Do heart patients fare better when doctors away?

Doctors joke that if you're going to have a heart attack, the safest place would be at a big national gathering of heart specialists. But a new study suggests some older hospitalized heart patients may fare better when these doctors aren't around.

26 dec 2014--Survival chances were better for cardiac arrest patients and for the sickest heart failure patients if they were treated at teaching hospitals during the two biggest national cardiology meetings, compared with those treated during weeks before and after the meetings. Also, some of the sickest heart attack patients got fewer invasive procedures during meeting days, versus those treated at other times—but that didn't hurt their odds of surviving, the nine-year study found.

The findings were only at teaching hospitals, typically affiliated with medical schools and involved in doctor training and sometimes research; these are the workplaces for many doctors who attend major medical meetings. No differences were seen in death rates at non-teaching hospitals.

The evidence is only circumstantial and the study lacks information on whether the patients' own doctors actually attended the meetings.

"The solution is not to get the cardiologists to have meetings every week," said Dr. Anupam Jena, a Harvard Medical School economist and internist and the study's lead author. Identifying specific treatments that were given or not given during meeting times would be a better solution that might lead to better outcomes, Jena said.

It might be that doctors who don't attend the meetings are less inclined to try the most invasive treatments, and that a less intensive approach is better for the sickest patients, Jena said.

The study was published online Monday in JAMA Internal Medicine.

The research is provocative and might help doctors figure out how to lower patients' death rates throughout the year, said Dr. Rita Redberg, the journal's editor.

Redberg is a cardiologist at a teaching hospital at the University of California, San Francisco. She usually attends the national American College of Cardiology and American Heart Association meetings, but said she does not think her absences have affected patient outcomes.

"I'm from a big academic institution so there's always coverage while I'm gone," Redberg said.

The authors analyzed 30-day death rates for Medicare patients hospitalized during the annual meetings in the spring and fall, which typically draw thousands of doctors. Data included nearly 3,000 patients at teaching hospitals during meeting days from 2002 through 2011. The comparison group was about 18,000 patients hospitalized on the same days during the three weeks before and three weeks after the meetings.

The 30-day death rates for meeting-day versus non-meeting days patients were:

—60 percent versus 70 percent for cardiac arrests.

—18 percent versus 25 percent for the sickest heart failure patients.

— No difference for the sickest heart attack patients: about 39 percent for both groups.

Among the heart attack patients, the meeting-days group had fewer heart stent procedures to open blocked arteries. The researchers found no difference in rates for a few invasive procedures for cardiac arrest and high-risk heart failure patients, but said there may have been differences in other treatments not included in the study that might explain the results.

Dr. Patrick O'Gara, president of the American College of Cardiology, said the study's observational design makes it impossible to know if the national meetings had any effect on patients' survival. He also noted that the number of heart doctorswho attend the national meetings is a fraction of the nearly 30,000 cardiologists nationwide.

The American Heart Association echoed those comments in a statement and said the group does not recommend any changes in treatment based on the study.

More information: Journal: JAMA Intern Med. Published online December 22, 2014. doi:10.1001/jamainternmed.2014.6781

American Heart Association: www.heart.org

American College of Cardiology: www.acc.org

Stress may increase desire for reward but not pleasure, research finds

Credit: Bill Kuffrey/public domain

25 dec 2014--Feeling stressed may prompt you to go to great lengths to satisfy an urge for a drink or sweets, but you're not likely to enjoy the indulgence any more than someone who is not stressed and has the same treat just for pleasure, according to new research published by the American Psychological Association.

"Most of us have experienced stress that increases our craving for rewarding experiences, such as eating a tasty bar of chocolate, and it can make us invest considerable effort in obtaining the object of our desire, such as running to aconvenience store in the middle of the night," said lead author Eva Pool, MS, a doctoral student at the University of Geneva. "But while stress increases our desire to indulge in rewards, it does not necessarily increase the enjoyment we experience."

Stress prompted chocolate lovers in an experiment to exert three times as much effort to smell chocolate than unstressed chocolate lovers, but both groups reported about the same level of enjoyment when they got a whiff of the pleasing aroma, according to the study, published in APA's Journal of Experimental Psychology: Animal Learning and Cognition.

For the experiment, researchers recruited 36 university students, of whom 19 were men, who said they love chocolate. To induce stress, the researchers asked students to keep one hand in ice-cold water while being observed and videotaped. Another group immersed a hand in lukewarm water. Ten minutes before and 30 minutes after the task, researchers collected samples of the participants' saliva and tested them for levels of cortisol, a hormone involved in stress response. Following the stress conditioning, all participants had to press a handgrip for the chance to smell chocolate when they saw a certain symbol. The researchers measured the amount of effort participants invested for a chance to smell the chocolate, and asked participants how pleasant they found the odor.

"Stress plays a critical role in many psychological disorders and is one of the most important factors determining relapses in addiction, gambling and binge eating," said another author, Tobias Brosch, PhD, also of the University of Geneva. "Stress seems to flip a switch in our functioning: If a stressed person encounters an image or a sound associated with a pleasant object, this may drive them to invest an inordinate amount of effort to obtain it."

Previous research with laboratory rats supports the idea that wanting and liking rely on two distinct networks of neurons in the brain that can be activated independently, according to the study. "Although the findings with rodents provide a novel explanation for the stress-induced increase of reward pursuits, to the best of our knowledge, they have never been demonstrated in humans," the study said.

More studies with people are necessary to replicate the findings, according to the authors, who recommended further research to explore the effect of more intense everyday life stressors on human wanting and liking.

More information: "Stress Increases Cue-Triggered 'Wanting' for Sweet Reward in Humans," Eva Pool, MS, Tobias Brosch, PhD, Sylvain Delplanque, PhD, and David Sander, PhD, University of Geneva; Journal of Experimental Psychology: Animal Learning and Cognition; online, Dec. 22, 2014. www.apa.org/pubs/journals/releases/xan-0000052.pdf.

Provided by American Psychological Association

Yoga has the potential to reduce risk factors of cardiovascular disease

There is "promising evidence" that the popular mind-body practice of yoga is beneficial in managing and improving the risk factors associated with cardiovascular disease and is a "potentially effective therapy" for cardiovascular health.

24 dec 2014--Indeed, following a systematic review of 37 randomised controlled trials (which included 2768 subjects), investigators from the Netherlands and USA have found that yoga may provide the same benefits in risk factor reduction as such traditional physical activities as biking or brisk walking. "This finding is significant," they note, "as individuals who cannot or prefer not to perform traditional aerobic exercise might still achieve similar benefits in [cardiovascular] risk reduction." Their study is published today in the European Journal of Preventive Cardiology.

Yoga, an ancient mind-body practice which originated in India and incorporates physical, mental, and spiritual elements, has been shown in several studies to be effective in improving cardiovascular risk factors, with reduction in the risk of heart attacks and strokes. This meta-analysis was performed, say the investigators, to appraise the evidence and provide a realistic pooled estimate of yoga's effectiveness when measured against exercise and no exercise.

Results showed first that risk factors for cardiovascular disease improved more in those doing yoga than in those doing no exercise, and second, that yoga had an effect on these risks comparable to exercise.

When compared to no exercise, yoga was associated with significant improvement in each of the primary outcome risk factors measured: body mass index was reduced by 0.77 kg/m2 (measured as a "mean difference"), systolic blood pressure reduced by.21 mm Hg, low-density (bad) lipoprotein cholesterol reduced by 12.14 mg/dl, and high-density (good) lipoprotein cholesterol increased by 3.20 mg/dl. There were also significant changes seen in secondary endpoints - body weight fell by 2.32 kg, diastolic blood pressure by 4.9 mm Hg, total cholesterol by 18.48 mg/dl, and heart rate by.27 beats/min. However, no improvements were found in parameters of diabetes (fasting blood glucose and glycosylated hemoglobin).

Risk factor improvements (in BMI, blood pressure, lipid levels) were significant when yoga was used in addition to medication. Among patients with existing coronary heart disease, yoga provided a statistically significant benefit in lowering LDL cholesterol when added to medication (statins and lipid-lowering drugs).

In comparisons with exercise itself, yoga was found to have comparable effects on risk factors as aerobic exercise. The investigators note that this might be because of yoga's impact on stress reduction, "leading to positive impacts on neuroendocrine status, metabolic and cardio-vagal function".

The similarity of yoga and exercise's effect on cardiovascular risk factors, say the investigators, "suggest that there could be comparable working mechanisms, with some possible physiological aerobic benefits occurring with yoga practice, and some stress-reducing, relaxation effect occurring with aerobic exercise".

Commenting on the results, senior author Professor Myriam Hunink from Erasmus University Medical Center, Rotterdam, and Harvard School of Public Health, Boston, said that, although the evidence of yoga's beneficial effect incardiovascular health is growing, a physiological explanation for this effect remains unclear. "Also unclear," she added, "are the dose-response relationship and the relative costs and benefits of yoga when compared to exercise or medication. However, these results indicate that yoga is potentially very useful and in my view worth pursuing as a risk improvement practice."

Moreover, in view of yoga's ease of uptake, the investigators also note that evidence supports yoga's acceptability to "patients with lower physical tolerance like those with pre-existing cardiac conditions, the elderly, or those with musculoskeletal or joint pain".

Thus, they conclude that "yoga has the potential to be a cost-effective treatment and prevention strategy given its low cost, lack of expensive equipment or technology, potential greater adherence and health-related quality of life improvements, and possible accessibility to larger segments of the population".

More information: Chu P, Gotink RA, Yeh GY, Goldie SJ, Hunink MGM. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Prevent Cardiol 2014: DOI: 10.1177/2047487314562741

Provided by European Society of Cardiology

Healthy eaters, ignore glycemic index: Clinical trial shows no beneficial effects on heart disease, diabetes risk

Credit: Wikipedia.

22 dec 2014--Good news for people who are already following a diet rich in fruits, vegetables and whole grains, and low in sweets: New research suggests these heart-healthy eaters don't need to worry about choosing low glycemic index foods to lower the risk of diabetes and heart disease. Though the study was not designed to test the effects of low glycemic index foods on weight control, its lead researchers looked at studies that did focus on weight and found no clear proof of a benefit.

The glycemic index is a measure of how quickly foods containing carbohydrates, such as fruits, cereals and baked goods, raise glucose levels in the bloodstream. Conventional wisdom says that high glycemic index foods like bananas and pasta are "bad" for heart health and may increase diabetes risk. But in a clinical trial reported Dec. 17 in the Journal of the American Medical Association, researchers at the Johns Hopkins University School of Medicine and Harvard Medical School found little evidence to support these claims.

Study volunteers followed carefully planned diets high or low in carbohydrates and with high or low glycemic index scores. Tests tracked the volunteers' blood pressure, cholesterol levels and sensitivity to insulin at the beginning and end of each diet. The results showed little difference between high and low glycemic index foods, says study co-director Lawrence J. Appel, M.D., M.P.H., a professor of medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research at Johns Hopkins Medicine.

"We were really surprised," Appel says. "We did not detect any clear benefit of the low glycemic index diets on the major risk factors for heart disease, and we found no evidence of benefit for diabetes prevention."

The authors looked closely at other studies focusing on the use of low glycemic index foods in weight control. "The evidence has been inconsistent that low glycemic foods help people lose more weight or keep it off," Appel says. "In looking at the causes of obesity and ways to combat it, a narrow focus on the glycemic index seems to be unwarranted."

Several popular diets recommend choosing carbohydrates that score low on the glycemic index, but that's not always easy. Only laboratory tests can determine a food's glycemic index, and the results can be unexpected: Apples score low, but cantaloupe scores high.

Appel and study co-director Frank M. Sacks, M.D., a professor of medicine at Harvard Medical School, wanted to find out whether foods' glycemic index matters to heart health and diabetes prevention. They recruited 163 volunteers from Baltimore and Boston—all of whom were overweight and had above normal blood pressure—and randomly assigned them to follow one of four diets. Each diet contained the same number of calories, but those calories came from foods that were either high or low in carbohydrates, and also either high or low on the glycemic index. The volunteers ate the day's main meal at a research center and took home their next two meals.

After five weeks on their assigned diets, the volunteers switched to a different one. Researchers tested the volunteers' blood pressure; sensitivity to insulin; and levels of "good" high-density lipoprotein (HDL) cholesterol, "bad" low-density lipoprotein (LDL) cholesterol and triglycerides—fat molecules, or lipids, that play a role in heart health. The low glycemic index diets did not lower blood pressure or LDL cholesterol, and they did not improve insulin resistance.

Women made up 51 percent of the study's volunteers, and African-Americans made up 52 percent, so the results have broad relevance, says Appel, who offers simple advice for anyone overwhelmed by conflicting messages about diet and health.

"Get back to the basics that most people already know," he says. "Don't drink sugar-sweetened drinks. Try to eat fruits, vegetables and whole grains. Try to avoid sweets, salt, and foods high in saturated and trans fats. People who follow these principles will reap the benefits."

Appel and Sacks led three earlier clinical trials that tested ways to reduce the risk of cardiovascular disease and diabetes, providing volunteers with carefully designed diets and measuring the effects on key health indicators. Their work established the health benefits of the DASH (Dietary Approaches to Stop Hypertension) and OmniHeart Mediterranean-style diets.

More information: Paper: DOI: 10.1001/jama.2014.16658
Editorial: DOI: 10.1001/jama.2014.15338

Provided by Johns Hopkins University School of Medicine

Despite risks, benzodiazepine use highest in older people

Prescription use of benzodiazepines—a widely used class of sedative and anti-anxiety medications—increases steadily with age, despite the known risks for older people, according to a comprehensive analysis of benzodiazepine prescribing in the United States. Given existing guidelines cautioning health providers about benzodiazepine use among older adults, findings from the National Institutes of Health-funded study raise questions about why so many prescriptions—many for long-term use—are being written for this age group.

21 dec 2014--The study found that among all adults 18 to 80 years old, about 1 in 20 received a benzodiazepine prescription in 2008, the period covered by the study. But this fraction rose substantially with age, from 2.6 percent among those 18 to 35, to 8.7 percent in those 65 to 80, the oldest group studied. Long-term use—a supply of the medication for more than 120 days—also increased markedly with age. Of people 65 to 80 who used benzodiazepines, 31.4 percent received prescriptions for long-term use, vs. 14.7 percent of users 18 to 35. In all age groups, women were about twice as likely as men to receive benzodiazepines. Among women 65 to 80 years old, 1 in 10 was prescribed one of these medications, with almost a third of those receiving long-term prescriptions.

"These new data reveal worrisome patterns in the prescribing of benzodiazepines for older adults, and women in particular," said Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), which supported the study. "This analysis suggests that prescriptions for benzodiazepines in older Americans exceed what research suggests is appropriate and safe."

Benzodiazepines—named for their chemical structure—are among the most commonly prescribed medications in developed countries. They include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).The most common uses of benzodiazepines are to treat anxiety and sleep problems. While effective for both conditions, the medications have risks, especially when used over long periods. Long-term use can lead to dependence and withdrawal symptoms when discontinued. In older people, research has shown that benzodiazepines can impair cognition, mobility, and driving skills, and they increase the risk of falls.

Despite the large number of prescriptions in the United States—85 million in 2007—relatively little was known prior to this study about the specifics of benzodiazepine prescribing in the United States relative to other countries. Mark Olfson, M.D., M.P.H., at the New York State Psychiatric Institute and Columbia University; Marissa King, Ph.D., at Yale University; and Michael Schoenbaum, Ph.D., at NIMH used data from a national prescription database (IMS LifeLink LRx Longitudinal Prescription database) and a national database on medical expenditures collected by the Agency for Healthcare Research and Quality to examine prescription patterns from 2008.

These medications can pose real risks, and there are often safer alternatives available," said Dr. Schoenbaum, who was senior author. "Our findings strongly suggest that we need strategies to reduce benzodiazepine use, particularly for older women."

Among the findings:

• Use of benzodiazepines increased steadily with age: 5.2 percent of adults 18 to 80 years old received one or more benzodiazepine prescriptions in 2008; 2.6 percent of those 18 to 35, 5.4 percent of those 36 to 50, 7.4 percent of those 51 to 64, and 8.4 percent of those 65 to 80.
• Overall, about one quarter of prescriptions involve long-acting formulations of benzodiazepines.
• Most prescriptions for benzodiazepines are written by non-psychiatrists. For adults 18 to 80 years old, about two thirds of prescriptions for long-term use are written by non-psychiatrists; for adults 65 to 80, the figure is 9 out of 10.

Benzodiazepines are effective in relieving anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. However, the prevalence of anxiety disorders declines with age. Practice guidelines recommend nonpharmacologic approaches and antidepressants over benzodiazepines as first-line treatment. Rates of insomnia increase with age, but practice guidelines recommend that health care providers consider behavioral interventions as first-line treatment over medication. Neither of these conditions explains the rates of prescribing benzodiazepines for older age groups.

Adding to concerns about the possible health consequences of benzodiazepine use, a recently reported study found an association between benzodiazepine use in older people and increased risk of Alzheimer's disease. The association was stronger with increasing length of use; the risk was nearly doubled for those using benzodiazepines for more than 180 days.

The study appears online December 18 in JAMA Psychiatry.

Provided by National Institutes of Health

Latest evidence on using hormone replacement therapy for treating menopausal symptoms

Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, in particular for younger women at the onset of the menopause, suggests a new review published today in The Obstetrician & Gynaecologist (TOG).

20 dec 2014--The review highlights that menopausal symptoms, including hot flushes and night sweats are common, affecting around 70% of women for an average of 5 years but may continue for many years in about 10% of women.

Every woman experiences the menopause differently; some experience one or two symptoms mildly while others have more severe symptoms. Menopausal symptoms can be debilitating and can adversely affect a woman's quality of life.

HRT is a medical treatment for the menopause. It provides low doses of the hormone estrogen, with or without progestogen, which a woman no longer produces.

The review notes that the risk-benefit ratio of HRT has always been debated and discusses previous studies examining the effects of HRT.

The Women's Health Initiative Study in 2003 examined the effect of HRT on healthy postmenopausal women with a particular interest in cardiovascular outcomes. The study reported an increase in breast cancer, stroke and venous thromboembolism. Consequently, an 80% reduction in HRT use was reported. However, the re-analysis in 2007 demonstrated that giving HRT to women within 10 years of the menopause was associated with fewer risks and a reduction in cardiovascular problems.

The Million Women Study in 2001 suggested that HRT use increased the risk of breast cancer significantly and the Cochrane Collaboration systematic review identified an increased risk of similar conditions.

However, the authors of the TOG review highlight that such studies failed to address the effect of HRT in symptomatic younger postmenopausal women and have not addressed the benefits of HRT given at the window of opportunity, for example, administrating HRT for symptom relief during the early phase of the menopausal transition.

Additionally, the review advises that any woman with relative contraindications should be offered the option of discussing this further with a menopause specialist. Women with premature ovarian sufficiency should be strongly advised to consider taking HRT until the average menopausal age of 51.4 years, state the authors.

The authors conclude that doctors should not be concerned about discussing the risks and benefits of HRT with women who have menopausal symptoms, or be hesitant to offer a trial of appropriate treatment. They also emphasise that HRT is a patient choice.

Shagaf Bakour, Honorary Senior Lecturer and Consultant Obstetrician and Gynaecologist at City Hospital, Birmingham, and co-author of the review said:

"Women are sometimes concerned about the increased risk of breast cancer related to HRT. However, this risk is much lower than that associated with other factors such as obesity, alcohol consumption and later maternal age.

"HRT is the most effective treatment for symptoms of the menopause and when HRT is individually tailored, women gain maximum advantages and the risks are minimised.

"There are various types and regimens of HRT and healthcare professionals will be able to advise on the suitability of HRT to any woman."

Jason Waugh, TOG Editor-in-chief added: "The use of HRT is an individual decision, which a woman can only make once she has been given correct information and advice from healthcare professionals.

"If women have any concerns about menopausal symptoms or HRT, they should talk to their doctor who will be happy to discuss treatment options further."

More information: S H Bakour, J Williamson. Latest evidence on using hormone replacement therapy in the menopause. The Obstetrician & Gynaecologist 2014; onlinelibrary.wiley.com/doi/10.1111/tog.12155/

Provided by Wiley

Life expectancy increases globally as death toll falls from major diseases

Credit: Bill Kuffrey/public domain

People are living much longer worldwide than they were two decades ago, as death rates from infectious diseases and cardiovascular disease have fallen, according to a new, first-ever journal publication of country-specific cause-of-death data for 188 countries.

18 dec 2014--Causes of death vary widely by country, but, at the global level, drug use disorders and chronic kidney disease account for some of the largest percent increases in premature deaths since 1990. Death rates from some cancers, including pancreatic cancer and kidney cancer, also increased. At the same time, countries have made great strides in reducing mortality from diseases such as measles and diarrhea, with 83% and 51% reductions, respectively, from 1990 to 2013.

Globally, three conditions - ischemic heart disease, stroke, and chronic obstructive pulmonary disease (COPD) - claimed the most lives in 2013, accounting for nearly 32% of all deaths.

Published in The Lancet on December 18, the study, "Global, regional, and national age-sex-specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013," was conducted by an international consortium of more than 700 researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Compared to previous Global Burden of Disease (GBD) studies, researchers from more than 100 nations incorporated more country-level data as well as additional data on specific conditions. They also examined whether leading causes of death in lower-income countries are beginning to mirror those in higher-income countries. What they found is that even with big improvements in longevity in low-income countries, the types of health challenges faced by countries such as Bolivia, Nepal, and Niger are far different from those faced by countries such as the Japan, Spain, and the United States. The health challenges of many middle-income countries such as China or Brazil are also closer to those in the US.

The average age of death increased from 46.7 in 1990 to 59.3 in 2013, as a result of declining fertility and a demographic shift in the world's population to older ages. Partly because of global population growth, the number of deaths in both sexes for all ages combined increased from 47.5 million to 54.9 million.

The number of people dying from certain conditions, such as heart disease, has increased as population has increased, but decreases in age-specific mortality rates for these conditions is a sign of progress. Death rates from most cancers, including breast cancer, cervical cancer, and colon cancer, have decreased, but the reverse is true for pancreatic cancer, kidney cancer, and non-Hodgkin lymphoma.

"People today are less likely than their parents to die from certain conditions, but there are more people of older ages throughout the world," said IHME Director Dr. Christopher Murray. "This is an encouraging trend as people are living longer. We just need to make sure we are making the right health policy decisions today to prepare for the health challenges and associated costs that are coming."

Global life expectancy for both sexes increased from 65.3 years in 1990 to 71.5 years in 2013, and women made slightly greater gains than men. Female life expectancy at birth increased by 6.6 years and male life expectancy by 5.8 years. If trends seen over the past 23 years hold, by 2030 global female life expectancy will be 85.3 years and male life expectancy will be 78.1 years.

Disparities remain across age groups and countries. In all age groups except 80 and older, mortality has decreased more for women than men. Men aged 30-39 and over 80 showed some of the smallest declines in mortality. The gender gap in death rates for adults between the ages of 20 and 44 is widening, and HIV/AIDS, interpersonal violence, road injury, and maternal mortality are some of the key conditions responsible. For children under 5, diarrheal diseases, lower respiratory tract infections, neonatal disorders, and malaria are still among the leading causes of death.

Given the size of India's population in particular, and projections that it may soon become the world's most populous country, mortality trends there have global implications. In 2013, India accounted for 19%, or 10.2 million, of the world's deaths. The country has made great strides in reducing both child and adult mortality since 1990. The average yearly rates of decline in mortality have been 3.7% per year for children and 1.3% per year for adults. Between 1990 and 2013, life expectancy at birth increased from 57.3 years to 64.2 years for males and from 58.2 years to 68.5 years for females.

"It's very encouraging that adults and children in India are living longer and healthier lives," said Dr. Jeemon Panniyammakal of the Public Health Foundation of India and a co-author of the study. "But India's growing influence on global health means we must do more to address the diseases that kill people prematurely."

In other parts of the world, life expectancy gains in sub-Saharan Africa were mainly driven by reductions in deaths from diarrhea, lower respiratory tract infections, and neonatal disorders. Reductions in cardiovascular disease, some cancers, transport injuries, and chronic respiratory conditions have led to the longevity gains in high-income regions.

A variety of causes contributed to life expectancy declines globally. Diabetes, other endocrine disorders, and chronic kidney disease decreased life expectancy across many regions, including central Latin America; mental disorders had a negative impact in multiple regions, especially North America; intentional injuries reduced life expectancy in South Asia, the high-income countries of the Asia Pacific region, and southern sub-Saharan Africa. In Eastern Europe and Central Asia, cirrhosis took a toll on life expectancy. HIV/AIDS was a major cause of death in Southern sub-Saharan Africa and to a smaller extent in Western and Eastern sub-Saharan Africa.

"Almost a decade after HIV/AIDS peaked globally, this remains the leading cause of premature death in more than a dozen countries in sub-Saharan Africa," said Dr. Andre Kengne, of the South African Medical Research Council, and a co-author of the study. "As fewer young people die from childhood diseases we must do more to ensure that HIV/AIDS does not become a threat for people of all ages."

When looking at other causes of death, progress is seen in lower death rates despite increasing numbers of deaths. Some of the biggest increases in premature mortality since 1990 were seen for diabetes, HIV/AIDS, hypertensive heart disease, chronic kidney disease, and Alzheimer's disease. But for many disorders, including stomach cancer, Hodgkin's lymphoma, rheumatic heart disease, peptic ulcer disease, appendicitis, and schizophrenia, death rates have fallen by more than one-third since 1990.

Death rates for some cancers have fallen (lung by 9%, breast by 18%, and leukemia by 20%). Global age-standardized death rates also have fallen by more than one-fifth for ischemic heart disease and stroke.

Overall, global mortality rates increased significantly for very few diseases between 1990 and 2013.

Leading causes of death globally, with the number of deaths

2013

1. Ischemic heart disease (8,139,900)
2. Stroke (6,446,900)
3. Chronic obstructive pulmonary disease (2,931,200)
4. Pneumonia (2,652,600)
5. Alzheimer's disease (1,655,100)
6. Lung cancer (1,639,600)
7. Road injuries (1,395,800)
8. HIV/AIDS (1,341,000)
9. Diabetes (1,299,400)
10. Tuberculosis (1,290,300)

1990

1. Ischemic heart disease (5,737,500)
2. Stroke (4,584,800)
3. Pneumonia (3,420,700)
4. Diarrheal diseases (2,578,700)
5. Chronic obstructive pulmonary disease (2,421,300)
6. Tuberculosis (1,786,100)
7. Neonatal preterm birth complications (1,570,500)
8. Road injuries (1,058,400)
9. Lung cancer (1,050,000)
10. Malaria (888,100)

More information: The Lancet, www.thelancet.com/journals/lan… (14)61682-2/abstract

Provided by Institute for Health Metrics and Evaluation

In nursing homes, statins often continued in advanced dementia

17 dec 2014—For nursing home (NH) residents with dementia taking statins, most continue statins with the progression to advanced dementia, according to research published in the November issue of the Journal of the American Geriatrics Society.

Jennifer Tjia, M.D., from the University of Massachusetts Medical School in Worcester, and colleagues examined patterns of and factors associated with statin use and discontinuation among NH residents with dementia. Data were collected from NH residents with dementia from all NHs in five states. The authors observed residents who developed advanced dementia from baseline and followed them for at least 90 days to statin discontinuation or death.

The researchers found that 16.6 percent of the 10,212 residents used statins. The odds of statin use were increased with having diabetes mellitus (adjusted odds ratio [aOR], 1.24), stroke (aOR, 1.31), and hypertension (aOR, 1.35). Lower odds of statin use were seen in association with hospice enrollment (aOR, 0.75). Statins were discontinued by 37.2 percent during follow-up, with a median time to discontinuation of 36 days. Correlations were observed for shorter time to discontinuation with hospitalization in the past 30 days (adjusted hazard ratio [aHR], 1.67) and more daily medications (aHR, 1.02). When statins were discontinued, 15.0 and 47.5 percent of residents stopped only statins and at least one other medication, respectively.

"Most NH residents who use statins at the time of progression to advanced dementia continue use in follow-up," the authors write.

More information: Abstract
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Parkinson's patients identify balance and anxiety among top 10 research priorities

Immunohistochemistry for alpha-synuclein showing positive staining (brown) of an intraneural Lewy-body in the Substantia nigra in Parkinson's disease. Credit: Wikipedia

16 dec 2014--Patients with Parkinson's, medics and carers have identified the top ten priorities for research into the management of the condition in a study by the University of East Anglia and Parkinson's UK.

Commissioned by Parkinson's UK, people with direct and indirect personal experience of the condition worked together to identify crucial gaps in the existing evidence to address everyday practicalities in the management of the complexities of Parkinson's. Patients stated that the overarching research aspiration was an effective cure for Parkinson's but whilst waiting for this more research was needed into the management of the condition.

Top of the list, which was narrowed down from a list of 94 uncertainties, was the need to identify what treatments help reduce balance problems and falls in people with Parkinson's.

This was followed in second place by questioning what approaches are helpful for reducing stress and anxiety in patients, and what treatments help reduce involuntary movements - a side effect of some medications - in third place.

Also outlined in the top ten research priorities for Parkinson's management, published today on BMJ Open, are better monitoring methods, improving sleep quality and the need to develop interventions specific to the different types of Parkinson's and the dementia that can be associated with Parkinson's.

Dr Katherine Deane, lead researcher from the University of East Anglia, said: "Ensuring that research is effective in addressing the needs of patients and the clinicians treating them is critically important, and the priorities will inform the research plans and funding from Parkinson's UK and hopefully other funders."

"The research agenda has been accused of being overly influenced by the pharmaceutical industry and of not addressing the questions about treatments that are of greatest importance to patients, their carers and clinicians. Research needs to focus on whether treatments are doing more harm than good, or whether one treatment is better than another, and ensure the outcomes reflect issues that have impact on the patient's wellbeing and participation.

"These priorities identify crucial gaps in the existing evidence to address everyday practicalities in the management of the complexities of Parkinson's, with an overarching research aspiration to work towards an effective cure for Parkinson's."

One thousand participants provided initial ideas on research uncertainties, which were narrowed down to 94 unique ideas, which 475 participants used to select their own top ten priority list. A final 26 top priorities were then examined by 27 stakeholders who agreed a final top 10. People with Parkinson's were in the majority in all of these groups.

Arthur Roach, Director of Research and Development at Parkinson's UK, said: "This study highlights the very important fact, sometimes overlooked, that for many people with Parkinson's the most troublesome problems are not the classical motor symptoms, but things like sleep, falls, anxiety and difficulties with thinking. Ensuring that research meets the needs of people with Parkinson's is key and we will be using this awareness to guide our research programme in the future."

The project was led by Parkinson's UK, with the University of East Anglia and the University of Birmingham acting as academic partners. The James Lind Alliance provided an independent chair, advised on the methodology, and facilitated the process.

Overarching research aspiration: An effective cure for Parkinson's

The top ten research priorities for the management of Parkinson's:

1. What treatments are helpful for reducing balance problems and falls in people with Parkinson's?
2. What approaches are helpful for reducing stress and anxiety in people with Parkinson's?
3. What treatments are helpful for reducing dyskinesias (involuntary movements, which are a side effect of some medications) in people with Parkinson's?
4. Is it possible to identify different types of Parkinson's, eg, tremor dominant? And can we develop treatments to address these different types?
5. What best treats dementia in people with Parkinson's?
6. What best treats mild cognitive problems such as memory loss, lack of concentration, indecision and slowed thinking in people with Parkinson's?
7. What is the best method of monitoring a person with Parkinson's response to treatments?
8. What is helpful for improving the quality of sleep in people with Parkinson's?
9. What helps improve the dexterity (fine motor skills or coordination of small muscle movements) of people with Parkinson's so they can do up buttons, use computers, phones, remote controls etc?
10. What treatments are helpful in reducing urinary problems (urgency, irritable bladder, incontinence) in people with Parkinson's?

Provided by University of East Anglia

The state of euthanasia in Europe

13 dec 2014--French legislation introduced Friday to ease restrictions on doctor-assisted death risks further diversifying the range of clashing national laws on euthenasia across Europe.

Following is a round-up of the state of current euthanasia regulations in Europe.

LEGALISED

In THE NETHERLANDS, active, direct euthanasia has been legal since April 2002. Requested administration of a drug in lethal doses is authorised if patients make the request while fully mentally lucid. They must also endure unbearable and endless suffering from a condition diagnosed as incurable by at least two doctors.

The Netherlands has also authorised euthanasia for children younger than 12 under strict conditions.

BELGIUM lifted restrictions on euthanasia in September 2002 for patients facing constant, unbearable and untreatable physical or psychic suffering; aged 18 or over; and who request termination of life in a voluntary, deliberated and repeated manner free from coercion.

Provisions for doctor-assisted death in cases that meet those criteria may also be stipulated in "living wills" written by healthy people before they fall ill, and which remain valid for five years.

In February 2014, Belgium became the first country to authorise children to request euthanasia if they suffer a terminal disease, and understand the consequences of the act.

In LUXEMBOURG, a text legalising euthanasia in certain terminal cases was approved in March 2009. It excludes minors.

AUTHORISED OR TOLERATED

SWITZERLAND is one of the rare countries that allows assisted suicide by patients administering a lethal dose of medication themselves. Switzerland does not allow active, direct euthanasia by a third party, but tolerates the provision of substances to relieve suffering even if death is a possible side-effect.

Passive euthanasia, or the halting of medical procedures that maintain life, is also tolerated.

In FRANCE, a 2005 law acknowledges a "right to die" in connection with procedures to ease suffering.

A doctor can prescribe pain killers even if their use under certain conditions may result in death, provided the patient is in an advanced stage of an incurable disease.

SWEDEN authorised passive euthanasia in 2010.

BRITAIN has allowed medical personnel to halt life-preserving treatment in certain cases since 2002. Prosecution of those who have helped a close relative die after clearly expressing the desire to end their lives has receded since 2010.

In AUSTRIA and GERMANY, passive euthanasia is permitted if the patient has requested it.

Since 1992, DENMARK has allowed patients to file previously written refusal of excessive treatment in dire situations, with the document held in a centralised register.

In NORWAY, passive euthanasia is permitted if requested by the patient, or by a relative if the patient is unconscious.

In HUNGARY, SPAIN and the CZECH REPUBLIC, people with incurable diseases can refuse treatment.

In PORTUGAL, active and passive euthanasia is not legal, but an ethical council has approved the halting of treatment in certain cases.

PROHIBITED

In ITALY, ROMANIA, GREECE, BOSNIA, SERBIA, CROATIA, POLAND AND IRELAND euthanasia is forbidden, and considered homicide. Punishment can range from 14 and 15 years in prison in Ireland and Italy respectively, to relatively light sentences in Croatia.

Bilingualism and ageing

Many older people keep mentally active and enjoy using 'brain training' puzzles and games for their leisure, however the science on their efficacy is as yet partial and inconclusive.

12 dec 2014--Another area which is as yet, still not fully understood and has also resulted in conflicting results, is whether being bilingual offers a protective factor in age-related conditions such as Alzheimer's disease.   

A small-scale study of bilingual Welsh/English speakers funded by the Economic & Social Research Council, was led by Prof Linda Clare of Bangor University's School of Psychology. At the outset of the research, there was no evidence available about the effects of bilingualism for older Welsh speakers. The now completed study has found no evidence for a significant delay in the onset of Alzheimer's Disease in Welsh/English bilinguals. This finding was comparable to that in Montreal, Canada where no bilingual advantage was found in non-immigrant bilinguals.

One explanation, researchers suggest, is that where people have grown up speaking two languages in a bilingual community, the simultaneous language use may be an automatic and effortless process for lifelong bilinguals, so not sufficiently 'mentally challenging', as compared to the mental activity required by bilinguals who have acquired fluency in a second language at a later stage.

"This may perhaps make bilingualism less likely to provide resilience in the face of cognitive impairment" Professor Linda Clare suggests.

Prof Clare adds:

"Moving science forward can be very piece-meal and slow- we hear about the breakthroughs, but for each breakthrough, there are other research questions which are less dramatic in their results, but no less important. Having completed this small study, the information gained may lead the way for us or others to refine or enlarge the research to see whether we can learn more about what is actually taking place, and improve our understanding…"

A research paper on the findings is available in the Journal of Neuropsychology.

More information: "Bilingualism, executive control, and age at diagnosis among people with early-stage Alzheimer's disease in Wales." J Neuropsychol. 2014 Nov 25. DOI: 10.1111/jnp.12061. [Epub ahead of print]

Provided by Bangor University

Imaging shows brain connection breakdown in early Alzheimer's disease

Structural connectomes (top two rows) and corresponding florbetapir PET images (bottom two rows) in four patients with normal cognition (NC) with the lowest whole cortex amyloid burden (left) and the four patients with AD with the highest whole cortex amyloid burden (right) focused on the composite regions used in connectome versus amyloid analysis. Nodes represent the centroids of the FreeSurfer parcellations in the frontal (red), cingulate (green), temporal (light blue), and parietal (dark blue) regions. This is merely a schematic intended to show the concepts and is not intended to show any visually discernible generalizable difference between the patients with NC and those with AD. Structural network metrics provide more sensitive information about the connectome than are apparent through visualization alone. Credit: RSNA

11 dec 2014--Changes in brain connections visible on MRI could represent an imaging biomarker of Alzheimer's disease, according to a new study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Alzheimer's disease is the most common form of dementia. As many as 5 million Americans are affected, a number expected to grow to 14 million by 2050, according to the Centers for Disease Control and Prevention. Preventive treatments may be most effective before Alzheimer's disease is diagnosed, such as when a person is suffering from mild cognitive impairment (MCI), a decline in cognitive skills that is noticeable but not severe enough to affect independent function. Previous efforts at early detection have focused on beta amyloid, a protein found in abnormally high amounts in the brains of people with Alzheimer's disease.

For the new study, researchers looked at the brain's structural connectome, a map of white matter tracts that carry signals between different areas of the brain.

"The structural connectome provides us with a way to characterize and measure these connections and how they change through disease or age," said study co-author Jeffrey W. Prescott, M.D., Ph.D., radiology resident at Duke University Medical Center in Durham, N.C.

Dr. Prescott and colleagues analyzed results from 102 patients enrolled in a national study called the Alzheimer's Disease Neuroimaging Initiative (ADNI) 2. The patients had undergone diffusion tensor imaging (DTI), an MRI method that assesses the integrity of white matter tracts in the brain by measuring how easy it is for water to move along them.

"It is known that water prefers moving along the defined physical connections between regions in the brain, which makes DTI a great tool for evaluating the structural connectome," Dr. Prescott said.

The researchers correlated changes in the structural connectome with results from florbetapir positron emission tomography (PET) imaging, a technique that measures the amount of beta amyloid plaque in the brain. Increased florbetapir uptake corresponds with greater amounts of the protein.

The results showed a strong association between florbetapir uptake and decreases in strength of the structural connectome in each of the five areas of the brain studied.

"This study ties together two of the major changes in the Alzheimer's brain—structural tissue changes and pathological amyloid plaque deposition—and suggests a promising role for DTI as a possible diagnostic adjunct," Dr. Prescott said.

Based on these findings, DTI may offer a role in assessing brain damage in early Alzheimer's disease and monitoring the effect of new therapies.

"Traditionally, Alzheimer's disease is believed to exert its effects on thinking via damage to the brain's gray matter, where most of the nerve cells are concentrated," said Jeffrey R. Petrella, M.D., professor of radiology at Duke and senior author on the study. "This study suggests that amyloid deposition in the gray matter affects the associated white matter connections, which are essential for conducting messages across the billions of nerve cells in the brain, allowing for all aspects of mental function."

"We suspect that as amyloid plaque load in the gray matter increases, the brain's white matter starts to break down or malfunction and lose its ability to move water and neurochemicals efficiently," added Dr. Prescott.

The researchers plan to continue studying this cohort of patients over time to gain a better understanding of how the disease evolves in individual patients. They also intend to incorporate functional imaging into their research to learn about how the relationship between function and structure is affected with increasing amyloid burden.

Provided by Radiological Society of North America

UWE mental health expert helps produce new dementia guidelines

A UWE Bristol professor in mental health is one of the key experts behind a new care pathway and Guide to Psychosocial Interventions in Dementia launched recently by the British Psychological Society.

10 dec 2014--Professor Richard Cheston is a clinical psychologist who worked with colleagues from five NHS Trusts to produce the documents which bring together current research and best practice in psychosocial care.

Dementia has been a key topic since the Prime Minister's Dementia Challenge highlighted the need for the UK to become dementia aware. Dementia was also on the agenda at the recent G7 summit.

The Guide to Psychosocial Interventions in Dementia offers an A to Z of approaches which can be used in this area to enable people to live well with dementia.

Professor Cheston said, "The documents highlight the importance of personalised pre-assessment counselling, skilful cognitive assessment, sympathetic communication of the diagnosis and appropriate post-diagnostic support and access to relevant psychosocial interventions. They provide clear recommendations and guidance not only to clinical psychologists working in the field but to their colleagues in other disciplines and partnership agencies working with people living with dementia."

By 2015 there will be 850,000 people with dementia in the UK including 40,000 younger people. One in six people aged 80 and over have dementia and there are 670,000 carers of people with dementia in the UK. Two-thirds of people with dementia live in the community while one-third live in a care home. Only 44% of people with dementia in England, Wales and Northern Ireland receive a diagnosis.

According to the Alzheimer's Society, up to a quarter of all general hospital beds in the UK are occupied by a person over 65 years who has dementia.

The guidelines are the output of a two-year project coordinated by Reinhard Guss of the Faculty of the Psychology of Older People (FPOP). The project involved consultation with service users, carers, and stakeholder groups such as the Alzheimer's Society, Dementia Action Alliance (DAA) and DEEP (The Dementia Engagement and Empowerment Project). They are supported by the Royal College of Psychiatrists Old Age Faculty and the Royal College of Nursing.

The documents Clinical Psychology in Early Stage Dementia Care Pathway and Guide to Psychosocial Interventions in Dementia can be downloaded from the British Psychological Society webpage.

Provided by University of the West of England

Cans lined with Bisphenol A may increase blood pressure

Drinking or eating from cans or bottles lined with Bisphenol A (BPA) could raise your blood pressure, according to new research reported in the American Heart Association's journal Hypertension.

09 dec 2014--BPA, a chemical used as an epoxy lining for cans and plastic bottles, is everywhere, and its consumption has been associated with high blood pressure and heart rate variability. Previous studies have shown that BPA can leach into foods and drinks.

"A 5 mm Hg increase in systolic blood pressure by drinking two canned beverages may cause clinically significant problems, particularly in patients with heart disease or hypertension," said Yun-Chul Hong, M.D., Ph.D., study author and chair of the Department of Preventive Medicine and director of the Environmental Health Center at Seoul National University College of Medicine in South Korea. "A 20 mm Hg increase in systolic blood pressure doubles the risk of cardiovascular disease."

In this study, researchers conducted a randomized crossover trial recruiting 60 adults, mostly Korean women, over the age of 60 from a local community center. Each trial member visited the study site three times and was randomly provided with soy milk in either glass bottles or cans. Later urine was collected and tested for BPA concentration, blood pressure and heart rate variability two hours after consumption of each beverage.

Urinary BPA concentration increased by up to 1,600 percent after consuming canned beverages compared to after consuming the glass-bottled beverages.

Soy milk was the ideal beverage for the test because it has no known ingredient that elevates blood pressure, researchers said.

The study may provide important information for decision-makers, clinicians and the public on the heart risks associated with BPA, researchers said.

"Thanks to the crossover intervention trial design, we could control most of the potential confounders, such as population characteristics or past medical history. Time variables, such as daily temperatures, however, could still affect the results," Hong said.

"I suggest consumers try to eat fresh foods or glass bottle-contained foods rather than canned foods and hopefully, manufacturers will develop and use healthy alternatives to BPA for the inner lining of can containers," Hong said.

Provided by American Heart Association

What that 'BPA-free' label isn't telling you

Do you worry about BPA in your plastic?

08 dec 2014--Purchase a plastic water bottle, and there's a good chance that it will feature a "BPA-free" label. You might be seeing it more often because the industrial chemical Bisphenol-A has now been removed from a wide array of products. But, are products that are "BPA-free" actually less risky? And do these labels actually effect consumer behavior?

To start, let's remind ourselves what Bisphenol-A is used for: to make many kinds of plastics and resins. BPA is found in products ranging from polycarbonate plastic used to make food and beverage containers to canned food liners and thermal cash register receipts

Many studies have examined how BPA enters the human body, what it does once it's inside us, and the possible impact of exposure. Research shows that BPA behaves like a human hormone once in the body. At high exposures BPA can potentially affect the liver and kidneys, and it may possibly affect reproductive, nervous, immune, metabolic and cardiovascular systems. At low exposures, most experts, but not all, say the studies show the material to be acceptably safe.

It is this uncertainty that has led – in part – to BPA being removed from many products and to the subsequent emergence of the "BPA-free" label. This may sound like good news for consumers looking to avoid potentially harmful exposures. Yet, what many consumers may not realize is that, in most cases, if you take out BPA, you have to replace it with something else, which might be not safer.

A regrettable substitution

While a "BPA-free" label does say the BPA has been removed, it says nothing about what the BPA has been replaced with. In many cases, this will be a substance that has not been as thoroughly studied as BPA. It might turn out that the substitute chemical is safer, in which case this choice indeed reduces risk. However, because substitute chemicals have not been studied as much, they may present a greater health risk than BPA – a problem often referred to as the "regrettable substitution" problem.

Which brings us to our second question: do "BPA-free" labels influence how people think about risk trade-offs between BPA and non-BPA products? A study we've just published in Health, Risk & Society suggests that they do.

In one of our online surveys, we asked participants to read a mock news article about the benefits and risks of eating tomatoes from cans lined with a BPA-based plastic. The article provided a fairly detailed summary of the research on BPA and noted that "it is generally accepted that BPA may slightly raise the risk of certain health problems." Participants then read a second article about a BPA substitute – polyethylene terephthalate (PET). In contrast to the information about BPA, participants were told that "nothing is known for sure about how PET affects human or animal health".

The key part of our experimental design was that we varied whether the article referred to canned tomatoes using PET linings as being "BPA-free" or not. Half of participants read materials that always described PET products as being "BPA-free," while the remaining half read the exact same materials without the "BPA-free" label. We then asked participants about their preferences for tomatoes from cans containing BPA or PET.

Labeling canned tomatoes as "BPA-free" reduced how risky participants thought the non-BPA product was – even after they had been told that little was known about the safety of the substitute material. They were highly interested in having "BPA-free" options and indicated they would be willing to pay on average 28 cents more for a product labeled as "BPA-free".

When forced to choose between cans with BPA or PET, the proportion of participants selecting PET-lined cans was 20 percentage points greater when those cans were labeled as "BPA-free." Put simply, the BPA-free label appears to mislead some people into thinking that "free" means "safer" – even when it is explicitly stated that alternative products contain substitute chemicals that are potentially more toxic.

Communicating risk

Our study shows that labeling a product as chemical-free reduces how much people consider the risks potentially presented by substitute materials. Any label that describes a product as "free" of something is likely to make it seem less risky. This effect occurs even when consumers are explicitly told that a substitute chemical is present and even when they are told that there is vastly more research on the riskiness of the original chemical (here, BPA) than there is for the substitute.

Our study sheds new light on how people respond to different types of uncertainty. When people face choices between well-studied but still controversial substances and poorly studied substitutes, their choices can be easily changed by a simple label or by changing the order in which people learn about their options. As a result, our study strongly suggests that care needs to be taken in how evidence and risk are communicated to the public about BPA or any other substance where there is some element or doubt over risk and safety.

This is not a trivial issue. Consumer reaction to "BPA-free" and similar labels may in some cases cause people to make riskier decisions, decisions that feel safer but actually expose them to agents which may ultimately be more toxic.

"BPA-free" labels don't make it easier for consumers to make reasoned choices. They lead people to substitute unconscious assumptions about safety and benefit for reasoned consideration of what is known or not known about different chemicals and products. And that is truly a regrettable substitution.

Obesity may shorten life expectancy up to eight years

Credit: Peter Häger

07 dec 2014--'Tis the season to indulge. However, restraint may be best according to a new study led by investigators at the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University. The researchers examined the relationship between body weight and life expectancy. Their findings show that overweight and obese individuals have the potential to decrease life expectancy by up to 8 years. The study, published in the current issue of The Lancet Diabetes and Endocrinology, further demonstrates that when one considers that these individuals may also develop diabetes or cardiovascular disease earlier in life, this excess weight can rob them of nearly two decades of healthy life.

"In collaboration with researchers from the University of Calgary and the University of British Columbia our team has developed a computer model to help doctors and their patients better understand how excess body weight contributes to reduced life expectancy and premature development of heart disease and diabetes," says lead author Dr. Steven Grover, a Clinical Epidemiologist at the RI-MUHC and a Professor of Medicine at McGill University.

Diabetes and Cardiovascular Disease: The Predictors of Health

Dr. Grover and his colleagues used data from the National Health and Nutrition Examination Survey (from years 2003 to 2010) to develop a model that estimates the annual risk of diabetes and cardiovascular disease in adults with different body weights. This data from almost 4,000 individuals was also used to analyze the contribution of excess body weight to years of life lost and healthy years of life lost.

Their findings estimated that individuals who were very obese could lose up to 8 years of life, obese individuals could lose up to 6 years, and those who were overweight could lose up to three years. In addition, healthy life-years lost were two to four times higher for overweight and obese individuals compared to those who had a healthy weight, defined as 18.5-25 body mass index (BMI). The age at which the excess weight accumulated was an important factor and the worst outcomes were in those who gained their weight at earlier ages.

"The pattern is clear - the more an individual weighs and the younger their age, the greater the effect on their health," Dr. Grover adds. "In terms of life-expectancy, we feel being overweight is as bad as cigarette smoking."

The next steps are to personalize this information in order to make it more relevant and compelling for patients. "What may be interesting for patients are the 'what if?' questions. What if they lose 10 to 15 pounds? Or, what if they are more active? How will this change the numbers?" says Dr. Grover. The research team is now conducting a three year study in community pharmacies across the country to see if engaging patients with this information and then offering them a web-based e-health program will help them adopt healthier lifestyles, including healthier diets and regular physical activity.

"These clinically meaningful models are useful for patients, and their healthcare professionals, to better appreciate the issues and the benefits of a healthier lifestyle, which we know is difficult for many of us to adopt and maintain, Dr. Grover adds.

More information: The Lancet Diabetes and Endocrinology, www.thelancet.com/journals/lan… (14)70229-3/abstract

Provided by McGill University Health Centre

"Obesity may shorten life expectancy up to eight years." December 4th, 2014. http://medicalxpress.co