Chronic pain found to increase risk of falls in older adults

BOSTON, 30 nov 2009 – Chronic pain is experienced by as many as two out of three older adults. Now, a new study finds that pain may be more hazardous than previously thought, contributing to an increased risk of falls in adults over age 70. The findings appear in the November 25 issue of The Journal of the American Medical Association (JAMA).

"It's clear that pain is not just a normal part of aging and that pain is often undertreated in older adults," explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. "Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations – mainly in the joints of the arms and legs – as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals."

Leveille used data gathered as part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a cohort study headquartered at the Institute for Aging Research at Hebrew SeniorLife and led by Principal Investigator Lewis Lipsitz, MD. One of the goals of the study is to gain a better understanding of what causes falls in older adults in order to develop new ways to prevent falls from occurring.

Between September 2005 and January 2008, 749 adults over the age of 70 enrolled in the MOBILIZE study were interviewed about their health, including being asked questions about pain. They also underwent a physical assessment by a nurse. Over the next 18 months, the participants recorded any falls they had on monthly calendar postcards that were then mailed to the Institute for Aging Research.

"At the beginning of the study, 40 percent of the participants reported experiencing chronic pain in more than one joint area and 24 percent reported chronic pain in a single joint," explains Leveille. "During the 18-month study period, the 749 participants reported a total of 1,029 falls, with more than half the participants falling at least once during this period." Data analysis revealed that compared with study participants who reported no pain, the participants who experienced chronic pain in two or more joints had a 50 percent greater risk of falling.

"Our results suggest that pain should be added to the list of risk factors for falls, as persons who have chronic pain in two or more joints, and those who have moderate to severe pain or disabling pain, are at significantly higher risk," says Leveille. "Assessment and management of chronic pain is a key part of health care for many older adults."

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This study was funded by a grant from the National Institute on Aging and support from Pfizer, Inc.

Study coauthors include Robert Shmerling, MD, of BIDMC; Hebrew SeniorLife Institute for Aging Research investigators Richard Jones, ScD, Dan Kiely, MPH, Douglas Kiel, MD, and Lewis Lipsitz, MD; Jonathan Bean, MD, of Spaulding Rehabilitation Hospital; Jeffrey Hausdorff, PhD, of Tel-Aviv Sourasky Medial Center; and Jack Guralnik, MD, PhD, of the National Institute on Aging.

About BIDMC: Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks in the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is a clinical partner of the Joslin Diabetes Center and is a research partner of the Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.

CPR is successful without mouth-to-mouth, but not without oxygen

COLUMBUS, Ohio, 30 nov 2009 – People can survive cardiac arrest if they receive only chest compressions during attempts to revive them – as advised by the current American Heart Association guidelines. But they cannot survive without access to oxygen sometime during the resuscitation effort, research suggests.

Scientists tested different scenarios in an animal study of cardiac arrest. Rats received either 100 percent oxygen, 21 percent oxygen – the equivalent of room air – or no oxygen (100 percent nitrogen) at the same time they received cardiopulmonary resuscitation (CPR).

About 80 percent of the rats survived regardless of the percentage of oxygen they received along with chest compressions. However, in the group receiving no oxygen, only one animal could be resuscitated.

Though these animals received the oxygen via ventilation, people who suffer cardiac arrest in a public setting would more likely obtain some oxygen by gasping during CPR or by receiving some air from a vacuum effect resulting from chest compressions, researchers say.

"The study showed that there is a need for oxygen. How much oxygen is needed remains unknown. There is probably a sweet spot in there somewhere," said Mark Angelos, professor of emergency medicine at Ohio State University and senior author of the study.

"For the first few minutes, it's probably right just to push on the chest. But at some point you probably need to add oxygen, however you can – maybe mouth-to-mouth or with supplemental oxygen. Where that sweet spot is is not yet clear."

The research is published in a recent issue of the journal Resuscitation.

According to the American Heart Association, almost 80 percent of cardiac arrests that take place outside a hospital occur at home and are witnessed by a family member. Yet only 6.4 percent of sudden cardiac arrest victims survive because most witnesses do not know how to perform CPR.

The association is in the midst of a new campaign touting "hands-only" CPR, urging people to call 911 and push "hard and fast" in the center of the chest of a person in cardiac arrest.

Angelos said his research is not intended to counter the current guidelines. Instead, scientists continue to study the intricacies of the resuscitation process in the pursuit of ways to improve the potential for survival after cardiac arrest.

Approximately 30 percent of cardiac arrest patients will survive long enough to be hospitalized. But far fewer are ever discharged from the hospital; most typically die of heart failure or brain damage resulting from an extended loss of oxygen to the brain, said Angelos, also an investigator in Ohio State's Davis Heart and Lung Research Institute.

In the study, Angelos and colleagues imposed six minutes of cardiac arrest on 33 rats before CPR was started. During CPR, animals were ventilated with either 100 percent oxygen or 21 percent oxygen.

A control group of rats received nitrogen, which eliminated oxygen from their lungs. This scenario allowed for lab comparisons, but was not intended to mimic normal conditions because people would likely have some residual oxygen in their lungs and blood even during cardiac arrest.

CPR was continued until the surviving animals experienced what is called the "return of spontaneous circulation," when the heart pumped blood on its own. All animals receiving oxygen returned to spontaneous circulation at approximately the same time, between about 90 seconds and two minutes after CPR began.

All surviving animals continued to receive the same levels of oxygen that they had received during CPR for two minutes after their hearts started working, and then they were all transferred to 100 percent oxygen for an hour.

"That's pretty typical for a hospitalized cardiac arrest victim, to get a high concentration of oxygen early on," Angelos said.

One rat unexpectedly survived CPR without any oxygen, but died within 72 hours. Among the rats receiving oxygen during CPR, nine of 11 (82 percent) of the rats in the 21-percent oxygen group survived CPR, and 10 of 12 (83 percent) of the rats receiving 100 percent oxygen survived. At the 72-hour mark, those figures had dropped: 77 percent of the room-air rats were still alive, and 80 percent of 100-percent oxygen rats were still living.

Neurological tests showed that five of seven (71 percent) of the room-air rats and three of eight (38 percent) of the rats on 100-percent oxygen during CPR returned to normal brain function at 72 hours. The researchers considered these findings secondary to the initial finding that oxygen was required for success during the initial resuscitation process, Angelos noted.

"In a public setting, presumably we don't have any options. We see that ventilating with room air is just as good as supplemental oxygen," he said. "However, we also know now that too little or the absence of any ventilation might be harmful, at least over time, due to the lack of oxygen."

Generally, Angelos noted, the concern has been too much ventilation, which lessens the effectiveness of CPR.

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This work was supported by the American Heart Association, Great Rivers Affiliate.

Angelos conducted the research with Steven Yeh, Rebekah Cawley and Sverre Aune of Ohio State's Department of Emergency Medicine; Yeh and Aune also are researchers in the Davis Heart and Lung Research Institute and Ohio State's Biophysics Graduate Program.

Gingko Biloba May Not Prevent Cardiovascular Disease

Study of G. biloba and placebo finds no difference in incidence of death, heart attack or angina

28 nov 2009-- Twice daily doses of Gingko biloba did not show any benefit over placebo in preventing cardiovascular disease (CVD) events among elderly subjects in a study published online Nov. 24 in Circulation: Cardiovascular Quality and Outcomes.

Lewis H. Kuller, M.D., of the University of Pittsburgh, and colleagues randomized 3,069 subjects over 75 years of age to take either 120 mg of G. biloba twice daily or placebo. The group was followed for a mean of 6.1 years for the incidence of CVD, and differences between the G. biloba and placebo groups were evaluated using Cox proportional hazards regression.

Eighty-seven deaths from coronary heart disease occurred in follow-up, but the researchers discerned no difference between the G. biloba and placebo groups. Similarly, no differences were found between G. biloba and placebo for myocardial infarction (164 incidents), angina pectoris (207 incidents), or stroke (151 incidents). The researchers found that there were 16 hemorrhagic strokes among the subjects taking G. biloba and eight taking placebo, a difference not regarded as significant. However, there were significantly more peripheral vascular disease events in the placebo group (23) than in the G. biloba group (12).

"There was no evidence that G. biloba reduced total or CVD mortality or CVD events. There were more peripheral vascular disease events in the placebo arm. G. biloba cannot be recommended for preventing CVD. Further clinical trials of peripheral vascular disease outcomes might be indicated," the authors conclude.

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Effect of Dietary Restriction on Lifespan Explained


Factors mediating enhancement of lifespan and reduction of disease pathology identified

28 nov 2009-- Factors have been identified that explain how dietary restriction increases lifespan and reduces pathology in a model of Alzheimer's disease, according to a study published Nov. 17 in PLoS Biology.

Minhua Zhang and colleagues from Mount Sinai School of Medicine in New York City investigated how dietary restriction increases lifespan by examining changes in gene expression in the mouse hypothalamus, which mediates physiological responses to nutritional deprivation.

The researchers found that the transcription factor CBP and associated cofactors were induced by dietary restriction and accounted for 84 percent of lifespan variance. Blocking their expression blocked the ability of dietary restriction to increase lifespan and to reduce pathology in a model of Alzheimer's disease, while drugs that mimicked enhanced CBP activity increased lifespan and reduced Alzheimer's pathology.

"Other factors implicated in lifespan extension are also CBP-binding partners, suggesting that CBP constitutes a common factor in the modulation of lifespan and disease burden by dietary restriction and the insulin/IGF1 signaling pathway," Zhang and colleagues conclude.

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Guidelines for cancer screening differ by group

24 nov 2009--Several doctors groups and advocacy groups set guidelines for cancer screening, and they update that advice periodically as new information emerges. Sometimes they agree, sometimes they don't. Last year, a number of groups got together and issued consensus guidelines for colon cancer.

The U.S. Preventive Services Task Force, a government-appointed, independent panel of doctors and scientists, also makes recommendations looked to by doctors groups, insurers and policy makers.

The latest advice from the major medical groups for routine screening — primarily for people who don't have a family history of a particular cancer or other risk factors:

Breast cancer:

• American Cancer Society: Mammograms yearly beginning at age 40; breast exam by doctor at least every three years in 20s and 30s, annually after 40; breast self-exam an option.

• American College of Obstetricians and Gynecologists: Mammograms every 1-2 years for women in their 40s; annual mammograms age 50 and older; breast exam by a doctor annually from age 19; breast self-exam can be recommended.

• U.S. Preventive Services Task Force: Mammograms every two years for women ages 50 to 74, after 75 the risks and benefits unknown; recommends against self-exam; value of exams by doctors unknown.

Cervical cancer:

• Cancer Society: Start Pap tests about three years after first intercourse but no later than 21; annually or every 2-3 years for women over 30 who have three normal tests; stop at 70 after at least three negative tests and no abnormal tests in last 10 years; discontinue after a total hysterectomy.

• ACOG: Start Pap tests at age 21 and then every two years; 30 years and older, every three years after three normal tests; reasonable to stop at age 65 or 70; discontinue after hysterectomy.

• Task Force: Start Pap tests within three years of sexual activity or by age 21; at least every three years, stop after 65 if negative tests and no high risk; discontinue after hysterectomy.

Prostate cancer:

• Cancer Society: No routine testing recommended; doctors should discuss benefits and limitations, and offer screening — a physical exam and blood test for a substance called PSA — to men beginning at age 50, with at least a 10-year life expectancy.

• Task Force: No recommendation for or against screening for men under 75; men over 75 should not be screened.

• American Urological Association: Men 40 and older should be offered a baseline PSA test and exam.

Colon cancer:

• Cancer Society and other major groups: Start screening at 50 with one of these tests: colonoscopy every 10 years; a sigmoidoscopy of the lower colon every five years; CT colonography or "virtual colonoscopy" every five years; barium enema every five years, stool blood test annually; stool DNA test, no interval given.

• Task force: Screen from age 50 to 75 with one of three tests: colonoscopy every 10 years; a sigmoidoscopy every five years, combined with a stool blood test every three years; a stool blood test every year.

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On the Net:

Task Force: http://www.ahrq.gov/CLINIC/uspstfix.htm

Cancer Society: http://tinyurl.com/screening-guidelines

Diet, Cognitive Ability May Play Role in Heart Disease

24 nov 2009-- Seniors who eat plenty of fruits and vegetables and who have good cognitive function are much less likely to die from heart disease than those who have poorer cognitive function and eat fewer fruits and vegetables, a new study has found.

Cognitive function refers to the ability to think, remember, plan and organize information.

Researchers at the Drexel University School of Public Health in Philadelphia analyzed diet and cognitive data on 4,879 people (3,101 women and 1,778 men), age 70 and older, who took part in the U.S. Longitudinal Study of Aging. The participants were followed for an average of seven years.

The analysis revealed that:

• Those who ate three or more servings of vegetables daily had a 30 percent lower risk for dying from heart disease and a 15 percent lower risk for dying from any cause during the follow-up period than those who ate fewer than three servings of vegetables a day.
• There was a significant association between higher consumption of fruits and vegetables and decreased prevalence of cognitive impairment.
• People who scored high on cognitive functions tests were less likely to die from heart disease or any other cause during the follow-up than were those with low scores.

The study was to be presented Wednesday at the American Heart Association's annual meeting in Orlando, Fla.

More information

The U.S. National Heart, Lung, and Blood Institute explains how to prevent and control heart disease risk factors.

Alcohol Associated With Lower Heart Disease Risk


Study finds Spanish men who drink alcohol have less coronary events than non-drinkers

23 nov 2009-- Men who drink alcohol are at lower risk of coronary heart disease than their non-drinking counterparts, according to a Spanish study published online Nov. 19 in Heart.

Larraitz Arriola, M.D., of the Public Health Department of Gipuzkoa in San Sebastian, Spain, and colleagues analyzed data on 15,630 men and 25,808 women who comprised the Spanish cohort of the European Prospective Investigation into Cancer to look at the relation between alcohol intake and coronary heart disease events during 10 years of follow-up.

For men, the researchers found that the crude coronary heart disease incidence rate was 300.6 per 100,000 person-years, while the rate was 47.9 per 100,000 for women. There was a reduced risk of coronary heart disease in men, associated with their extent of alcohol consumption -- hazard ratio 0.90 for former drinkers, 0.65 for low-level consumers, 0.49 for moderate drinkers, 0.46 for heavy drinkers, and 0.50 for those who consumed more than 90 grams a day. The authors further note that the small number of coronary events may explain why the benefits detected among women were not statistically significant.

"The results of our study show a negative association between alcohol intake and coronary heart disease," the authors write. "We can also state, although with caution, that our study is free of the so called 'abstainer error' and that residual confounding does not influence the results obtained to any significant degree."

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Slow Eating Raises Response to Appetite Control Hormones

Study finds slower eating rate linked to higher anorexigenic gut peptide response

23 nov 2009-- The rate at which individuals eat a meal may affect the postprandial response of gut peptides, according to a crossover study conducted in Greece and published online Oct. 29 in the Journal of Clinical Endocrinology & Metabolism.

Alexander Kokkinos, M.D., of Athens University Medical School in Greece, and colleagues conducted a study of 17 healthy adult males who were given a 300 ml portion of ice cream on two different occasions, and who were instructed in random order to eat it either within five minutes or over a half-hour period.

When the researchers measured the postprandial response of the orexigenic hormone ghrelin and the anorexigenic peptides PYY and GLP-1, they found that there was a more pronounced response to PYY and GLP-1 when the ice cream was consumed over 30 minutes compared with five minutes. However, there was no difference in response of ghrelin. The subjects reported higher fullness ratings after eating the ice cream over 30 minutes as compared to five minutes.

"Our study demonstrates that eating the same meal over 30 minutes instead of five minutes leads to higher concentrations of anorexigenic gut peptides and favors earlier satiety," the authors conclude.

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New guidelines push back age for Pap smears

CHICAGO,22 nov 2009– Women in the United States should start cervical cancer screening at age 21 and most do not need an annual Pap smear, according to new guidelines issued on Friday that aim to reduce the risk of unnecessary treatment.

The guidelines from the American College of Obstetricians and Gynecologists or ACOG now say women younger than 30 should undergo cervical cancer screening once every two years instead of an annual exam. And those age 30 and older can be screened once every three years.

The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman's chances of carrying a child full term.

"Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk," said Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers.

"Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus," said Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, who supports the guideline changes.

AVOIDING UNNECESSARY PROCEDURES

"These new guidelines will allow us to avoid doing unnecessary procedures on the sexually active adolescent female," she said in an e-mail.

The guidelines are unlikely to be met with the kind of rebellion that accompanied new breast cancer screening guidelines this week, which were largely based on computer projections, Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said in a telephone interview.

"There is a lot more agreement about the science of cervical cancer screening," Lichtenfeld said.

Prior recommendations called for annual cervical cancer screening to start three years after a women first becomes sexually active, or by age 21. Although the rate of HPV infection is high in this population, rates of cervical cancer are very low.

Herzog said the new recommendations are based on studies that suggest starting screening earlier than age 21 causes more harm than benefit.

"We were overdiagnosing and overtreating adolescents and very young women," Herzog said in a telephone interview.

Cervical cancer is a slow-growing cancer caused by exposure to certain strains of the human papillomavirus (HPV), a common sexually transmitted disease among women and men.

"Women do not get cervical cancer first. They acquire HPV, the sexually transmitted virus that causes precancerous abnormalities of the cervix and cervical cancer. It takes years to progress from an HPV-infection to full-blown cervical cancer," Milosavijevic said.

For that reason, she said changing the screening interval will not mean more cervical cancers will be missed. She said most deaths from cervical cancer in the United States happen in people who are screened infrequently, or not at all.

"The take-home message for women is that you should still get your pap smear screening," Milosavijevic said.

HPV is the most common sexually transmitted disease in the world. About 20 million Americans currently are infected with HPV, according to the CDC.

In the past 30 years, cervical cancer rates in the United States have fallen by more than half, due in large part to widespread use of cervical cancer screening.

Surgery not linked to memory problems in older patients

22 nov 2009--For years, it has been widely assumed that older adults may experience memory loss and other cognitive problems following surgery. But a new study from researchers at Washington University School of Medicine in St. Louis questions those assumptions. In fact, the researchers were not able to detect any long-term cognitive declines attributable to surgery in a group of 575 patients they studied.

"There's a perception that people go in for surgery, and they aren't quite the same afterward," says first author Michael S. Avidan, M.D. "The reports of cognitive deterioration have varied, but several studies have suggested it affects many elderly people. In my experience as an anesthesiologist, I've found this is a very common concern."

But Avidan, associate professor of anesthesiology and surgery, and fellow investigator Alex S. Evers, M.D., the Henry E. Mallinckrodt Professor and head of the Department of Anesthesiology, questioned those conclusions.

"We wondered how reasonable it was to compare people having surgery to people who were perfectly healthy," Evers explains. "We thought a better comparison group might be people who were equally ill."

Past cognitive studies tested surgery patients just before an operation and then retested them several months later. So if a patient was just beginning to suffer declines at the time of the first test, it might be assumed that further declines at follow-up were caused by their operation when, in fact, they already were underway. To get better initial screenings, Avidan and Evers examined data from Washington University's Alzheimer's Disease Research Center (ADRC).

The ADRC tests cognitive function in volunteers annually, beginning at the age of 50. Having years of cognitive data on hand made it easier to map a person's cognitive trajectory before and after surgery or illness and see whether either had any long-term impact on cognitive performance.

The 575 patients they studied had been tested annually at the ADRC and include those with Alzheimer's-type dementia. At the start of the study, 361 people had mild to moderate dementia, and 214 were dementia-free. Those patients were divided into three groups: those who had surgery, those with illness, and a third group with neither.

"We were able to use patients as their own controls before and after surgery and to compare groups of patients over time, and we did not detect any evidence of a long-term cognitive decline," Evers says. "Our findings suggest that if older people physically recover from surgery, they should expect that within six months or a year, they will return to their previous level of cognitive ability, too."

Evers and Avidan say this study would have been impossible without a database of patients like those at the ADRC. Knowing how people functioned for years before and after surgery or illness allowed them to learn whether a major event somehow changed their cognitive trajectories. It did not, even in patients with dementia at the time of surgery.

"This is an important finding for persons with Alzheimer's and their families who may worry that a pending operation could adversely affect the patient's cognitive status" says John C. Morris M.D., the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology and director of the ADRC. "There has been a widespread belief that the memory and thinking abilities of patients with early Alzheimer's disease may worsen as a consequence of surgery, but the evidence from this study does not support that belief."

The investigators say their study, published in the November issue of the journal Anesthesiology, is not the final word on the relationship between surgery and cognitive declines. They believe that some patients may be more vulnerable for genetic reasons or because of how their brains react to surgery or anesthesia. They also excluded cardiac surgery patients from this study because of elevated stroke risk and other risks posed by cardiac surgery that aren't as common in other types of operations. But they say, in general, the findings should be a relief for older people facing surgery.

"An older person should not anticipate cognitive deterioration following surgery," says Avidan. "If you need surgery, and you're elderly, even if you already have some cognitive impairment, whether you decide to have surgery or not should depend on surgical risks and benefits, and not the possibility of cognitive problems."

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Avidan, MS, Searleman AD, Storandt M, Barnett K, Vannucci A, Saager L, Xiong C, Grant EA, Kaiser D, Morris, JC, Evers AS. Long-term cognitive decline in older subjects was not attributable to noncardiac surgery or major illness. Anesthesiology, vol. 111:5, pp. 1651-1657. Nov. 2009

This study was supported by grants from the University of Missouri Alzheimer's Disease and Related Disorders Program and from the National Institute on Aging of the National Institutes of Health.

AHA: Proton Pump Inhibitors May Up Post-PCI Mortality


In patients with drug-eluting stents, omeprazole and pantaprazole linked to higher risk of death

20 nov 2009-- In patients who undergo percutaneous coronary intervention with drug-eluting stents, use of proton pump inhibitors is associated with an increased risk of all-cause mortality, according to research presented this week at the American Heart Association Scientific Sessions, held from Nov. 14 to 18 in Orlando, Fla.

Joseph M. Sweeny, M.D., of Mount Sinai Medical Center in New York City, and colleagues conducted a retrospective cohort study of 8,311 patients, including 1,385 (17 percent) who took proton pump inhibitors.

During a mean two years of follow-up, 602 patients died. The researchers found that use of proton pump inhibitors was associated with an increased risk of death (multivariable adjusted hazard ratio, 1.30). They also found that the risk was elevated for those taking omeprazole and pantoprazole (multivariable adjusted hazard ratios, 1.72 and 1.54, respectively) compared to those taking esomeprazole and lansoprazole (multivariable adjusted hazard ratios, 0.97 and 1.02, respectively).

"Proton pump inhibitor use was associated with a non-significant increased risk of 30-day stent thrombosis and target lesion revascularization following percutaneous coronary intervention," the authors conclude.

Two co-authors reported financial relationships with pharmaceutical companies.

Abstract
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AHA: Niacin Can Affect Carotid Intima-Media Thickness


In high-risk patients, extended-release niacin may be superior to ezetimibe as an adjunctive therapy

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20 nov 2009-- In patients at high risk of cardiovascular disease, adjunctive therapy with niacin is superior to therapy with ezetimibe, according to a study published online Nov. 15 in The New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions, held from Nov. 14 to 18 in Orlando, Fla.

Allen J. Taylor, M.D., of the Walter Reed Army Medical Center in Washington, D.C., and colleagues randomly assigned patients who had coronary heart disease or a coronary heart disease risk equivalent and were receiving statin therapy to receive either extended-release niacin or ezetimibe for 14 months. The subjects had a "therapeutic" low-density lipoprotein (LDL) cholesterol level below 100 mg/dL and a high-density lipoprotein (HDL) level of under 50 mg/dL for men or 55 mg/dL for women Two hundred eight patients completed the trial. The trial was stopped early due to efficacy.

The researchers found that niacin increased HDL levels by 18.4 percent, and also reduced levels of LDL cholesterol and triglycerides. Although ezetimibe was associated with a mean reduction in LDL of 19.2 percent, patients taking it had increased carotid intima-media thickness, while patients taking niacin had decreased thickness. Rates of major cardiovascular events were also significantly lower in the niacin group (1 versus 5 percent).

"Unfortunately, the premature termination of the ARBITER 6-HALTS trial, the small number of patients studied, and the limited duration of follow-up preclude us from conclusively declaring niacin the adjunctive agent of choice on the basis of the evidence," states the author of an accompanying editorial.

The study was supported by Abbott; several authors reported financial relationships with Abbott or other pharmaceutical companies.

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New Study Identifies Sources For Surgical Complications In Older Patients

19 nov 2009--The elderly are more vulnerable to problems after a major surgical procedure than younger patients, but a team of investigators using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) suggest that one way to improve surgical results in this age group is to have hospitals expand their quality control guidelines to include more types of surgery-related complications.

The investigators reviewed almost 55,000 gastrointestinal operations (GI) at 121 hospitals participating in ACS NSQIP. Specifically, these operations involved the upper GI tract, the gall bladder, pancreas, and colon and rectum. Elderly patients were up to twice as likely to have complications related to the operation than younger patients. The mortality rate in the elderly group was three to almost seven times higher than the younger group, depending on the procedure. The results of this study have been published in the November issue of Archives of Surgery.

This analysis departed from previous studies by focusing on the types of complications in the elderly and comparing those rates with those for younger patients. "Here we were able to really identify the specific complications that occur more frequently using standardized data from a number of hospitals," according to Karl Y. Bilimoria, MD, MS former research fellow at the American College of Surgeons and general surgery resident at Northwestern University, Department of Surgery, Chicago and a coauthor (one word) of the study.

The investigators reported that hospital quality measures for older patients having an operation typically concentrate on three types of risk: heart attack, surgical wound infections and blood clots in the legs. The analysis determined that rates of complications from wound infections and blood clots were comparable in both elderly and younger patients, but that the elderly were significantly more susceptible to a heart attack, pneumonia, pulmonary embolism, respiratory failure, urinary tract infection and renal failure.

The report authors concluded that quality improvement initiatives need to include pulmonary and urologic complications in older patients. Eventually, according to Dr. Bilimoria, the intent is to develop a "risk estimator" through ACS NSQIP that will enable surgeons to evaluate risks before surgical procedures and make more informed decisions about whether a patient is truly a candidate for an operation.

"Basically, surgeons can enter the risk factors of their patients preoperatively and identify the rates of these complications and discuss those with the patients," said Dr. Bilimoria. "It's one piece of decision making that can help guide the discussion about whether surgery should be done or whether the risk is too prohibitive."

These data would be available through ACS NSQIP in 2010, according to Dr. Bilimoria. "The next step would be to try to get this information back to more hospitals, have more hospitals involved in NSQIP and receive risk-adjusted data based on these specific complications in comparison to other hospitals, and to give them an idea of where to focus their quality improvement efforts," he said.

Previously, research from the ACS NSQIP program published in the Annals of Surgery showed that hospitals participating in the program reported significant improvements in patient morbidity and mortality. The ACS NSQIP program provides a prospective, peer-controlled, validated database of surgical outcomes based on clinical data, not claims data. Originally launched in the 1990s by the Veterans Health Administration, the program was piloted in private sector hospitals in 2001 by the American College of Surgeons in partnership with the Agency for Healthcare Research and Quality (AHRQ). The program was made available to all private sector hospitals in 2005. Today, nearly 250 hospitals participate in the program.

The study was supported by the American College of Surgeons Clinical Scholars in Residence program and the Department of Surgery, Feinberg School of Medicine, Northwestern University.

CITATION: "Identification of specific quality improvement opportunities for elderly undergoing gastrointestinal surgery."
Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY.
Arc Surg. In press.

Source
American College of Surgeons (ACS)

Don't blame fast food: Mummies had heart disease

ORLANDO, Fla., 19 nov 2009 – You can't blame this one on McDonald's: Researchers have found signs of heart disease in 3,500-year-old mummies.

"We think of it as being caused by modern risk factors," such as fast food, smoking and a lack of exercise, but the findings show that these aren't the only reasons arteries clog, said Dr. Randall Thompson, a cardiologist at the Mid America Heart Institute in Kansas City.

He and several other researchers used CT scans, a type of X-ray, on 22 mummies kept in the Egyptian National Museum of Antiquities in Cairo. The subjects were from 1981 B.C. to 334 A.D. Half were thought to be over 45 when they died, and average lifespan was under 50 back then.

Sixteen mummies had heart and blood vessel tissue to analyze. Definite or probable hardening of the arteries was seen in nine.

"We were struck by the similar appearance of vascular calcification in the mummies and our present-day patients," said another researcher, Dr. Michael Miyamoto of the University of California at San Diego. "Perhaps the development of atherosclerosis is a part of being human."

One mummy had evidence of a possible heart attack but scientists don't know if it was fatal. Nor can they tell how much these people weighed — mummification dehydrates the body.

Of those whose identities could be determined, all were of high social status, and many served in the court of the Pharaoh or as priests or priestesses.

"Rich people ate meat, and they did salt meat, so maybe they had hypertension (high blood pressure), but that's speculation," Thompson said.

With modern diets, "we all sort of live in the Pharaoh's court," said another of the researchers, Dr. Samuel Wann of the Wisconsin Heart Hospital in Milwaukee.

The oldest mummy with heart disease signs was Lady Rai, a nursemaid to Queen Ahmose Nefertari who died around 1530 B.C. — 200 years before King Tutankhamun.

German imaging company Siemens AG, the National Bank of Egypt and the Mid-America Heart Institute paid for the work. Results are in this week's Journal of the American Medical Association and were reported Tuesday at an American Heart Association conference.

Mount Sinai researchers to test first gene therapy For Alzheimer's patients

Recruiting participants now for Phase 2 clinical trial

18 nov 2009--Mount Sinai School of Medicine is one of 12 sites nationwide participating in the first Phase 2 clinical trial to test gene therapy treatment for Alzheimer's disease. The study is the first multicenter neurosurgical intervention in Alzheimer's research in the U.S.

The experimental treatment utilizes a viral-based gene transfer system, CERE-110, that makes Nerve Growth Factor (NGF), a naturally occurring protein that helps maintain nerve cell survival in the brain. CERE-110 has been previously studied in animals, where it reversed brain degeneration in aged monkeys and rats. For this study, CERE-110, will be injected by a neurosurgeon directly into the nucleus basalis of Meynert (NBM) of the brain, an area where neuronal death occurs in Alzheimer's patients.

In animal studies, NGF has been shown to support the survival and function of the neurons that deteriorate in Alzheimer's patients. These neurons produce the chemical acetylcholine, which is important in memory and cognitive function. The hope is that improvement of this system's function may lead to better memory performance in Alzheimer's patients.

A Phase 1 study in Alzheimer's patients has been conducted at Rush University in Chicago and the University of California San Diego, where researchers observed increases in brain metabolism in several cortical regions of the brain at 6- and 12-month follow-up in some of the participants. With follow-up ranging from six months to more than four years post-treatment, there have been no side effects thought to be caused by CERE-110.

Participants in the Phase 2 study will be randomly placed into one of two treatment groups, with half receiving CERE-110 via neurosurgery and half receiving placebo surgery without any cranial injections. Once the study is completed, and if the results are promising, participants in the placebo group will be eligible to be treated with CERE-110. All participants will receive a thorough medical examination and cognitive testing. In addition, participants will be closely monitored by a team of physicians for the duration of the two-year study. Participants will also be encouraged to participate in long-term follow-up.

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The study, to be conducted at 12 sites throughout the country, is the first multicenter neurosurgical intervention in Alzheimer's research in the United States. The local study at Mount Sinai will involve approximately four to six volunteers between the ages of 50 and 80 with mild to moderate Alzheimer's symptoms. People seeking more information about participating in the study should call Mount Sinai at (212) 659-8885.

More information about this Phase 2 trial can be found on the ADCS website at http://www.adcs.org/Studies/NGF.aspx , and at the NIA's Alzheimer's Disease Education and Referral Center (ADEAR) website at http://www.alzheimers.org/clinicaltrials/fullrec.asp?PrimaryKey=308.

The study is sponsored by the Alzheimer's Disease Cooperative Study (ADCS) through a grant from the National Institute on Aging (a part of the NIH) in association with Ceregene, Inc, which developed and will provide the active agent (CERE-110).

New study links vitamin D deficiency to cardiovascular disease and death

Study finds inadequate levels of vitamin D may significantly increase risk of stroke, heart disease and death

MURRAY, UT, 18 nov 2009 – While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well – and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.

For more than a year, the Intermountain Medical Center research team followed 27,686 patients who were 50 years of age or older with no prior history of cardiovascular disease. The participants had their blood Vitamin D levels tested during routine clinical care. The patients were divided into three groups based on their Vitamin D levels – normal (over 30 nanograms per milliliter), low (15-30 ng/ml), or very low (less than 15 ng/ml). The patients were then followed to see if they developed some form of heart disease.

Researchers found that patients with very low levels of Vitamin D were 77 percent more likely to die, 45 percent more likely to develop coronary artery disease, and 78 percent were more likely to have a stroke than patients with normal levels. Patients with very low levels of Vitamin D were also twice as likely to develop heart failure than those with normal Vitamin D levels.

Findings from the study will be presented at the American Heart Association's Scientific Conference on Monday, Nov. 16 in Orlando, Florida.

"This was a unique study because the association between Vitamin D deficiency and cardiovascular disease has not been well-established," says Brent Muhlestein, MD, director of cardiovascular research of the Heart Institute at Intermountain Medical Center and one of the authors of the new study. "Its conclusions about how we can prevent disease and provide treatment may ultimately help us save more lives."

A wealth of research has already shown that Vitamin D is involved in the body's regulation of calcium, which strengthens bones — and as a result, its deficiency is associated with musculoskeletal disorders. Recently, studies have also linked Vitamin D to the regulation of many other bodily functions including blood pressure, glucose control, and inflammation, all of which are important risk factors related to heart disease. From these results, scientists have postulated that Vitamin D deficiency may also be linked to heart disease itself.

"Utah's population gave us a unique pool of patients whose health histories are different than patients in previous studies," Dr. Muhlestein says. "For example, because of Utah's low use of tobacco and alcohol, we were able to narrow the focus of the study to the effects of Vitamin D on the cardiovascular system."

The results were quite surprising and very important, says Heidi May, PhD, MS, an epidemiologist with the Intermountain Medical Center research team and one of the study authors.

"We concluded that among patients 50 years of age or older, even a moderate deficiency of Vitamin D levels was associated with developing coronary artery disease, heart failure, stroke, and death," she says. "This is important because Vitamin D deficiency is easily treated. If increasing levels of Vitamin D can decrease some risk associated with these cardiovascular diseases, it could have a significant public health impact. When you consider that cardiovascular disease is the leading cause of death in America, you understand how this research can help improve the length and quality of people's lives."

Because the study was only observational, definitive links between Vitamin D deficiency and heart disease could not be assigned — but the findings create an impetus for further study, says Dr. Muhlestein.

"We believe the findings are important enough to now justify randomized treatment trials of supplementation in patients with Vitamin D deficiency to determine for sure whether it can reduce the risk of heart disease," he says.

USPSTF mammography recommendations will result in countless unnecessary breast cancer deaths each year

Reston, Va.17 nov 2009 — If cost-cutting U.S. Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year. The recommendations ─ created by a federal government-funded committee with no medical imaging representation ─ would advise against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74.

"These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women," said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.

Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. In truth, there are no data to support this premise.

"The USPSTF claims that the "harms" of mammography, including discomfort of the exam, anxiety over positive results, and possibility of overtreatment because medical science cannot distinguish which cancers will become deadly most quickly ─ outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. Without doubt, the possibility of having one's life saved through early detection far outweighs any of these concerns. Their premise is tragically incorrect and will result in many needless deaths if their recommendations are adopted by the American public." said Lee.

"The USPSTF recommendations are a step backward and represent a significant harm to women's health. To tell women they should not get regular mammograms starting at 40 when this approach has overwhelmingly been shown to save lives is shocking. At least 40 percent of the lives saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives," said W. Phil Evans, M.D., FACR, president of the Society of Breast Imaging (SBI).

The USPSTF is an independent panel of primary care physicians funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for additional preventive services. Recently, Congress has expressed their desire to broaden this authority and enhance the role of the USPSTF in terms of its impact on coverage for existing services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-savings measure.

"I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer. These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions. I can't help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives," said James H. Thrall, M.D., FACR, chair of the American College of Radiology Board of Chancellors.

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To speak to an ACR spokesperson, please contact ACR Director of Public Affairs Shawn Farley at 703-869-0292 or sfarley@acr-arrs.org.

Boehringer Ingelheim announces Phase III data of flibanserin in pre-menopausal women with HSDD

Ridgefield, CT,17 nov 2009- Data from pivotal Phase III clinical trials demonstrate that flibanserin 100mg increased the number of satisfying sexual events (SSE) and sexual desire (the co-primary endpoints) while decreasing the distress associated with Hypoactive Sexual Desire Disorder (HSDD). Flibanserin is an investigational compound being developed by Boehringer Ingelheim for the treatment of HSDD in pre-menopausal women. HSDD is a decrease or lack of sexual desire that causes distress for the patient, may put a strain on relationships with partners, and is not due to the effects of a substance, including medications, or another medical condition.

The findings, presented at the 12th Congress of the European Society for Sexual Medicine in Lyon, France, include data from a pre-specified pooled analysis of two pivotal North American trials (DAISY® and VIOLET®) assessing flibanserin 100mg in pre-menopausal women suffering from HSDD.

"HSDD is a complex condition that can cause distress and negatively impact a woman's self-esteem," said Anita Clayton, MD, one of the lead study authors and professor of psychiatry and neurobehavioral sciences, University of Virginia. "With this data, we are making exciting progress in women's sexual health research, as flibanserin is the first in a class of drugs being studied for this condition in pre-menopausal women. This is an important milestone for an under-recognized condition for which there is no FDA-approved treatment."

North American Phase III Trial Results

In the pooled analysis of 1,378 pre-menopausal women with HSDD, the frequency of SSE increased significantly in women taking flibanserin 100mg (increasing from 2.8 at baseline to 4.5 at study end) versus placebo (2.7 at baseline increasing to 3.7 at study end) over the 24-week study period. Flibanserin also demonstrated statistically significant improvements in sexual desire versus placebo as measured by a daily electronic diary (eDiary) and the Female Sexual Function Index (FSFI) desire domain.

Flibanserin significantly improved sexual functioning (as measured by the FSFI total score), distress related to sexual dysfunction (as measured by the Female Sexual Distress Scale-Revised, FSDS-R, score) and distress related to low sexual desire (the score on FSDS-R question 13) versus placebo, which were secondary endpoints.

The most commonly reported adverse events (AEs) with flibanserin 100mg were mild to moderate and emerged during the first 14 days of treatment. These AEs reported by more women on flibanserin than on placebo included somnolence (daytime sleepiness), dizziness, fatigue, anxiety, dry mouth, nausea and insomnia. The majority of these AEs resolved with continued treatment. About 15 percent of women on flibanserin 100mg and seven percent of women on placebo discontinued treatment due to AEs.

"Sexual desire disorders can affect women of all ages, at any stage of life," said Peter Piliero, MD, executive director, Medical Affairs, Boehringer Ingelheim Pharmaceuticals, Inc. "Boehringer Ingelheim is pleased to present this data, which provides valuable scientific knowledge about HSDD."

About the North American Phase III Trial

The North American Phase III clinical trial studied flibanserin at 25, 50 and 100mg doses. The pre-specified pooled analysis included data from two 24-week randomized, placebo-controlled North American trials. The analysis involved women with generalized, acquired HSDD who were treated with flibanserin 100mg or placebo. Flibanserin 100mg increased the number of SSE and sexual desire and decreased distress associated with HSDD. The women in the study were in stable, communicative, monogamous, heterosexual relationships with a sexually-functional partner for at least one year and were required to use a reliable form of contraception. About 40 percent of women were on some form of hormonal contraception.

In the North American pivotal trials, the co-primary endpoints were changes from a four-week baseline period to week 21 to 24 in sexual desire score and in the number of SSE, as recorded daily by patients using an electronic diary (eDiary For HSDD Trials). Both are patient reported outcome measures. SSE measures the number of sexual events (defined as sexual intercourse, oral sex, masturbation or genital stimulation by the partner), and whether each event was satisfying for the woman (i.e. gratifying, fulfilling, satisfactory and/or successful).

The FSFI and FSDS-R desire scores - independently developed and validated tools - were included as secondary endpoints to provide additional measurement of changes in desire over a four-week recall period. The FSFI is a 19-item self-administered questionnaire composed of six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain). The FSDS-R is a 13-item self-administered questionnaire. The total score ranges from zero to 52, with the higher scores indicating more sexual distress. Additionally, Boehringer Ingelheim designed the eDiary For HSDD Trials to measure levels of desire on a daily basis.

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About Hypoactive Sexual Desire Disorder

HSDD is a form of female sexual dysfunction (FSD). As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), HSDD is the persistent lack (or absence) of sexual fantasies or desire for any form of sexual activity causing marked distress or interpersonal difficulty and not better accounted for by another disorder (except another sexual dysfunction), direct physiological effects of a substance (including medications), or a general medical or psychiatric condition. Generalized, acquired HSDD is not limited to certain types of stimulation, situations or partners, and develops only after a period of normal functioning. Sexual Desire Disorders are generally under-diagnosed.

Study Finds Features Linked to Mortality Risk in Parkinson's


Cognitive impairment, dysphagia, postural instability gait difficulty associated with risk

16 nov 2009-- A variety of motor and non-motor factors may be associated with a higher risk of mortality in patients with early Parkinson's disease, according to research published in the November issue of the Archives of Neurology.

Raymond Y. Lo, M.D., of the Parkinson's Institute and Clinical Center in Sunnyvale, Calif., and colleagues analyzed Kaiser Permanente Medical Care Program data on 573 subjects with Parkinson's disease that was newly diagnosed during 1994 and 1995. Subjects were followed for death until the end of 2005.

During follow-up, the researchers note that 352 subjects died. Factors associated with a higher risk of all-cause mortality included severe cognitive impairment based on Mini-Mental State Examination scores, symmetry of motor signs, older age at diagnosis, dysphagia, and postural instability gait difficulty subtype (hazard ratios, 2.7, 2.0, 1.1, 1.4, and 1.8, respectively).

"In this multiethnic incident Parkinson's disease cohort, we conclude that several motor and non-motor features in early Parkinson's disease can predict higher mortality risk, particularly older age at diagnosis, postural instability gait difficulty, cognitive impairment, and hallucinations. Our findings are in keeping with those of others, suggesting that these results are robust and generalizable. With effective clinical predictors, we can improve understanding of the disease process, refine risk stratification in designing clinical trials, and guide decision making in clinical practice," the authors conclude.

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Clopidogrel Can Be Effective in Reducing Cardiac Risk


Drug shown to reduce the risk of cardiovascular events in both men and women

16 nov 2009-- The antiplatelet drug clopidogrel is likely effective in reducing the risk of cardiovascular events in both men and women, according to a study in the Nov. 17 issue of the Journal of the American College of Cardiology.

Jeffrey S. Berger, M.D., of the New York University School of Medicine in New York City, and colleagues performed a meta-analysis of five randomized clinical trials involving 79,613 patients (30 percent women) that examined the safety and efficacy of clopidogrel at reducing cardiovascular events.

The researchers found that clopidogrel significantly reduced the risk of cardiovascular events by 14 percent (odds ratio, 0.86), with similar efficacy in men and women. Clopidogrel significantly reduced the risk of myocardial infarction in both women and men (odds ratios, 0.81 and 0.83, respectively). In men, clopidogrel also reduced the risk of stroke (odds ratio, 0.83) and total death (odds ratio, 0.91), while in women the effects were not statistically significant. In addition, clopidogrel increased the risk of major bleeding in both men and women (odds ratios, 1.22 and 1.43, respectively).

"The cumulative evidence continues to show that women with coronary artery disease differ from men in many important ways, including the response to antiplatelet therapy," the author of an accompanying editorial writes. "The good news is that clopidogrel is an exception."

Several authors of the article and editorial reported financial and consulting relationships with pharmaceutical companies.

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Elderly Slow Walkers at More Risk of Cardiovascular Death

Study finds association applies regardless of sex, body mass index or age

15 nov 2009-- Elders who walk slowly are more likely to die of cardiovascular disease than their faster walking counterparts, regardless of age, sex, body mass index or the amount of physical activity they engage in, according to a study published Nov. 10 in BMJ.

Julien Dumurgier, M.D., of INSERM in Paris, and colleagues conducted a study of 3,208 community-dwelling men and women aged 65 years and above who were followed up for an average of 5.1 years.

During follow-up, 209 participants died, 99 due to cancer and 59 from cardiovascular disease, while 51 died from other causes, the researchers found. There was a higher risk of mortality among the lowest third based on walking speed versus the upper two-thirds (hazard ratio, 1.44), and the risk of cardiovascular death among slow walkers increased about three-fold compared to the risk for faster walkers, while there was no increased risk of cancer mortality noted.

"This increased risk of cardiovascular death was seen in both sexes, younger as well as in older participants, those with or without a high risk vascular profile, and those with low or usual physical activity," the authors write. "These findings show that assessment of motor performances in older people with simple measures such as walking speed can be performed easily and that the role of fitness in preserving life and function in older age is important."

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Muscle Strength May Lower Alzheimer's Disease Risk

Study finds increased muscle strength likely decreases cognitive decline in elderly

15 nov 2009-- Older individuals with greater muscular strength may have a lower risk of developing mild cognitive impairment and Alzheimer's disease, according to research published in the November issue of the Archives of Neurology.

Patricia A. Boyle, Ph.D., of the Rush Alzheimer's Disease Center in Chicago, and colleagues analyzed data from 970 subjects free of dementia at baseline. Participants underwent measurement of the strength of numerous muscle groups, which were used to create a composite strength measure. Subjects had a mean age of 80.3 years and were followed for a mean of 3.6 years.

The researchers found that each unit of additional muscle strength at baseline was associated with a 43 percent lower risk of Alzheimer's disease. Those in the 90th percentile for strength had about a 61 percent lower risk compared to those in the 10th percentile. In addition, increased muscle strength was associated with a lower risk of mild cognitive impairment, with those in the 90th percentile having approximately a 48 percent lower risk.

"These findings suggest a link between muscle strength, Alzheimer's disease, and cognitive decline in older persons," the authors conclude. "The basis of the association of muscle strength with Alzheimer's disease is unknown. Although decreased muscle strength may represent a true risk factor for Alzheimer's disease, it is more likely that loss of muscle strength is the result of an underlying disease process that also leads to cognitive decline and clinical Alzheimer's disease."

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More Disabilities Today In 60-Year-Olds Than In Prior Generations

14 nov 2009--In a development that could have significant ramifications for the nation's health care system, Baby Boomers may well be entering their 60s suffering far more disabilities than their counterparts did in previous generations, according to a new UCLA study. The findings, researchers say, may be due in part to changing American demographics.

In the study, which will be published in the January 2010 issue of the American Journal of Public Health, researchers from the division of geriatrics at the David Geffen School of Medicine at UCLA found that the cohort of individuals between the ages of 60 and 69 exhibited increases in several types of disabilities over time. By contrast, those between the ages of 70 and 79 and those aged 80 and over saw no significant increases - and in some cases exhibited fewer disabilities than their previous cohorts.

While the study focused on groups born prior to the post-World War II Baby Boom, the findings hold "significant and sobering implications" for health care because they suggest that people now entering their 60s could have even more disabilities, putting an added burden on an already fragile system and boosting health costs for society as a whole, researchers say.

If this is true, it's something we need to address," said Teresa Seeman, UCLA professor of medicine and epidemiology and the study's principal investigator. "If this trend continues unchecked, it will put increasing pressure on our society to take care of these disabled individuals. This would just put more of a burden on the health care system to address the higher levels of these problems."

The researchers used two sets of data - the National Health and Nutrition Examination Surveys (NHANES) for 1988 and 1999 - to examine how disabilities for the three groups of adults aged 60, 70, and 80 and older had changed over time. They assessed disability trends in four areas: basic activities associated with daily living, such as walking from room to room and getting into and out of bed; instrumental activities, such as performing household chores or preparing meals; mobility, including walking one-quarter mile or climbing 10 steps without stopping for rest; and functional limitations, which include stooping, crouching or kneeling.

The study focused primarily on trends for the more recent 60 age group - those born between 1930 and 1944, just before the start of the Baby Boom, whose data was included in the 1999 NHANES. In particular, researchers felt this group could offer insights into the health of the Boomers following them, who are now entering their 60s.

The researchers found that between the periods 1988 and 1999, disability among those in their 60s increased between 40 and 70 percent in each area studied except functional limitations, independent of sociodemographic characteristics, health status and behaviors, and relative weight. The increases were considerably higher among non-white and overweight subgroups.

By contrast, the researchers found no significant changes among the group aged 70 to 79, while the 80-plus group actually saw a drop in functional limitations.

One reason for this uptick, researchers say, is that disabilities may be linked with the changing racial and ethnic makeup of the group that recently reached or will soon be reaching its 60s, with the most rapid growth projected to be among African Americans and Hispanics - groups with significantly higher rates of obesity and lower socioeconomic status, both of which are associated with higher risk for functional limitations and disabilities.

The researchers note that their controls for differences in sociodemographics, health status (such as chronic conditions and biological risk factors) and health behavior do not completely explain the increase in disability trends among the 60- to 69-year olds. Still, the trends within that group "are disturbing," Seeman said.

"Increases in disability in that group are concerning because it's a big group," she said. "These may be people who have longer histories of being overweight, and we may be seeing the consequences of that. We're not sure why these disabilities are going up. But if this trend continues, it could have a major impact on us, due to the resources that will have to be devoted to those people."

Study co-authors included Arun Karlamangla and Sharon Merkin, of UCLA's geriatrics division, and Eileen Crimmins, of the Andrus Gerontology Center at the University of Southern California.

The National Institute on Aging funded this study.

Source: Enrique Rivero
University of California - Los Angeles

Lack Of Social Engagement Is A Risk Factor For Self Neglect In Older Adults

14 nov 2009--Seniors who neglect themselves, risking their own health and safety, tend to be individuals with limited social networks and little social engagement, according to a study by Rush University Medical Center.

The study, currently appearing online in the medical journal Gerontology, is the largest epidemiological study to date examining a wide range of sociodemographic, health-related and psychosocial characteristics associated with elder self-neglect.

"We need to better understand elder self-neglect who is at risk and why so that we can find solutions and establish appropriate policies," said Dr. Xinqi Dong, a researcher and geriatrician at Rush University Medical Center and the study's lead author. "This is particularly important because reports of self-neglect to social service agencies are rising.

"Moreover, as our aging population is rapidly increasing in size, elder self-neglect will likely become an even more pervasive public health issue."

The study was based on records drawn from the Chicago Health and Aging Project, a longitudinal epidemiological study of a community-dwelling population of 9,056 individuals 65 years of age and older who live in three communities on Chicago's South side.

Over the 12-year course of this population-based study, 1,812 of these seniors, or 20 percent, were reported to the Chicago Department of Aging because of concern about suspected self-neglect.

Elder self-neglect is defined by the National Centers on Elder Abuse as "the behavior of an elderly person that threatens his/her own health and safety." It generally manifests as "a refusal or failure by the person to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication and safety precautions."

Twice as many women as men and more than seven times the number of African Americans as whites were reported for self-neglect. Those reported, compared with those not reported, tended to be over the age of 80 and have a lower socioeconomic status. The individuals also tended to have nutritional deficiencies, medical conditions and cognitive, physical and psychological deficits.

However, independent of all these factors, lower levels of social well-being specifically, limited social networks and little social engagement were major risk factors for self-neglect.

The study has important implications for health and social service professionals, Dong said.

"Professionals who work with the elderly need to be mindful not just of their patients' health profile, but also of their social well-being, a factor that may put them at risk of self-neglect," Dong said. "With social services being cut, and community and city resources lacking to help seniors, the problems of isolation can only grow worse."

Dong will be testifying before the City Council of Chicago on November 13 in support of a resolution seeking to identify measures to address the problem of elder self-neglect. The resolution has been submitted by Alderman Emma Mitts of the 37th Ward and is supported by 29 other Chicago aldermen.

Other researchers involved in the study were Dr. Denis Evans at Rush and Dr. Melissa Simon at Northwestern University.

The study was supported by the National Institute on Aging, a Paul B. Beeson Career Development Award in Aging, The Starr Foundation, the John A. Hartford Foundation and The Atlantic Philanthropies.

Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Rush is currently constructing a 14-floor, 806,000-square-foot hospital building at the corner of Ashland Avenue and Congress Parkway. The new hospital, scheduled to open in 2012, is the centerpiece of a $1-billion, 10-year campus redevelopment plan called the Rush Transformation, which also includes a new orthopedics building (to open in Fall 2009), a new parking garage and central power plant completed in June 2009, renovations of selected existing buildings and demolition of obsolete buildings. The new hospital is being designed and built to conserve energy and water, reduce waste and use sustainable building materials. Rush is seeking Leadership in Energy and Environmental Design (LEED) gold certification from the U.S. Green Building Council. It will be the first full-service "green" hospital in Chicago.

Rush's mission is to provide the best possible care for our patients. Educating tomorrow's health care professional, researching new and more advanced treatment options, transforming our facilities and investing in new technologies all are undertaken with the drive to improve patient care now, and for the future.

Source: Rush University Medical Center

For Older Walkers, Faster Is Better

13 nov 2009-- Highlighting the importance of staying fit in old age, a French study has found that seniors who walk slowly are three times more likely to die from cardiovascular disease than are fast walkers.

The researchers measured the walking speed of the participants -- 3,208 men and women, ages 65 to 85 -- and collected medical and demographic information on them at the start of the study. Follow-up exams were performed at regular intervals over the next five years.

After adjusting for a number of baseline characteristic, the researchers found that seniors with the slowest walking speed were 44 percent more likely to die than the fastest walkers. The slowest walkers also had a three-fold higher risk of cardiovascular death.

The increased risk of cardiovascular death was found in both women and men, in younger as well as older seniors and in those with low or usual physical activity levels.

There was no link between walking speed and risk of death from cancer.

"These findings show that assessment of motor performances in older people using simple measures such as walking speed can be performed easily and that the role of fitness in preserving life and function in older age is important," the researchers wrote.

The study was published online Nov. 10 in BMJ.

Longevity tied to genes that preserve tips of chromosomes

Findings from Einstein study of healthy centenarians

13 nov 2009 - A team led by researchers at Albert Einstein College of Medicine of Yeshiva University has found a clear link between living to 100 and inheriting a hyperactive version of an enzyme that rebuilds telomeres – the tip ends of chromosomes. The findings appear in the latest issue of the Proceedings of the National Academy of Sciences.

Telomeres play crucial roles in aging, cancer and other biological processes. Their importance was recognized last month, when three scientists were awarded the 2009 Nobel Prize in Physiology and Medicine for determining the structure of telomeres and discovering how they protect chromosomes from degrading.

Telomeres are relatively short sections of specialized DNA that sit at the ends of all chromosomes. One of the Nobel Prize winners, Elizabeth Blackburn, Ph.D., of the University of California at San Francisco, has compared telomeres to the plastic tips at the ends of shoelaces that prevent the laces from unraveling.

Each time a cell divides, its telomeres erode slightly and become progressively shorter with each cell division. Eventually, telomeres become so short that their host cells stop dividing and lapse into a condition called cell senescence. As a result, vital tissues and important organs begin to fail and the classical signs of aging ensue.

In investigating the role of telomeres in aging, the Einstein researchers studied Ashkenazi Jews because they are a homogeneous population that was already well studied genetically. Three groups were enrolled: 86 very old – but generally healthy – people (average age 97); 175 of their offspring; and 93 controls (offspring of parents who had lived a normal lifespan).

"Telomeres are one piece of the puzzle that accounts for why some people can live so long," says Gil Atzmon, Ph.D., assistant professor of medicine and of genetics at Einstein, Genetic Core Leader for The LonGenity Project at Einstein's Institute for Aging Research, and a lead author of the paper. "Our research was meant to answer two questions: Do people who live long lives tend to have long telomeres? And if so, could variations in their genes that code for telomerase account for their long telomeres?"

The answer to both questions was "yes."

"As we suspected, humans of exceptional longevity are better able to maintain the length of their telomeres," said Yousin Suh, Ph.D., associate professor of medicine and of genetics at Einstein and senior author of the paper. "And we found that they owe their longevity, at least in part, to advantageous variants of genes involved in telomere maintenance."

More specifically, the researchers found that participants who have lived to a very old age have inherited mutant genes that make their telomerase-making system extra active and able to maintain telomere length more effectively. For the most part, these people were spared age-related diseases such as cardiovascular disease and diabetes, which cause most deaths among elderly people.

"Our findings suggest that telomere length and variants of telomerase genes combine to help people live very long lives, perhaps by protecting them from the diseases of old age," says Dr. Suh. "We're now trying to understand the mechanism by which these genetic variants of telomerase maintain telomere length in centenarians. Ultimately, it may be possible to develop drugs that mimic the telomerase that our centenarians have been blessed with."

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The study, "Genetic Variation in Human Telomerase is Associated with Telomere Length in Ashkenazi Centenarians," appears in the November 9 online issue of the Proceedings of the National Academy of Sciences. In addition to Drs. Atzmon and Suh, the study's other Einstein researchers were co-lead author Miook Cho, M.S., Temuri Budagov, M.S., Micol Katz, M.D., Xiaoman Yang, M.D., Glenn Siegel, M.D., Aviv Bergman, Ph.D., Derek M. Huffman, Ph.D., Clyde B. Schechter, M.D., and Nir Barzilai, M.D.