SPRINT post-hoc analysis: Food for thought on defining the ideal blood pressure target

Adding to the debate on optimal blood pressure control, new findings presented at ESC Congress today suggest there may be variations in the ideal target depending on baseline pressure and overall cardiovascular risk.

30 aug 2017--A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), suggests that for some patients with systolic blood pressure (SBP) readings of 160 mmHg or more, lightening up on blood pressure control might be beneficial.
"The key message from our analysis is that a universal blood pressure target may not be appropriate for all, and that for some with baseline SBP of 160 mmHg or more, the harms of aggressive treatment might outweigh the benefits," said Tzung-Dau Wang, MD, PhD, from National Taiwan University Hospital.
"Although these results need further verification, it's worth considering that a universal target of 120 mmHg might not be best for everyone," he advised.
The SPRINT trial (N Engl J Med 2015;373:2103-16) prompted widespread debate about blood pressure guidelines after showing significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause among intensively treated patients.
In all 9,361 subjects with an SBP of 130 mmHg or higher were randomised to either intensive treatment, which targeted an SBP of less than 120 mmHg, or standard treatment with a target of less than 140 mmHg.
But despite the study's clear findings of better overall outcomes with intensive treatment, there were suggestions that aggressively lowering blood pressure could be associated with risks as well as benefits.
Now, the post-hoc analysis offers further insight.
Among the SPRINT participants, there were 480 who had a SBP of 160 mmHg or more.
The group's median 10-year Framingham risk score was ≤31.3%. Within this group, after adjustment for age and sex, those who were randomised to the aggressive treatment arm had almost triple the risk of death from any cause compared to those treated less intensively (4.9% vs 1.7%, hazard ratio [HR] 3.12, [95% CI 1.00-9.69]; p=0.012), although the results barely reached statistical significance.
In contrast, there were no increased risks associated with intensive treatment among SPRINT subjects with lower baseline SBP.
Dr. Wang said these new results may help inform the debate that has ensued in the wake of the initial SPRINT results, and shed light on a sub-group of the study population who may more accurately represent "real world patients".
"It seems there was an intricate interaction between each individual's baseline blood pressure, their inherent cardiovascular risk, and their degree of blood pressure reduction - so we have to consider all three of these elements in managing hypertensive patients," he concluded.


Provided by European Society of Cardiology

Dancing can reverse the signs of aging in the brain

As we grow older we suffer a decline in mental and physical fitness, which can be made worse by conditions like Alzheimer's disease. A new study, published in the open-access journal Frontiers in Human Neuroscience, shows that older people who routinely partake in physical exercise can reverse the signs of aging in the brain, and dancing has the most profound effect.

29 aug 2017--"Exercise has the beneficial effect of slowing down or even counteracting age-related decline in mental and physical capacity," says Dr Kathrin Rehfeld, lead author of the study, based at the German center for Neurodegenerative Diseases, Magdeburg, Germany. "In this study, we show that two different types of physical exercise (dancing and endurance training) both increase the area of the brain that declines with age. In comparison, it was only dancing that lead to noticeable behavioral changes in terms of improved balance."
Elderly volunteers, with an average age of 68, were recruited to the study and assigned either an eighteen-month weekly course of learning dance routines, or endurance and flexibility training. Both groups showed an increase in the hippocampus region of the brain. This is important because this area can be prone to age-related decline and is affected by diseases like Alzheimer's. It also plays a key role in memory and learning, as well as keeping one's balance.
While previous research has shown that physical exercise can combat age-related brain decline, it is not known if one type of exercise can be better than another. To assess this, the exercise routines given to the volunteers differed. The traditional fitness training program conducted mainly repetitive exercises, such as cycling or Nordic walking, but the dance group were challenged with something new each week.
Dr Rehfeld explains, "We tried to provide our seniors in the dance group with constantly changing dance routines of different genres (Jazz, Square, Latin-American and Line Dance). Steps, arm-patterns, formations, speed and rhythms were changed every second week to keep them in a constant learning process. The most challenging aspect for them was to recall the routines under the pressure of time and without any cues from the instructor."
These extra challenges are thought to account for the noticeable difference in balance displayed by those participants in dancing group. Dr Rehfeld and her colleagues are building on this research to trial new fitness programs that have the potential of maximizing anti-aging effects on the brain.
"Right now, we are evaluating a new system called "Jymmin" (jamming and gymnastic). This is a sensor-based system which generates sounds (melodies, rhythm) based on physical activity. We know that dementia patients react strongly when listening to music. We want to combine the promising aspects of physical activity and active music making in a feasibility study with dementia patients."
Dr Rehfeld concludes with advice that could get us up out of our seats and dancing to our favorite beat.
"I believe that everybody would like to live an independent and healthy life, for as long as possible. Physical activity is one of the lifestyle factors that can contribute to this, counteracting several risk factors and slowing down age-related decline. I think dancing is a powerful tool to set new challenges for body and mind, especially in older age."
This study falls into a broader collection of research investigating the cognitive and neural effects of physical and cognitive activity across the lifespan.

More information: Kathrin Rehfeld et al, Dancing or Fitness Sport? The Effects of Two Training Programs on Hippocampal Plasticity and Balance Abilities in Healthy Seniors, Frontiers in Human Neuroscience (2017). DOI: 10.3389/fnhum.2017.00305


Provided by Frontiers

High levels of lithium in tap water linked to lowered rates of dementia

28 aug 2017—A team of researchers from several institutions in Denmark has found what appears to be a link between the amount of lithium naturally present in tap water and dementia in the people that drink it. In their paper published in JAMA Psychiatry, the group describes how they tested tap water that reached approximately 800,000 people in Denmark and compared it with dementia rates to see if there might be any connection between the two. John McGrath with the University of Queensland and Michael Berk with Deakin University, both in Australia, offer an editorial piece in the same journal issue describing the work done by the team in Denmark and the possibility of adding lithium to drinking water to lower dementia rates.
Lithium is well known as a medication for people with bipolar disorder—it has also shown promise as a possible delay mechanism for Alzheimer's disease. Some have suggested it might also slow the progression of dementia in some people. It was this latter case that interested McGrath and Berk. They wondered if the amounts of lithium naturally present in drinking water have an impact on the people that drink it. To learn more about that possibility, they tested water samples from water treatment facilities in 151 areas in Denmark. They then compared medical records of the people living in those same areas to see if there might be a connection between levels of lithium ingestion and dementia cases.
The researchers found that there were lower rates of dementia in areas where there were higher levels of lithium in the drinking water. They also found that there were higher rates of dementia in areas where there were medium levels of lithium in the water. This, the researchers contend, suggests that consuming high amounts of lithium on a regular basis might ward off the onset of dementia, though they also acknowledge that there could be other factors at play influencing dementia progression rates for the people they studied. The group also assumed that all or most of the people living in the areas tested actually drank water from their tap on a regular basis and presumably drank an average amount of it when they did so.

More information: Association of Lithium in Drinking Water With the Incidence of Dementia, JAMA Psychiatry. Published online August 23, 2017. DOI: 10.1001/jamapsychiatry.2017.2362

Abstract
Importance. Results from animal and human studies suggest that lithium in therapeutic doses may improve learning and memory and modify the risk of developing dementia. Additional preliminary studies suggest that subtherapeutic levels, including microlevels of lithium, may influence human cognition.
Objective. To investigate whether the incidence of dementia in the general population covaries with long-term exposure to microlevels of lithium in drinking water.
Design, Setting, and Participants. This Danish nationwide, population-based, nested case-control study examined longitudinal, individual geographic data on municipality of residence and data from drinking water measurements combined with time-specific data from all patients aged 50 to 90 years with a hospital contact with a diagnosis of dementia from January 1, 1970, through December 31, 2013, and 10 age- and sex-matched control individuals from the Danish population. The mean lithium exposure in drinking water since 1986 was estimated for all study individuals. Data analysis was performed from January 1, 1995, through December 31, 2013.
Main Outcomes and Measures. A diagnosis of dementia in a hospital inpatient or outpatient contact. Diagnoses of Alzheimer disease and vascular dementia were secondary outcome measures. In primary analyses, distribution of lithium exposure was compared between patients with dementia and controls.
Results. A total of 73 731 patients with dementia and 733 653 controls (median age, 80.3 years; interquartile range, 74.9-84.6 years; 44 760 female [60.7%] and 28 971 male [39.3%]) were included in the study. Lithium exposure was statistically significantly different between patients with a diagnosis of dementia (median, 11.5 µg/L; interquartile range, 6.5-14.9 µg/L) and controls (median, 12.2 µg/L; interquartile range, 7.3-16.0 µg/L; P < .001). A nonlinear association was observed. Compared with individuals exposed to 2.0 to 5.0 µg/L, the incidence rate ratio (IRR) of dementia was decreased in those exposed to more than 15.0 µg/L (IRR, 0.83; 95% CI, 0.81-0.85; P < .001) and 10.1 to 15.0 µg/L (IRR, 0.98; 95% CI, 0.96-1.01; P = .17) and increased with 5.1 to 10.0 µg/L (IRR, 1.22; 95% CI, 1.19-1.25; P < .001). Similar patterns were found with Alzheimer disease and vascular dementia as outcomes.
Conclusions and Relevance. Long-term increased lithium exposure in drinking water may be associated with a lower incidence of dementia in a nonlinear way; however, confounding from other factors associated with municipality of residence cannot be excluded.

Editorial: Could Lithium in Drinking Water Reduce the Incidence of Dementia? JAMA Psychiatry. Published online August 23, 2017. DOI: 10.1001/jamapsychiatry.2017.2336

Sedentary behavior increases risk of death for frail, inactive adults

Sedentary time, for example, time spent sitting, increases the risk of death for middle-aged and older people who are frail and inactive, but does not appear to increase the risk for nonfrail people who are inactive, according to a new study published in CMAJ (Canadian Medical Association Journal).

27 aug 2017--Many studies have looked at the benefits of physical activity on health, although little data exists on sedentary behaviour and risk of death linked to levels of frailty. Frailty refers to a person's overall health state, determined by the number of health problems this person has.
To understand if level of frailty and prolonged sitting are linked to a higher risk of death, researchers looked at data on 3141 adults aged 50 and over in the US National Health and Nutrition Examination Survey (NHANES) from 2003/04 and 2005/06. Participants used activity trackers during waking hours and were assessed using a 46-item frailty index; they were then followed until 2011 or date of death.
"We found that in people who scored low on the frailty index, sitting time was not linked to risk of death," states Dr. Olga Theou, Department of Medicine, Dalhousie University, Halifax, Nova Scotia. "Prolonged sitting was associated with a higher risk of death only in vulnerable or frail people who did not meet the weekly recommendation for 2.5 hours of moderate physical activity."
The authors note study limitations such as limited activity tracking data for people with higher levels of frailty, which prevented them from segmenting people with severe frailty into one category for analysis.
"Physicians should stress the harms of inactivity with patients, similar to the harms of smoking, to encourage movement," states Dr. Olga Theou. "Even something as simple as getting up and walking around the house with a walker or cane can benefit frailer people."
The authors suggest this key public health message should be included in health promotions about the importance of healthy behaviours.

More information: Olga Theou et al. Association between sedentary time and mortality across levels of frailty, Canadian Medical Association Journal (2017). DOI: 10.1503/cmaj.161034


Provided by Canadian Medical Association Journal

LGB older adults suffer more chronic health conditions than heterosexuals

Lesbian and bisexual older women are more likely than heterosexual older women to suffer chronic health conditions, experience sleep problems and drink excessively, a new University of Washington study finds.

24 aug 2017--In general, lesbian, gay and bisexual (LGB) older adults were found to be in poorer health than heterosexuals, specifically in terms of higher rates of cardiovascular disease, weakened immune system and low back or neck pain. They also were at greater risk of some adverse health behaviors such as smoking and excessive drinking. At the same time, however, findings point to areas of resilience, with more LGB adults engaging in preventive health measures, such as obtaining HIV tests and blood pressure screening.
The study is the first to use national, population-based data to evaluate differences in health outcomes and behaviors among lesbian, gay and bisexual older adults. Using two-year survey data of 33,000 heterosexual and LGB adults ages 50 and older from a probability-based study of the U.S. Centers for Disease Control and Prevention, researchers from the UW School of Social Work report noticeable health disparities between LGB and heterosexual adults.
The findings were published in the August issue of the American Journal of Public Health.
While this study did not delve into what causes the poorer health outcomes, UW social work professor Karen Fredriksen-Goldsen pointed to other research, including the landmark longitudinal study, Aging with Pride: National Health, Aging and Sexuality/Gender Study, that has identified associated factors.
"The strong predictors of poor health are discrimination and victimization," said Fredriksen-Goldsen, the principal investigator on Aging with Pride, which surveyed 2,450 adults aged 50 to 100, studying the impact of historical, environmental, psychological, social, behavioral and biological factors on LGBT older adult health and well-being.
The new UW study relied on the 2013-14 National Health Interview Survey, which for the first time asked respondents about their sexual orientation. In the United States, approximately 2.7 million adults age 50 and older self-identify as lesbian, gay, bisexual or transgender. This number is expected to increase to more than 5 million by 2060.
Among the UW study's findings:

• Disability and mental distress are significantly more prevalent among lesbians or gay men than among their bisexual counterparts.
• Strokes, heart attacks, asthma, arthritis and lower back or neck pain affected significantly greater percentages of lesbian and bisexual women than heterosexual women. For example, 53 percent of lesbians and bisexual women experienced lower back or neck pain, versus not quite 40 percent of heterosexuals.
• Nearly 7 percent of gay and bisexual men, compared to 4.8 percent of heterosexual men, suffered chest pain related to heart disease.
• More LGB people reported weakened immune systems: about 17 percent of women, and 15 percent of men, compared to 10 percent of heterosexual women, and 5 percent of heterosexual men.
• Lesbian and bisexual women were up to two times as likely to engage in adverse health behaviors such as excessive drinking.

More than three-fourths of gay and bisexual men, and almost half of lesbians and bisexual women, had received an HIV test. In contrast, roughly one-fourth of heterosexuals had obtained a test. Slightly more lesbian and bisexual women had health insurance than heterosexual women, a possible reflection of professional choices, financial independence or same-sex partner benefits. But the health disparities among lesbian and bisexual women indicate a population that merits greater attention, Fredriksen-Goldsen said.
"Most people think gay and bisexual men would have more adverse health effects, because of the HIV risk," she said. "Lesbian and bisexual women tend to be more invisible, less often considered when it comes to health interventions. This is a population that isn't getting the attention it deserves," she said.
Bisexual men and women, meanwhile, may be marginalized not only in the general population, but also within gay and lesbian communities. As a result, bisexuals report feeling more isolated and experience greater stress, which, in turn, could lead to more adverse health conditions associated with stress as well as frequent risky health behaviors, Fredriksen-Goldsen said.
Like Aging with Pride, this new national study brings to light the need to target prevention efforts and health care services to improve health and the quality of life of LGB older adults, Fredriksen-Goldsen said.

More information: Karen I. Fredriksen-Goldsen et al, Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013–2014, American Journal of Public Health (2017). DOI: 10.2105/AJPH.2017.303922


Provided by University of Washington

Clear link between heavy vitamin B intake and lung cancer

High-dose, long-term use of vitamins B12 and B6 dramatically increase a man's risk of lung cancer, especially among those who smoke, according to a new study from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

22 aug 2017--New research suggests long-term, high-dose supplementation with vitamins B6 and B12—long touted by the vitamin industry for increasing energy and improving metabolism—is associated with a two- to four-fold increased lung cancer risk in men relative to non-users.
Risk was further elevated in male smokers taking more than 20 mg of B6 or 55 micrograms of B12 a day for 10 years. Male smokers taking B6 at this dose were three times more likely to develop lung cancer. Male smokers taking B12 at such doses were approximately four times more likely to develop the disease compared to non-users.
Epidemiologists from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Fred Hutchinson Cancer Research Center and National Taiwan University report their findings in the Aug. 22, 2017 issue of the Journal of Clinical Oncology.
This is the first prospective, observational study to look at the effects of long-term high-dose B6/B12 supplement use and lung cancer risk. These supplements have been broadly thought to reduce cancer risk.
For this study, Theodore Brasky, PhD, of the OSUCCC - James, and colleagues analyzed data from more than 77,000 patients participants in the VITamins And Lifestyle (VITAL) cohort study, a long-term prospective observational study designed to evaluate vitamin and other mineral supplements in relation to cancer risk. All participants were aged between 50 and 76 were recruited in the state of Washington between the years 2000 and 2002. Upon enrolling in the study, participants reported information to researchers about B-vitamin usage over the past 10 years. This included dosage information—a critical but often missing detail needed for strong risk assessment and association research.

Diana Sullivan, RN examines a patient at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. In a newly published study, researchers there discovered that men who take high-dose vitamin B6 and B12 supplements for a decade had significantly higher risks for developing lung cancer, especially if they also smoked while taking the supplements.

For this new analysis, researchers used statistical techniques to adjust for numerous factors including: personal smoking history, age, race, education, body size, alcohol consumption, personal history of cancer or chronic lung disease, family history of lung cancer and use of anti-inflammatory drugs.
"This sets all of these other influencing factors as equal, so we are left with a less confounded effect of long-term B6 and B12 super-supplementation," explains Brasky. "Our data shows that taking high doses of B6 and B12 over a very long period of time could contribute to lung cancer incidence rates in male smokers. This is certainly a concern worthy of further evaluation."
Brasky notes these findings relate to doses that are well above those from taking a multivitamin every day for 10 years.
"These are doses that can only be obtained from taking high-dose B vitamin supplements, and these supplements are many times the U.S. Recommended Dietary Allowance," he said.
Two additional studies are underway at The OSUCCC - James to further evaluate high dose, long-term B6 and B12 supplementation and lung cancer risk. One study will examine associations in post-menopausal women in order to confirm the current finding of no elevated risk in women. The second will examine B6/B12 high dose, long-term supplementation in a second large prospective study of men in an effort to determine whether the increases risk observed in the current study can be replicated.


Provided by The Ohio State University Comprehensive Cancer Center

Singing may be good medicine for Parkinson's patients

15 aug 2017--Singing? To benefit people with Parkinson's disease? It just may help, a researcher says.
"We're not trying to make them better singers, but to help them strengthen the muscles that control swallowing and respiratory function," said Elizabeth Stegemoller, an assistant professor of kinesiology at Iowa State University.
Stegemoller holds a weekly singing therapy class for Parkinson's disease patients. At each session, participants go through a series of vocal exercises and songs.
Singing uses the same muscles as swallowing and breathing control, two functions affected by Parkinson's disease. Singing significantly improves this muscle activity, according to Stegemoller's research.
"We work on proper breath support, posture and how we use the muscles involved with the vocal cords, which requires them to intricately coordinate good, strong muscle activity," she said in a university news release.
Other benefits noted by patients, their families and caregivers include improvements in mood, stress and depression, Stegemoller said.
Her research was published in Complementary Therapies in Medicine.
Parkinson's disease is a chronic and progressive movement disorder. Nearly one million Americans live with the disease. The cause isn't known, and there is no cure at present. But there are treatment options such as medication and surgery to manage symptoms, according to the Parkinson's Disease Foundation.
Symptoms can include tremors of the hands, arms, legs, jaw and face; slowness of movement; limb rigidity; and problems with balance and coordination.

More information: The U.S. National Institute of Neurological Disorders and Stroke has more on Parkinson's disease.

Social isolation, loneliness could be greater threat to public health than obesity, researchers say

Loneliness and social isolation may represent a greater public health hazard than obesity, and their impact has been growing and will continue to grow, according to research presented at the 125th Annual Convention of the American Psychological Association.

12 aug 2017--"Being connected to others socially is widely considered a fundamental human need—crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment," said Julianne Holt-Lunstad, PhD, professor of psychology at Brigham Young University. "Yet an increasing portion of the U.S. population now experiences isolation regularly."
Approximately 42.6 million adults over age 45 in the United States are estimated to be suffering from chronic loneliness, according to AARP's Loneliness Study. In addition, the most recent U.S. census data shows more than a quarter of the population lives alone, more than half of the population is unmarried and, since the previous census, marriage rates and the number of children per household have declined.
"These trends suggest that Americans are becoming less socially connected and experiencing more loneliness," said Holt-Lunstad.
To illustrate the influence of social isolation and loneliness on the risk for premature mortality, Holt-Lunstad presented data from two meta-analyses. The first involved 148 studies, representing more than 300,000 participants, and found that greater social connection is associated with a 50 percent reduced risk of early death. The second study, involving 70 studies representing more than 3.4 million individuals primarily from North America but also from Europe, Asia and Australia, examined the role that social isolation, loneliness or living alone might have on mortality. Researchers found that all three had a significant and equal effect on the risk of premature death, one that was equal to or exceeded the effect of other well-accepted risk factors such as obesity.
"There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators," said Holt-Lunstad. "With an increasing aging population, the effect on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a 'loneliness epidemic.' The challenge we face now is what can be done about it."
Holt-Lunstad recommended a greater priority be placed on research and resources to tackle this public health threat from the societal to the individual level. For instance, greater emphasis could be placed on social skills training for children in schools and doctors should be encouraged to include social connectedness in medical screening, she said. Additionally, people should be preparing for retirement socially as well as financially, as many social ties are related to the workplace, she noted, adding that community planners should make sure to include shared social spaces that encourage gathering and interaction, such as recreation centers and community gardens.

More information: Session 3328: "Loneliness: A Growing Public Health Threat," Plenary, Saturday, Aug. 5, 3-3:50 p.m. EDT, Room 151A, Street Level, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C.


Provided by American Psychological Association

Pneumonia or sepsis in adults associated with increased risk of cardiovascular disease

Pneumonia or sepsis in adults that results in hospital admission is associated with a six-fold increased risk of cardiovascular disease in the first year, according to research published today in the European Journal of Preventive Cardiology. Cardiovascular risk was more than doubled in years two and three after the infection and persisted for at least five years.

10 aug 2017--"Severe infections in adulthood are associated with a contemporaneously raised risk of cardiovascular disease," said last author Professor Scott Montgomery, director of the clinical epidemiology group, Örebro University, Sweden. "Whether this raised risk persists for several years after infection is less well established."
This study examined if hospital admission for sepsis or pneumonia is associated with an increased risk of cardiovascular disease in the years following infection, and whether there is a period of particularly heightened risk.
The study included 236 739 men born between 1952 and 1956 who underwent extensive physical and psychological examinations at around age 18 years as part of compulsory military conscription assessments. The researchers obtained infection and cardiovascular disease diagnoses from a register that has recorded information on patients admitted to hospital since 1964. The men were followed from late adolescence into middle age (follow-up was completed in 2010).
The researchers analysed the associations between a first infection with sepsis or pneumonia that resulted in hospital admission with subsequent cardiovascular disease risk at pre-specified time intervals post-infection (0-1, >1-2, >2-3, >3-4, >4-5, and 5+ years after hospital admission for the infection).
During the follow-up period, a total of 46 754 men (19.7%) had a first diagnosis of cardiovascular disease. There were 9 987 hospital admissions for pneumonia or sepsis among 8 534 men who received these diagnoses.
The researchers found that infection was associated with a 6.33-fold raised risk of cardiovascular disease during the first year after the infection. In the second and third years following an infection, cardiovascular disease risk remained raised by 2.47 and 2.12 times. Risk decreased with time but was still raised for at least five years after the infection by nearly two-fold (hazard ratio 1.87).
Similar findings were observed for coronary heart disease, stroke, and fatal cardiovascular disease. The persistently raised risk could not be explained by subsequent severe infections.
"Our results indicate that the risk of cardiovascular disease, including coronary heart disease and stroke, was increased after hospital admission for sepsis or pneumonia," said lead author Dr Cecilia Bergh, an affiliated researcher at Örebro University. "The risk remained notably raised for three years after infection and was still nearly two-fold after five years."
When the researchers examined the relationship between other risk factors such as high blood pressure, overweight, obesity, poorer physical fitness, and household crowding in childhood, they found that infection was associated with the highest magnitude of cardiovascular disease risk in the first three years post-infection.
Professor Montgomery said: "Conventional cardiovascular risk factors are still important but infection may be the primary source of risk for a limited time."
The authors said the results point to a causal relationship, since cardiovascular disease risk is very high immediately after infection and reduces with time. Persistent systemic inflammation after a severe infection may play a role, as inflammation is a risk for cardiovascular disease. Most patients with sepsis or pneumonia recover but many still have high circulating inflammatory markers after the acute phase of the infection.
Professor Montgomery said: "Our findings provide another reason to protect against infection and suggest that there is a post-infection window of increased cardiovascular disease risk. We did not study any interventions that could be initiated during this period, but preventative therapies such as statins could be investigated."

More information: Bergh C, et al. Severe infections and subsequent delayed cardiovascular disease. European Journal of Preventive Cardiology. 2017. DOI: 10.1177/2047487317724009


Provided by European Society of Cardiology

High intensity interval training can reverse frailty at advanced age, preclinical study finds

Growing older may not have to mean growing frail. A preclinical study has revealed that brief periods of intense physical activity can be safely administered at advanced age, and that this kind of activity has the potential to reverse frailty.
Published in the Journal of Gerontology A in June by University at Buffalo researchers, the study is the first to investigate whether a novel, short-session regimen of high-intensity interval training (HIIT) can be safe and effective in older populations.

06 aug 2017--The study was conducted on two groups of a dozen mice, each 24 months old, which correlates roughly to 65 years old in human terms. All the mice had been sedentary up until that age. While cautioning that the study was done in mice, the authors state that the results could have significant application to humans.
"We know that being frail or being at risk for becoming frail puts people at increased risk of dying and comorbidity," said Bruce R. Troen, MD, senior author on the study with Kenneth L. Seldeen, PhD, who is first author.
Troen is professor and chief of the Division of Geriatrics and Palliative Medicine in the Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at UB, a geriatrician with UBMD Internal Medicine, and a physician-investigator with the Veterans Affairs Western New York Health Care System. Seldeen is research assistant professor of medicine at UB.
"These results show that it's possible that high-intensity interval training can help enhance quality of life and capacity to be healthy," Troen said.
The results were striking with mice exhibiting "dramatic" improvements in numerous measurements, including strength and physical performance.

No longer frail

One of the most significant findings was that by the end of the study, five of six mice found to be frail or pre-frail at baseline improved, and four were no longer frail.
"Those four mice who had exhibited the kinds of deficits that correlate to frailty in humans improved to a completely robust level," said Troen. "The HIIT actually reversed frailty in them."
Troen and Seldeen developed mouse equivalents for measures that assess human frailty, including ways to evaluate grip strength, endurance and gait speed, so that they could establish baseline levels and then compare those with results once the study was complete.
"Because the performance measures for the mice are directly relevant to clinical parameters, we think this program of exercise is quite applicable to humans," said Troen. "We're laying a foundation so we can do this in people and so we can understand how to tailor it to individuals so they can successfully implement this."
Similar to the way that an athletic trainer might individualize a fitness program for a client, Troen and Seldeen tailored intensity levels to each mouse.
"While the mice are genetically identical, they aren't phenotypically identical," Seldeen explained, "so we customized the exercise program to each mouse, first finding out what each one was capable of at baseline, and then increasing or decreasing the intensity depending on the performance of the mouse during the study."

HIIT was well-tolerated

The 10-minute exercise program involved a three-minute warm-up, three intervals of one minute of high intensity and one minute at lower intensity, and a final minute of higher intensity on an inclined treadmill. The exercises were done three times a week over 16 weeks. All exercises were well-tolerated by the mice.
There were dramatic improvements in grip strength, treadmill endurance and gait speed. The mice showed greater muscle mass and an increase in total mitochondria, the energy factories of cells.
"Increased mitochondrial biomass allows you to utilize oxygen more efficiency," Troen explained. "With HIIT, we saw both mitochondrial increase and an improvement in muscle quality and fiber size in these mice."
As to why HIIT results in such significant benefits to those who engage in it, Troen said that it has to do with the stress to which it subjects the body.
"Exercise stresses the system and the body can respond beneficially," he explained. "We believe that the intensity of individualized HIIT provides a more significant but manageable stress so the body responds more robustly to these short, vigorous periods of exercise.
"In other words, you get more bang for your buck."
Troen and Seldeen cautioned that anyone considering HIIT should check with their physician first.


Provided by University at Buffalo

For white middle class, moderate drinking is linked to cognitive health in old age

Older adults who consume alcohol moderately on a regular basis are more likely to live to the age of 85 without dementia or other cognitive impairments than non-drinkers, according to a University of California San Diego School of Medicine-led study.
The findings are published in the August issue of the Journal of Alzheimer's Disease.

05 aug 2017--Previous studies have found a correlation between moderate alcohol intake and longevity. "This study is unique because we considered men and women's cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age," said senior author Linda McEvoy, PhD, an associate professor at UC San Diego School of Medicine.
In particular, the researchers found that among men and women 85 and older, individuals who consumed "moderate to heavy" amounts of alcohol five to seven days a week were twice as likely to be cognitively healthy than non-drinkers. Cognitive health was assessed every four years over the course of the 29-year study, using a standard dementia screening test known as the Mini Mental State Examination.
Drinking was categorized as moderate, heavy or excessive using gender and age-specific guidelines established by the National Institute on Alcohol Abuse and Alcoholism. By its definition, moderate drinking involves consuming up to one alcoholic beverage a day for adult women of any age and men aged 65 and older; and up to two drinks a day for adult men under age 65. Heavy drinking is defined as up to three alcoholic beverages per day for women of any adult age and men 65 and older; and four drinks a day for adult men under 65. Drinking more than these amounts is categorized as excessive.
"It is important to point out that there were very few individuals in our study who drank to excess, so our study does not show how excessive or binge-type drinking may affect longevity and cognitive health in aging," McEvoy said. Long-term excessive alcohol intake is known to cause alcohol-related dementia.
The researchers said the study does not suggest drinking is responsible for increased longevity and cognitive health. Alcohol consumption, particularly of wine, is associated with higher incomes and education levels, which in turn are associated with lower rates of smoking, lower rates of mental illness and better access to health care.
The UC San Diego School of Medicine research team adjusted the statistical analyses to remove confounding variables, such as smoking or obesity, but noted the study is based only on statistical relationships between different demographic factors, behaviors and health outcomes. There remain on-going debates about whether and how alcohol impacts lifespan or potentially protects against cognitive impairments with age.
One of the study's advantages, however, is that the data derive from a relatively homogenous population in a geographically well-defined area. All of the 1,344 older adults (728 women; 616 men) who participated in the study are from Rancho Bernardo, a white-collar, middle-to-upper-middle-class suburb in San Diego County. More than 99 percent of the study participants, tracked from 1984 to 2013, are Caucasian with at least some college education.
"This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging," said lead author Erin Richard, a graduate student in the Joint San Diego State University/UC San Diego Doctoral Program in Public Health. "However, it is not a recommendation for everyone to drink. Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences."

More information: Erin L. Richard et al, Alcohol Intake and Cognitively Healthy Longevity in Community-Dwelling Adults: The Rancho Bernardo Study, Journal of Alzheimer's Disease (2017). DOI: 10.3233/JAD-161153


Provided by University of California - San Diego

Worldwide health authorities urged to rethink vitamin D guidelines

Worldwide health authorities are being urged to rethink official guidance around vitamin D following the publication of a ground breaking study from the University of Surrey, which dispels the myth that vitamin D2 and D3 have the same nutritional value.

03 aug 2017--In the first ever study of its kind, using low doses of vitamin D in fortified food, researchers from the University of Surrey investigated which of the two types of vitamin D, D2 or D3, was more effective in raising levels of this vital nutrient in the body. Vitamin D3 is derived from animal products, while D2 is plant-based.
Researchers examined the vitamin D levels of 335 South Asian and white European women over two consecutive winter periods, a time when the nutrient is known to be lacking in the body. The women were split into five groups, with each group receiving either a placebo, a juice containing vitamin D2 or D3 and a biscuit with D2 or D3.
They found that vitamin D3 was twice as effective in raising levels of the vitamin in the body than its counterpart D2. Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75 per cent and 74 per cent respectively compared to those who were given D2 through the same methods. Those given D2 saw an increase of 33 per cent and 34 per cent over the course of the 12-week intervention.
The research also found that nutrient levels of both vitamin D2 and D3 rose as a result of both food and acidic beverages such as juice, which were found to be equally as effective.
Those who received the placebo experienced a 25 per cent reduction in the vitamin over the same period.
Current guidance given by a number of Government bodies around the world including the US National Institute of Health, state that the two forms of vitamin D are equivalent and can be used to equal effect.
Latest figures from Public Health England has found that more than 1 in 5 people in the UK have low levels of vitamin D and has increased the recommended intake of the vitamin to 10 micrograms per day, throughout the year, for everyone in the general population aged 4 years and older. Daily consumption of products containing vitamin D3 but not vitamin D2 will enable the population to meet this target helping to avoid the health implications such as osteoporosis, rickets and increased risk of cardio vascular disease which are associated with insufficient levels of vitamin D in the body.
This finding not only has implications for the health sector but also for the retail market. In recent years many retailers have added vitamin D2 to their products in the belief that it will help a person fulfil their daily intake. This study has proven that D3 is the most effective form of increasing vitamin D levels in the body.
Lead author Dr Laura Tripkovic from the University of Surrey, said: "The importance of vitamin D in our bodies is not to be underestimated, but living in the UK it is very difficult to get sufficient levels of it from its natural source, the sun, so we know it has to be supplemented through our diet.
"However, our findings show that vitamin D3 is twice as effective as D2 in raising vitamin D levels in the body, which turns current thinking about the two types of vitamin D on its head. Those who consume D3 through fish, eggs or vitamin D3 containing supplements are twice as more likely to raise their vitamin D status than when consuming vitamin D2 rich foods such as mushrooms, vitamin D2 fortified bread or vitamin D2 containing supplements, helping to improve their long term health."
Professor Susan Lanham-New, Head of the Department of Nutritional Sciences at the University of Surrey and who was Principal Investigator of the BBSRC DRINC funded trial said: "This is a very exciting discovery which will revolutionise how the healthand retail sector views vitamin D.
"Vitamin D deficiency is a serious matter, but this will help people make a more informed choice about what they can eat or drink to raise their levels through their diet."


Provided by University of Surrey

Poor appetite and food intake in older adults

Having a poor appetite is a serious health concern for older adults. It can lead to inadequate nutrition, which can shorten your life or reduce your quality of life. Between 11 percent and 15 percent of older adults who live independently are estimated to have poor appetites.

02 aug 2017--Strategies to improve our appetites as we age include reducing portion size, increasing meal frequency, and using flavor enhancers. Until recently, however, these options have not proven to improve food intake or quality of life for older people. That's part of the reason why a team of researchers designed a study to examine the differences in food intake among older adults with varied appetite levels. Their study was published in the Journal of the American Geriatrics Society.
The researchers looked at data from 2,597 people between the ages of 70 and 79. Nearly 22 percent of the people in the study described their appetite as "poor." The researchers interviewed the participants using a 108-item survey to estimate how much food they ate.
The researchers discovered that older adults with poor appetites ate much less protein and dietary fiber. They also ate fewer solid foods, protein-rich foods, whole grains, fruits, and vegetables. However, people with poor appetite did eat/drink more dairy foods, fats, oils, sweets, and sodas compared to older adults who reported having very good appetites.
"The results of this study show several differences in food consumption among older, independent adults with various appetite levels," wrote the researchers in their study. The team concluded that identifying the specific food preferences of older adults with poor appetites could be helpful for learning how to help improve their appetite and the quality of their diets.

More information: Barbara S. van der Meij et al, Poor Appetite and Dietary Intake in Community-Dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15017


Provided by American Geriatrics Society

Research finds increased risk of dementia in patients who experience delirium after surgery

Delirium is common in elderly hospitalized patients, affecting an estimated 14 - 56% of patients. It frequently manifests as a sudden change in behavior, with patients suffering acute confusion, inattention, disorganized thinking and fluctuating mental status.

01 aug 2017--Pre-existing cognitive impairment or dementia in patients undergoing surgery are widely recognized as risk factors for postoperative delirium, increasing its likelihood and severity.
However, little previous research has focused on whether delirium itself portends or even accelerates a decline into dementia in patients who showed no previous signs of cognitive impairment.
Research published today in the British Journal of Anaesthesia focuses on patients over the age of 65 who were assessed as cognitively normal prior to surgery. This study, led by Professor Juraj Sprung of the Mayo Clinic in Minnesota, finds those who developed postoperative delirium were three times more likely to suffer permanent cognitive impairment or dementia.
Over a ten year period, patients over the age of 65 enrolled at the Mayo Clinic Study of Ageing in Olmsted County Minnesota who were exposed to general anesthesia were included in an investigation involving over two 2000 patients. Their cognitive status was evaluated in regular 15 month periods before and after surgery by neuropsychologic testing and clinical assessment. Out of 2014 patients, 1667 were deemed to be cognitively normal before surgery. Of the 1152 patients who returned for follow-up cognitive evaluation, 109 (9.5%) had developed mild cognitive impairment (pre-dementia) or dementia, and those who had suffered postoperative delirium were three times more likely to be subsequently diagnosed with permanent cognitive decline or dementia. This research is the first to focus on the association between delirium and long-term cognitive decline in patients with normal mental capacity before surgery.
While previous studies have highlighted cognitive decline in the elderly following postoperative delirium, no others have involved such a detailed neuro-cognitive assessment identifying those with normal pre-operative cognitive abilities who go on to develop dementia. In conclusion, researchers believe that postoperative delirium could be a warning sign of future permanent cognitive impairment (dementia) in patients who at the time of surgery were still just above the threshold for registering cognitive decline. Alternatively, postoperative delirium could itself produce injury, which per se accelerates the trajectory of decline into dementia.
"Our research shows that delirium after surgery is not only distressing for patients and their families, but also may be a warning that patients could later develop dementia, said Sprung. "We don't yet know whether taking steps to prevent postoperative delirium could also help prevent dementia - but we need to find out."
British Journal of Anaesthesia Editor-in-Chief Professor Hugh Hemmings said: "This important research identifies a significant risk factor for developing dementia postoperatively, and highlights the need for more research in preventing, identifying and treating postoperative delirium."

More information: J. Sprung et al, Postoperative delirium in elderly patients is associated with subsequent cognitive impairment, BJA: British Journal of Anaesthesia (2017). DOI: 10.1093/bja/aex130


Provided by Oxford University Press