham, who writes software for business units on the University of California, Berkeley campus. "It was really intense, and on some days my legs felt like wet noodles. On a cranky day I'd say, 'Let me off this stupid bike!'"

But once the training "kicked in," she said," I was feeling good. I had energy left over at the end of the day, less mental sluggishness. And I dropped two dress sizes without any weight loss."

Graham's experience was typical of the 10 healthy but sedentary women, averaging 55 years of age, who participated in a 2006 study of endurance training in 50-something women.

In two papers based on the experiments and published in recent months, UC Berkeley researchers report that postmenopausal women can achieve the same health benefits from regular, vigorous exercise as younger women do.

"There is some good news here for older women in the population, in that they respond much like younger women do to training," said study leader and exercise physiologist George Brooks, UC Berkeley professor of integrative biology. "The results are very encouraging for exercise without weight loss as an effective means for increasing vigor and controlling risk factors for chronic diseases in older women."

"There have been very few studies looking at postmenopausal women, who are different because of decreased estrogen, decreased lean body mass and decreased aerobic capacity," said Zinta Zarins, a newly minted UC Berkeley Ph.D. who conducted the experiments and is now a post-doctoral fellow at UC San Francisco. "Yet, despite changes in hormones and changes in body composition, postmenopausal women can make significant changes in their cardiovascular fitness without going on extreme diets."

Although the endurance training involved cycling on an exercise bike for an hour, five days a week, at 65 percent of maximum lung capacity, the researchers noted that even less strenuous aerobic exercise would likely produce some benefit.

"Most people don't exercise at this level, but some exercise is better than none at all," Zarins said, noting that 60 minutes of jogging on a treadmill or swimming should be as effective as an hour on a stationary bike.

Brooks noted that a woman's metabolism changes as her hormone levels change after menopause, affecting glucose clearance from the blood, for example. He proposed the study, which was funded by the National Institutes of Health, to determine whether women achieve the same benefits from endurance training after menopause as they did before.

"We've done lots of studies on the effects of activity and training on metabolism in younger men and women, but this is the first in an older population," Brooks said.

In a paper appearing in the September issue of the journal Metabolism - Clinical and Experimental, Brooks and Zarins report that participants increased their body's capacity to consume and use oxygen - their VO2 max - by an average of 16 percent and dropped their resting heart rates by an average of 4 beats per minute. Brooks said that after the age of 30, people lose the capacity to consume and use oxygen at about 1 percent per year.

"So, in effect, the women in our study had the cardiovascular and metabolic capabilities of women 16 years younger," he said.

By the end of the study, the women's blood pressure during exercise had dropped by 8 millimeters of mercury, while their heart rates were 19 beats per minute less when performing at the same intensity as early in the study. In addition, the women decreased their carbohydrate burning during exercise and increased their fat burning by about 10 percent. Women in the study maintained their body weight as a way to balance energy input and expenditures.

"While men tend to burn carbohydrates first during exercise, women are better fat burners, and in our study, the women improved fat burning and decreased their reliance on carbohydrate after training," Brooks said. Because they burn fat more than carbohydrates during exercise, women, in general, are better than men at maintaining stable blood glucose levels - the glucose comes from stored carbohydrates - and maintaining their weight, even while undergoing vigorous training, he said. In fact, men continue to burn carbohydrates for several hours after exercise, while women's metabolism immediately returns to normal.

A second paper, published in the July issue of the Journal of Applied Physiology, showed that the women's use of blood glucose and their insulin levels during exercise showed similarities to those of younger women.

Like Graham, most training participants noticed health benefits. Carol Nyhoff, a UC Berkeley alumna who was 57 at the time of the study, admits that exercise on a treadmill at a pace suitable for reading pales in comparison to the endurance training she completed while in the study. During the final VO2 max tests, she said, "I pushed myself very hard to see how much I could do, thinking, 'Wow this could be dangerous, you're way out there somewhere.'" Yet, two weeks after the study ended, her acupuncturist told her she had the pulse of an athlete.

"I was really proud of my accomplishment and the fact that a lot of joint pain and malaise that I had been seeing the acupuncturist for was GONE two weeks after starting the study!" she wrote in an e-mail.

While many of the women who participated in the 2006 study have given up such vigorous training, claiming lack of time in a too-busy schedule, most say they have plans to resume regular exercise.

"Before, I didn't even know if getting in shape was a possibility," said Graham, who recently installed a treadmill at home. "Now I know I can, and I know how to do it."

Patti Owen, who was 54 when she participated in the study, retired in July and is finally finding time for daily vigorous walks. She aims for a pulse rate of 145, which was her target rate in the cycling study.

"Since we had to maintain our weight, the study taught me that losing weight isn't necessarily healthy, that exercise is what keeps us healthy and fit," said Owen, formerly the head of the campus's Academic Personnel office. During the 12-week study, she found herself no longer huffing and puffing as she walked uphill through campus.

"People were even noticing changes in my body shape, and I actually dropped about one size," she said. "It was all good."

Persistent Pain May Accelerate Signs Of Aging By Two To Three Decades In Middle-Aged Adults

18 sept 2009--Younger people with pain look similar in terms of their disability to people who are two to three decades older without pain, according to a study published in this month's issue of the Journal of the American Geriatric Society. The results of the study uncovered that people with pain develop the functional limitations classically associated with aging at much earlier ages.

Functional limitations that impair the ability to live independently increase markedly with age, and to examine the effect researchers looked at the data from the 18,531 participants, aged 50 and older, who took part in the 2004 Health and Retirement Study. The four physical abilities considered were: mobility, for example walking or jogging; stair climbing; upper extremity tasks, and; activity of daily living (bathing, dressing, eating, etc) with or without help.

24% of participants had significant pain (often troubled by pain that was moderate or severe most of the time) and across all four physical abilities looked at, participants with pain had much higher rates of functional limitations than subjects without pain. In the mobility function as an example, of subjects aged 50 to 59 without pain 37% were able to jog 1 mile and 91% were able to walk several blocks without difficulty, compared to only 9% and 50% respectively in those with pain.

The study was led by Dr. Kenneth Covinsky of the Division of Geriatrics at University of California, San Francisco. "We found that the abilities of those aged 50 to 59 with pain were far more comparable to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile and 55% were able to walk several blocks, making pain sufferers appear 20 to 30 years older than non-pain sufferers," surmised Covinsky. "After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations."

This is the first study of its kind to examine the relationship of pain across the age span, and to identify the large magnitude of the association between pain and age related disability. Although the strength of the association between pain and mobility limitation decreased somewhat with increasing age, a strong association between pain and mobility limitations persisted through the 10th decade of life.

"Our study cannot determine whether pain causes disability or whether disability causes pain. We think it is likely that both are true and that pain and disability probably can act together in ways that make both problems worsen in a downward spiral," said Dr. Covinsky. "One implication of our study is that pain and disability may not be fully separate processes, but may often be part of the same underlying process. Patients may be better served if pain and disability are evaluated and treated jointly rather than treated as separate issues."

The editor of the Journal of the American Geriatric Society, Dr. Thomas Yoshikawa, added "The drastic effect that pain can have on sufferer's abilities to carry out everyday tasks in their lives highlights the importance of managing pain and treating it effectively. Last month, we published our annual guidelines on the pharmacological management of persistent pain in older persons, and this study really brings home how essential it is for healthcare providers to be able to improve quality of life through awareness of the best treatments."

This study is published in the September issue of the Journal of the American Geriatrics Society.

Full citations:
Covinsky KE, Lindquist K, Dunlop DD, Yelin E; Pain, Functional Limitations, and Aging; AGS 2009; Volume 57 Issue 9, Pages 1556 - 1561; DOI: 10.1111/j.1532-5415.2009.02388.x View the abstract here.

"Pharmacological Management of Persistent Pain in Older Persons; American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons;" JAGS 57:1331-1346, 2009; DOI: 10.1111/j.1532-5415.2009.02376.x View the abstract here.

About the Author

Kenneth Covinsky, MD, MPH, is based at the Division of Geriatrics, University of California, San Francisco and staff physician at the San Francisco VA Medical Center.

About the Journal

The Journal of the American Geriatrics Society is a comprehensive and reliable source of monthly research and information about common diseases and disorders of older adults.

The Journal of the American Geriatrics Society is a comprehensive and reliable source of monthly research and information about common diseases and disorders of older adults. The journal is published by Wiley-Blackwell on behalf of the American Geriatrics Society. For more information, please visit http://www.blackwellpublishing.com/jgs.

Source
Wiley-Blackwell

Physical Therapists Offer Tips For Falls Prevention In Aging Adults

18 sept 2009--As the nation observes Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to schedule a balance and falls assessment with a physical therapist to reduce risk of falls and related injuries.

According to the Centers for Disease Control and Prevention, more than one third of adults ages 65 and older fall each year in the United States. Falls are the leading cause of deaths due to injuries and the most common cause of nonfatal injuries and hospital admissions for trauma for the aging population.

"Too many people erroneously consider falls a normal consequence of growing old," says physical therapist and APTA spokesperson Judith Daniel, PT, MS, GCS. "It's simply not true. There are evidence-based interventions that can help reduce their risk of falling and reduce falls-related injuries. A comprehensive examination that includes a balance assessment performed by a physical therapist can be effective in determining the factors that are contributing to an individual's loss of mobility, risk for falls, and/or decreased confidence. Once this information has been gathered, the physical therapist can then determine which type of muscle strengthening and balance retraining program would be most beneficial to reduce the individual's risk of falling."

In addition to adhering to a program designed specifically by a physical therapist, older adults should:

- Ask all health care providers to review their medicines -- both prescription and over-the counter -- to reduce side effects and interactions.
- Have their eyes checked by an eye doctor at least once a year.
- Reduce hazards and improve the lighting in their homes.

Older adults who use canes and walkers as walking aids should also be properly assessed and fitted by a physical therapist to avoid fall-related injuries. The following are general recommendations for older adults who use walking aids can help reduce falls (See APTA's New Tip Sheet on Proper Fit of Walking Aids )

- The walker or cane should be about the height of your wrists when your arms are at your sides.
- When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
- Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

To find a physical therapist in your area, visit the Find-a-PT database on APTA's Web site and use the drop down menu to find a physical therapist who is right for you.

Falls Awareness Day, hosted by the National Council on Aging, is observed on the first day of fall to promote and increase public awareness about how to prevent and reduce falls among older adults.

Source
APTA

Is there really a skin cancer epidemic?

NEW YORK , 16 sept 2009– Is melanoma, a potentially deadly form of skin cancer, on the rise, as is often reported? Maybe not, says a new study: The "melanoma epidemic" may simply represent a change in how doctors are diagnosing the disease.

Anti-skin cancer campaigns have highlighted the fact that the number of melanomas has doubled in the past two decades, and continue to rise. However, some have doubted whether there are actually more cases of the cancer.

"The main message is to be cautious about overstating messages about a melanoma epidemic to the public and media," study co-author Dr. Nick J. Levell from Norfolk and Norwich University Hospital, Norwich, UK, told Reuters Health in an email. "Such behavior will tend to induce unnecessary anxiety and behavior that may cause distress and harm."

Dr. Levell and colleagues had a hunch that some of the "epidemic" was due to the fact that many cases of a skin condition known as benign melanocytic nevi - a type of mole - were now being diagnosed as malignant melanoma. So they looked at diagnoses of melanomas from 1991 and 2004 in the East Anglia region of the UK.

The rate did in fact grow, from 9.39 cases per year per 100,000 people, to 13.91, the authors report in the British Journal of Dermatology.

But it was the early-stage melanomas that accounted for much of that difference, while the rate of diagnoses of later-stage melanomas did not change.

At the same time, the researchers note, the rate of death from melanoma rose from 2.16 to 2.54 deaths per 100,000 population per year, but essentially everyone with early stage melanomas survived.

Finally, most early cases were found in parts of the body not exposed to very much sun. Such exposure, which includes ultraviolet radiation, has been tied to melanoma.

All of that suggests, the authors write, that many of the cases of melanoma now being diagnosed would have been called benign melanocytic nevi in the past.

"The trend is to some degree a product of society's trend toward increasing litigation and physicians' increasing fear of making a mistake," Dr. Levell added. "Neither of these is likely to be reversed. Recognition of the phenomenon does however enable the public and physicians to compensate for it to some extent."

SOURCE: British Journal of Dermatology, September 2009.

More Chest Compressions in CPR May Improve Survival

Researchers urge changes to resuscitation practices to maximize chest compression in CPR

16 sept 2009-- The more that emergency personnel perform chest compression during cardiopulmonary resuscitation (CPR) of a patient in cardiac arrest, the greater the odds of patient survival, according to a study published online Sept. 14 in Circulation.

Jim Christenson, M.D., of the University of British Columbia in Vancouver, Canada, and colleagues studied a cohort of 506 patients who suffered out-of-hospital cardiac arrest due to ventricular fibrillation or ventricular tachycardia and did not undergo defibrillation before electronically-monitored CPR was performed. The researchers assessed the relationship between the fraction of time spent on chest compression (CCF) and patient survival to hospital discharge.

Generally, the researchers found that the adjusted odds ratio for survival increased with increased CCF. For 0 to 20 percent CCF, (reference); for 21 to 40 percent CCF, odds ratio, 2.27; for 41 to 60 percent CCF, odds ratio, 2.39; for 61 to 80 percent CCF, odds ratio, 3.01; and for 81 to 100 percent CCF, odds ratio, 2.33. The researchers attributed the drop in odds ratio in the highest CCF category to a plateau effect above 80 percent CCF or a patient group in which there was less likelihood of survival and more extreme resuscitation efforts.

"These data strongly support the contention that more time spent performing chest compressions in the early phase of resuscitation substantially affects survival to hospital discharge. Implementation of strategies to alter resuscitation practices to maximize chest compression fraction are likely to result in a real and sustainable increase in survival from cardiac arrest," the authors write.

Abstract
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FDA Approves Four Vaccines for H1N1 Influenza

Clinical studies have shown robust immune response in adults within 10 days

16 sept 2009-- The U.S. Food and Drug Administration has approved four H1N1 influenza vaccines, according to a Sept. 15 news release issued by the agency.

The news release states that the initial lots of the vaccines are expected to be available within the next four weeks, and they will be distributed nationally after that time. Based on preliminary data from clinical studies, the four vaccines induce a robust immune response in healthy adults eight to 10 days after a single dose is given. The optimal dose in children has not yet been determined by clinical studies.

The vaccines are manufactured by CSL Limited, MedImmune L.L.C., Novartis Vaccines and Diagnostics Ltd., and Sanofi Pasteur Inc. Side effects are expected to be similar to those of seasonal flu vaccines. In clinical trials, the H1N1 vaccines have been well-tolerated. People who have severe allergies to chicken eggs -- or to any other substance in the vaccine -- should not be vaccinated, according to the release.

"Today's approval is good news for our nation's response to the 2009 H1N1 influenza virus. This vaccine will help protect individuals from serious illness and death from influenza," FDA's Commissioner of Food and Drugs, Margaret A. Hamburg, M.D., said in a statement.

More Information

Exercise can extend survival even in 'oldest old'

CHICAGO, 15 sept 2009 – Even in the "oldest old," a little physical activity goes a long way, extending life by at least a few years for people in their mid- to late 80s, Israeli researchers found.

The three-year survival rate was about three times higher for active 85-year-olds compared with those who were inactive. Getting less than four hours of exercise weekly was considered inactive; more than that was active.

The results "clearly support the continued encouragement of physical activity, even among the oldest old. Indeed, it seems that it is never too late to start," the researchers wrote in Monday's Archives of Internal Medicine, which published the study.

They noted that exercise reaped benefits even for previously sedentary 85-year-olds; their three-year survival rate was double that of inactive 85-year-olds.

Oldsters didn't have to be super-athletes to live longer; walking at least four hours weekly counted, even if it was just in 15-minute strolls a few times daily.

"As little as four hours a week was as beneficial as more vigorous or prolonged activity," said study author Dr. Jeremy Jacobs, a geriatric specialist at Hadassah Hebrew University Medical Center in Jerusalem.

Active octogenarians also reported less depression and loneliness and a greater ability to perform daily tasks.

Similar benefits have been shown in people in their 60s and 70s, but there has been little research about exercise benefits in people in their 80s.

The study involved 1,861 Jerusalem residents who were 70 years old in 1990. Participants filled out questionnaires about their health and activity levels through 2008.

At age 85, 64 percent were physically active, a relatively high percentage that reflects the Israeli lifestyle, Jacobs said. But he said similar benefits from exercise likely would be seen among the very old in other countries.

There were 512 deaths. Slightly fewer than 7 percent of the active 85-year-olds died by age 88, versus about 24 percent of those who were inactive.

Jacobs said the researchers took into account factors that also affect survival, including participants' overall health and whether they smoked, and still found that activity levels were strongly related to longevity.

Dr. James Webster, a professor of geriatric medicine at Northwestern University's Feinberg School of Medicine in Chicago, said the study can't completely rule out that participants who were able to exercise were already healthier than the others, and thus likely to live longer.

Still, Webster said the link between octogenarian exercise and longevity appears valid. He was not involved in the study.

Laura Thorp, a researcher at Chicago's Rush University Medical Center, said very old patients who want to increase their activity should do so under a doctor's supervision. Still, Thorp said, "Even those who are not exercisers or athletes can start and still see substantial benefits."

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On the Net:

Archives: http://www.archinternmed.com

Hard To Build And Easy To Lose: How Aging Affects Muscle

15 sept 2009--Have you ever noticed that people have thinner arms and legs as they get older? As we age it becomes harder to keep our muscles healthy. They get smaller, which decreases strength and increases the likelihood of falls and fractures. New research is showing how this happens - and what to do about it.

A team of Nottingham researchers has already shown that when older people eat, they cannot make muscle as fast as the young. Now they've found that the suppression of muscle breakdown, which also happens during feeding, is blunted with age.

The scientists and doctors at The University of Nottingham Schools of Graduate Entry Medicine and Biomedical Sciences believe that a 'double whammy' affects people aged over 65. However the team think that weight training may "rejuvenate" muscle blood flow and help retain muscle for older people.

These results may explain the ongoing loss of muscle in older people: when they eat they don't build enough muscle with the protein in food; also, the insulin (a hormone released during a meal) fails to shut down the muscle breakdown that rises between meals and overnight. Normally, in young people, insulin acts to slow muscle breakdown. Common to these problems may be a failure to deliver nutrients and hormones to muscle because of a poorer blood supply.

The work has been done by Michael Rennie, Professor of Clinical Physiology, and Dr Emilie Wilkes, and their colleagues at The University of Nottingham. The research was funded by the UK's Biotechnology and Biological Sciences Research Council (BBSRC) as part of ongoing work on age-related muscle wasting and how to lessen that effect.

Research just published in the American Journal of Clinical Nutrition compared one group of people in their late 60s to a group of 25-year-olds, with equal numbers of men and women. Professor Rennie said "We studied our subjects first - before breakfast - and then after giving them a small amount of insulin to raise the hormone to what they would be if they had eaten breakfast, of a bowl of cornflakes or a croissant."

"We tagged one of the amino acids (from which proteins are made) so that we could discover how much protein in leg muscle was being broken down. We then compared how much amino acid was delivered to the leg and how much was leaving it, by analysing blood in the two situations.

"The results were clear. The younger people's muscles were able to use insulin we gave to stop the muscle breakdown, which had increased during the night. The muscles in the older people could not."

"In the course of our tests, we also noticed that the blood flow in the leg was greater in the younger people than the older ones," added Professor Rennie. "This set us thinking: maybe the rate of supply of nutrients and hormones is lower in the older people? This could explain the wasting we see."

Following this up led Beth Phillips, a PhD student working with Professor Rennie, to win the Blue Riband Award for work she presented at the summer meeting of The Physiological Society in Dublin. In her research Beth confirmed the blunting effect of age on leg blood flow after feeding, with and without exercise. The team predicted that weight training would reduce this blunting. "Indeed, she found that three sessions a week over 20 weeks 'rejuvenated' the leg blood flow responses of the older people. They became identical to those in the young," said Professor Rennie.

"I am extremely pleased with progress," he said. "Our team is making good headway in finding more and more out about what causes the loss of muscle with age. It looks like we have good clues about how to lessen it with weight training and possibly other ways to increase blood flow."

The team's research, published in the American Journal of Clinical Nutrition, can be accessed online at http://www.ajcn.org/papbyrecent.dtl "Blunting of insulin inhibition of proteolysis in legs of older subjects may contribute to age-related sarcopenia" by Emilie A Wilkes, Anna L Selby, Philip J Atherton, Rekha Patel, Debbie Rankin, Ken Smith, and Michael J Rennie, 2009 AmJ Clin Nutr (In press).

Source:
Professor Michael Rennie
University of Nottingham

Depression increases cancer patients' risk of dying

15 sept 2009--Depression can affect a cancer patient's likelihood of survival. That is the finding of an analysis published in the November 15, 2009 issue of Cancer, a peer-reviewed journal of the American Cancer Society. The results highlight the need for systematic screening of psychological distress and subsequent treatments.

A number of studies have shown that individuals' mental attitudes can impact their physical health. To determine the effects of depression on cancer patients' disease progression and survival, graduate student Jillian Satin, MA, of the University of British Columbia in Vancouver, Canada, and her colleagues analyzed all of the studies to date they could identify related to the topic.

The researchers found 26 studies with a total of 9417 patients that examined the effects of depression on patients' cancer progression and survival.

"We found an increased risk of death in patients who report more depressive symptoms than others and also in patients who have been diagnosed with a depressive disorder compared to patients who have not," said Satin. In the combined studies, the death rates were up to 25 percent higher in patients experiencing depressive symptoms and 39 percent higher in patients diagnosed with major or minor depression.

The increased risks remained even after considering patients' other clinical characteristics that might affect survival, indicating that depression may actually play a part in shortening survival. However, the authors say additional research must be conducted before any conclusions can be reached. The authors add that their analysis combined results across different tumor types, so future studies should look at the effects of depression on different kinds of cancer.

The investigators note that the actual risk of death associated with depression in cancer patients is still small, so patients should not feel that they must maintain a positive attitude to beat their disease. Nevertheless, the study indicates that it is important for physicians to regularly screen cancer patients for depression and to provide appropriate treatments.

The researchers did not find a clear association between depression and cancer progression, although only three studies were available for analysis.

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Article: "Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis." Jillian R. Satin, Wolfgang Linden, and Melanie J. Phillips. Cancer; Published Online: September 14, 2009 (DOI: 10.1002/cncr.24561); Print Issue Date: November 15, 2009.

Key Brain Receptors Linked To Learning And Memory Decrease With Age

14 sept 2009--Scientists studying cognitive decline that accompanies aging have been interested in nicotinic receptors, part of a key neural pathway that not only enhances learning and memory skills but reinforces addictions as well. The loss of these receptors has been difficult to study in living subjects, but Yale University researchers using advanced imaging technology have successfully tracked the loss of receptors with age, according to a report in the September issue of the journal Neurobiology of Aging.

"Measurable decline in cognitive abilities is evident by age 50, but our knowledge of the changes in the brain associated with these deficits has been largely confined to post-mortem studies," said Christopher H. van Dyck, senior author of the study and Professor of Psychiatry and Neurobiology and Director of the Alzheimer's Disease Research Unit.

The Yale University researchers used SPECT imaging to track concentrations of nicotinic receptors in eight brain regions of 47 subjects aged 18 to 85. They observed an age-related loss of receptors in seven of eight brain regions, at a rate of about 5 percent per decade of life.

Nicotinic receptors reinforce addictions such as smoking, but also facilitate learning and memory. Autopsies of dementia patients have revealed a significant decline of these receptors.

"Nicotinic receptors are such promising targets that pharmaceutical companies are currently exploring nicotine analogues as potential treatments for Alzheimer's disease and Mild Cognitive Impairment," van Dyck said.

The findings are additional evidence that nicotinic receptors may play a role in the cognitive decline associated with normal aging. "These results may encourage the broadening of therapeutic trials to target the cognitive decline associated with healthy aging," van Dyck said.

Other Yale authors of the paper are Effie M. Mitsis, Kelly P. Cosgrove, Julie K. Staley, Frederic Bois, Erin B. Frohlich, Gilles D. Tamagnan, Kristina M. Estok and John P. Seibyl.

The research was funded by the American Health Assistance Foundation, the Department of Veteran Affairs and the National Institute of Drug Abuse.

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Alan Garen

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Yale School of Medicine

Gum disease linked to head and neck cancer

14 sept 2009– The health hazards associated with chronic periodontitis (gum disease) extend way beyond the mouth. For years people have been warned that persistent periodontitis can cause heart disease. Now a new study suggests that gum disease may also be a risk factor for cancers of the head and neck.

As reported in the journal Cancer Epidemiology, Biomarkers, and Prevention, the study included 266 patients with cancers of the head or neck treated between 1999 and 2005, and 207 control subjects.

Periodontitis was determined by alveolar bone loss seen on x-rays, Dr. Mine Tezal, from The State University of New York, Buffalo, and colleagues note. Alveolar bone is the ridge of bone that surrounds the roots of the teeth, holding them in place. Loss of this bone is typically seen with severe periodontal disease.

With each millimeter of alveolar bone loss, the risk of head and neck cancer increased more than 4-fold, the report indicates. (One millimeter is about the size of the head of a pin.) The link was seen even in subjects who had never used tobacco and alcohol.

"Confirmatory studies ... are needed," Dr. Tezal said in a statement.

SOURCE: Cancer Epidemiology, Biomarkers, and Prevention, September 2009.

Ovarian Cancer Test Approved

14 sept 2009-- The U.S. Food and Drug Administration has approved a new test for women with pelvic tumors that are known to need surgery. The test, called OVA1, will help doctors decide if the tumor probably is ovarian cancer and how to proceed surgically.

OVA1 will identify some women who have negative results from ovarian cancer tests, but whose surgical cases would benefit from a gynecological oncologist's involvement, the agency said in a news release. Gynecological oncologists -- doctors who specialize in women's cancer -- have been found to help improve survival when they perform ovarian cancer surgery, the FDA said.

The new blood test -- approved for women aged 18 and older who have pelvic masses that require surgery -- is not meant to screen for ovarian cancer or replace diagnostics used to detect ovarian cancer, the FDA stressed.

OVA1 is produced by California-based Vermillion Inc., in conjunction with scientists at The Johns Hopkins University in Baltimore.

More information

The FDA has more about this approval.

Waist-Hip Ratio Better Predictor of Seniors' Mortality

Study finds elevated ratio, not body mass index or waist circumference, is appropriate yardstick

13 sept 2009-- In high-functioning older adults, waist-hip ratio is a more accurate predictor of all-cause mortality than either body mass index or waist circumference, according to a study published in the October issue of the Annals of Epidemiology.

Preethi Srikanthan, M.D., of the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues analyzed data from the MacArthur Successful Aging Study on 1,189 community-dwelling older men and women, ages 70 to 79 years at baseline, who met six physical and cognitive criteria for high-function status.

The researchers' unadjusted and adjusted analyses found that an increased waist-hip ratio was associated with increased all-cause mortality, and that the association varied by sex. In women, they observed a graded relationship between waist-hip ratio and mortality (relative hazard, 1.28 per 0.1 increase in waist-hip ratio). In men, they observed a threshold relationship (relative hazard, 1.75 for waist-hip ratio above 1.0 compared to a ratio of 1.0 or below). They found no association between body mass index or waist circumference and all-cause mortality.

"However, given our use of self-reported weight and height data, these findings need to be confirmed in other cohorts of older adults," the authors conclude. "Further research into the mechanisms underlying the increased health risks associated with high waist-hip ratio is also needed, specifically to delineate the role of intra-abdominal visceral fat, relative to pelvic bone size, gluteal muscle, and gluteal fat, in older adults' health risks."

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Screening Athletes Could Prevent Sudden Cardiac Death

One study finds 11 percent false-positive rate in screening young athletes for heart problems

13 sept 2009-- Athletes should undergo routine screening for heart abnormalities, as the practice would help prevent sudden death, according to two articles published in the September issue of the British Journal of Sports Medicine, a special issue in partnership with the International Olympic Committee dedicated to elite sports injury prevention.

Bram Bessem, M.D., and colleagues at the University Medical Centre Groningen in the Netherlands, analyzed the results of 428 cardiovascular screenings of athletes and found that, while 371 (87 percent) had a negative screening, further rounds of screening identified three athletes (0.7 percent) who were subsequently restricted from sports participation. Forty-seven athletes (11 percent) had a false-positive result.

Michael Papadakis and Sanjay Sharma, M.D., of King's College Hospital in London, reviewed the evidence relating to the efficacy, impact and cost-effectiveness of pre-participation cardiovascular screening in athletes age 35 years and younger and concluded that the argument for implementation of such screening for all young competitive athletes was compelling.

"The European recommendations have been endorsed by the International Olympic Committee and the football governing bodies, with the Union of European Football Associations advocating mandatory screening of all players participating in European championships," Papadakis and Sharma write. "Health care governing bodies need to be convinced that now is the time for universal electrocardiogram screening of all young athletes and make the necessary provisions for nationwide screening programs to commence."

Research by Papadakis is funded by Cardiac Risk in the Young, a charity advocating pre-participation screening for young athletes, and Sharma is a consultant cardiologist to the charity.

Abstract - Bessem
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Metabolic Syndrome Can Hike Peripheral Artery Disease Risk

Study in women also finds markers of inflammation elevated with metabolic syndrome

13 sept 2009-- Women with the array of cardiovascular risk factors known as metabolic syndrome (MetS) are at elevated risk for the eventual development of peripheral artery disease (PAD), according to a study published online Sept. 8 in Circulation.

David Conen, M.D., of Brigham and Women's Hospital in Boston, and colleagues followed a cohort of subjects in the Women's Health Study, who were free of cardiovascular disease at baseline, looking for incidence of PAD. Cox proportional hazards models were used to assess the PAD risk for women with and without MetS. The researchers also assessed the relationships between MetS and inflammation measured by levels of C-reactive protein (hsCRP) and soluble intercellular adhesion molecule-1 (sICAM-1).

The researchers found that women with MetS had a 62 percent increased risk for PAD. Following adjustment for age and smoking status, MetS remained significantly associated with PAD (hazard ratio, 1.48). However, when hsCRP and sICAM-1 were added to the risk models, risk associated with the MetS was attenuated and no longer achieved significance.

"In conclusion, similar to the previously noted relationship between the MetS and incident coronary heart disease and stroke, this study demonstrated a modest positive association with future PAD in a population of otherwise low-risk women. Substantially increased plasma levels of hsCRP and sICAM-1 were evident in subjects with MetS and a strong influence of these factors on the relationship between MetS and PAD was noted, suggesting a possible pathophysiologic role," the authors write.

One of the study authors is listed on patents related to the use of inflammatory biomarkers in cardiovascular disease.

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Poverty-Mortality Association Unchanged in England

Patterns from a century ago still have a significant relation with mortality today

12 sept 2009-- Despite myriad medical, public health, social, economic and political changes, the association between poverty and mortality in England and Wales is as strong today as it was at the start of the 20th century, according to a study published online Sept. 10 in BMJ.

Ian N. Gregory, Ph.D., of Lancaster University in the United Kingdom, compared census and mortality data from the 1900s with 2001 data in 634 districts.

The author found that the strength of the association between deprivation and mortality did not significantly change between the start and end of the 20th century, and that modern patterns of mortality and deprivation are closely related to those of a century ago. After adjustment for modern deprivation, he found that standardized mortality ratios from the 1900s are significantly correlated with modern mortality and most modern causes of death. However, after adjustment for modern deprivation, there is not a significant relationship between deprivation in the 1900s and modern mortality for most causes of death.

"Patterns of mortality and deprivation are deeply entrenched such that in both cases the patterns of a century ago are strong predictors of today's patterns," the author writes. "This is not simply because of inertia in socioeconomic conditions because mortality in the 1900s is significantly related to modern mortality even when modern deprivation is taken into account. This is true of many modern causes of death, including most common cancers and circulatory and respiratory disease."

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Smoking Linked to Arrhythmia Recurrence in Women Only

Female smokers undergoing cardioversion for atrial flutter had more recurrent atrial arrhythmia

12 sept 2009-- Smoking may be associated with a greater risk of atrial arrhythmia recurrence in women following cardioversion, and a higher risk of death in men, according to research published in the Sept. 1 issue of the American Journal of Cardiology.

Masayoshi Kinoshita, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues analyzed data from 1,424 patients undergoing cardioversion for atrial flutter over a six-year period. The mean age was 70 years, and 64 percent of the subjects were men.

Among women, the researchers found that current smokers were more likely to have recurrent atrial arrhythmia (hazard ratio, 1.71). Women's arrhythmia recurrence rate at one year was 58 percent in nonsmokers and 76 percent in current smokers. This association wasn't seen in male smokers. However, among men, current smokers had a higher risk of death after cardioversion (hazard ratio, 1.93).

"Several factors could account for the disparate results we found among men and women. First, an association between atrial arrhythmia recurrence and smoking might not have been seen in men because the men who smoked were more likely to die; thus, their death might have precluded documented atrial arrhythmia recurrence. Also, the men in our patient group were more likely than women to have coronary artery disease and, thus, they were at a greater risk of recurrent infarction and ventricular arrhythmias in association with cigarette use," the authors write.

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Parathyroid Hormone May Be Beneficial in Osteoporosis

Animal study demonstrates effects on lumbar vertebrae quality and quantity

12 sept 2009-- In a rat model of osteopenia, parathyroid hormone has beneficial short-term effects on bone stability and microstructure when compared with estradiol, according to a study published in the Sept. 1 issue of Spine.

Stephan Sehmisch, M.D., of the University of Goettingen in Germany, and colleagues studied 33 ovariectomized rats that received either parathyroid hormone, estradiol, or neither (control) for five weeks.

Compared to the estradiol-treated and control rats, the researchers found that the parathyroid hormone-treated rats had significantly improved trabecular bone in both the lumbar spine and cortical framework. They also demonstrated the effectiveness of a new biomechanical compression test of intact rat lumbar vertebrae for analyzing biomechanical properties of the cortical and trabecular bone. Compression strength was significantly improved in rats treated with parathyroid hormone and rats treated with estradiol when compared with controls.

"After a short-term application, parathyroid hormone is superior to estradiol in recreating bone biomechanical properties and lumbar vertebral microstructure in advanced osteoporosis. The cortical shell and trabecular thickness are primarily responsible for the biomechanical strength of vertebrae," the authors conclude.

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