High Fruit And Vegetable Intake Positively Correlated With Antioxidant Status, Cognitive Performance

10 sept 2009--Researchers at the Institute of Biochemistry and Molecular Biology I of the Heinrich-Heine University, Düsseldorf, Germany, investigated the relationship between fruit and vegetable intake, plasma antioxidant micronutrient status and cognitive performance in healthy subjects aged 45 to 102 years. Their results, published in the August issue of the Journal of Alzheimer's Disease, indicated higher cognitive performance in individuals with high daily intake of fruits and vegetables.

Subjects with a high daily intake (about 400 g) of fruits and vegetables had higher antioxidant levels, lower indicators of free radical-induced damage against lipids as well as better cognitive performance compared to healthy subjects of any age consuming low amounts (< 100 g/day) of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables, therefore, should be encouraged to lower the prevalence of cognitive impairment.

The work was performed in collaboration with the Department of Pharmacology at Temple University in Philadelphia, Pennsylvania, the Department of Geriatrics at Perugia University, Italy, and the Department of Neurology of the St. Elisabeth Hospital in Cologne, Germany.

Dr. M. Cristina Polidori, currently at the Department of Geriatrics, Marienhospital Herne, Ruhr-University of Bochum, Germany, explains: "It is known that there is a strong association between fruit and vegetable intake and the natural antioxidant defenses of the body against free radicals. It is also known that bad nutritional habits increase the risk of developing cognitive impairment with and without dementia. With this work we show a multiple link between fruit and vegetable intake, antioxidant defenses and cognitive performance, in the absence of disease and independent of age. Among other lifestyle habits, it is recommended to improve nutrition in general and fruit and vegetable intake in particular at any age, beginning as early as possible. This may increase our chances to remain free of dementia in advanced age."

These findings are independentof age, gender, body mass index, level of education, lipid profile and albumin levels, all factors able to influence cognitive and antioxidant status. The relevance of the findings is also strengthened by the large sample that included 193 healthy subjects.

Further studies are planned that will include larger subject cohorts, patients with Alzheimer's disease at different stages and patients with mild cognitive impairment without dementia.

Reference: Polidori MC, Pratico D, Mangialasche F, Mariani E, Aust O, Anlasik T, Mang N, Pientka L, Stahl W, Sies H, Nelles G. High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects. J Alzheimers Dis 17:4 (August 2009).

Source:
Esther Mateike
IOS Press

Face Processing Slows With Age

10 sept 2009--Identifying a face can be difficult when that face is shown for only a fraction of a second. However, young adults have a marked advantage over elderly people in these conditions. Researchers writing in the open access journal BMC Neuroscience found indications that elderly people have reduced perception speed.

Guillaume Rousselet, from the University of Glasgow, UK, worked with a team of researchers to study electric activity from the brains of young and old people as they watched pictures of faces with cloud-like noise. He said, "Very few studies have attempted to measure the effect of ageing on the time-course of visual processing in response to complex stimuli like faces. We found that, as well as a general reduction in speed in the elderly, one particular component of the response to a face, the N170, is less sensitive to faces in the elderly".

The N170 occurs 170 milliseconds after a stimulus is presented. In the young, it was more closely associated with the appearance of a face, while in older subjects it occurred also in response to noise, perhaps implying reduced ability to differentiate faces from noise. Speaking about the results, Rousselet said, "Our data support the common belief that as we get older we get slower. Beyond this general conclusion, our research provides new tools to quantify by how much the brain slows down in the particular context of face perception. Now, we need to identify the reasons for the speed reduction and for the heterogeneity of the effects - indeed, why the brains of some older subjects seem to tick as fast as the brains of some young subjects is, at this point, a complete mystery".

Notes:
Age-related delay in information accrual for faces: Evidence from a parametric, single-trial EEG approach
Guillaume A Rousselet, Jesse S Husk, Cyril R Pernet, Carl M Gaspar, Patrick J Bennett and Allison B Sekuler
BMC Neuroscience (in press)
http://www.biomedcentral.com/bmcneurosci/

Elderly? Check obesity using waist, hips, not BMI

10 sept 2009– Do you like to blame your weight on being "big-boned?" If you've ever thought that the body mass index (BMI) - a ratio of weight to height often used as a yardstick of obesity - doesn't tell the true story of your relative weight and health, you may be onto something if you're elderly, UCLA researchers say.

A fundamental question is "whether or not BMI is the appropriate measure of obesity in older adults," Dr. Preethi Srikanthan and colleagues at David Geffen School of Medicine at UCLA, Los Angeles, California write in the Annals of Epidemiology.

In these individuals, the authors write, "changes in body size and composition that commonly occur with aging may limit the usefulness of BMI" for determining how much fat a person is carrying around - and also their risk of death in a given period.

The researchers looked at data from 1189 male and female subjects in their 70s over more than a decade, starting in 1988. By 2000, 492 subjects had died.

The investigators found no link between the risk of death during the study and BMI or waist size. However, the risk of death during the 12-year study was tied to the ratio of waist to hips.

Typically, that ratio is less than one, because the waist is smaller than the hips. As it grew closer to one, or increased above one, the risk of death in the study period increased.

Why was one yardstick a better predictor of death than another? "Waist-to-hip circumference ratio is different (from) waist circumference as it...also takes into account hip circumference, which includes muscle in the upper thigh, Srikanthan told Reuters Health. And a higher ratio of muscle, as opposed to fat, may suggest better health.

The link between a higher waist-to-hip ratio seemed to be stronger for women than for men.

The study may mean that "improving muscle bulk in the lower extremities may be important in moderating the health risk of abdominal fat in older individuals."

SOURCE: Annals of Epidemiology, October 2009.

Study Supports Protocol for Cardiac Computed Tomography

CT stress myocardial perfusion imaging compared well against SPECT in finding stenosis

09 sept 2009-- Adenosine stress computed tomography (CT) may have similar accuracy in discovering stress-induced myocardial perfusion defects as single-photon emission computed tomography (SPECT), according to research published in the Sept. 15 issue of the Journal of the American College of Cardiology.

Ron Blankstein, M.D., of the Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues analyzed data from 34 patients who underwent invasive angiography and a nuclear stress test. Dual-source computed tomography (DSCT) involved stress CT with adenosine, rest CT, and a delayed scan.

On a per-vessel basis, the researchers found that CT perfusion had a sensitivity of 79 percent and a specificity of 80 percent for detecting stenosis of at least 50 percent on invasive angiography, compared to 67 and 83 percent, respectively, for SPECT myocardial perfusion imaging. CT angiography during adenosine had a per-vessel sensitivity of 96 percent and a specificity of 73 percent for detecting stenosis of at least 70 percent.

"In one of the first human studies of adenosine-mediated stress DSCT, we showed the feasibility of a novel cardiac CT protocol that combines stress and rest myocardial perfusion imaging together with coronary computed tomography angiography in a single examination. Furthermore, we showed that CT stress myocardial perfusion imaging has comparable diagnostic accuracy to SPECT in detecting hemodynamically significant stenosis. Importantly, in this comprehensive CT protocol information on coronary anatomy, stress perfusion, rest perfusion, function, and delayed enhancement was available with an average radiation exposure that was equivalent to SPECT," the authors write.

The study was supported by Astellas Inc., and several co-authors reported financial relationships with Astellas or other companies.

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Thigh Size Can Have Impact on Risk of Heart Disease

Too little muscle mass may explain why small thighs are associated with higher risk

09 sept 2009-- A thigh circumference below 60 centimeters is associated with increased risk of cardiovascular and coronary heart disease and premature mortality in both men and women, according to a study published online Sept. 3 in BMJ.

Berit L. Heitmann, Ph.D., of Copenhagen University Hospital in Denmark, and Peder Frederiksen, of Glostrup University Hospital, also in Denmark, conducted a study of 1,436 men and 1,380 women. Measurements of the subjects' height and weight, along with thigh, hip and waist circumference were taken in 1987 to 1988 and the cohort was followed up for 10-year incidence of cardiovascular and coronary heart disease and 12.5 years for total death.

Subjects with a thigh circumference of approximately below 60 centimeters had increased risk of premature death, but there was no benefit to either men or women of having thighs larger than this, the investigators found. The association held even after abdominal obesity, general obesity, and cardiovascular and lifestyle risk factors were taken into account.

"The risk was more highly related to thigh circumference than to waist circumference. In this regard, it is important to note that modifiable risk factors for abdominal obesity, or behaviors to selectively reduce waist circumference, are generally unknown," the authors write. "Thigh muscle mass, on the other hand, can be selectively increased by lower body physical activity, and a clear public health recommendation to change this risk factor can be easily communicated."

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Yoga Effective in Treating Chronic Low Back Pain

Less disability, pain and depression when patients do yoga regularly

09 sept 2009-- Patients with chronic low back pain derive better results in terms of reduced functional disability, pain and depression when they do a 24-week course of yoga compared with standard medical care, according to a study in the Sept. 1 Spine.

Kimberly Williams, Ph.D., of West Virginia University in Morgantown, and colleagues conducted a study of 90 subjects with chronic low back pain, of whom 43 were randomized to participate in a 24-week, biweekly course of Iyengar yoga sessions, while the 47 subjects in the control group received standard medical care.

The researchers assessed the outcome of the two treatment arms after 12, 24 and 48 weeks, and found that clinical improvements were reported at 12 and 24 weeks by a significantly larger proportion of the yoga group than the group receiving standard care, and these subjects also had significantly reduced functional disability at 24 weeks. The authors further note that the yoga group subjects also reported less depression.

"The majority of participants (82 percent) completed the 24-week therapeutic Iyengar yoga intervention, and, as hypothesized, the intervention was effective and efficacious in treating chronic low back pain when compared to standard medical care," Williams and colleagues conclude. "There was also a clinically important trend for the yoga group to reduce their pain medication usage compared to the control group."

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Infections may lead to faster memory loss in Alzheimer's disease

ST. PAUL, Minn., 08 sept 2009 – Getting a cold, stomach bug or other infection may lead to increased memory loss in people with Alzheimer's disease, according to research published in the September 8, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.

The study found that people who had respiratory, gastrointestinal or other infections or even bumps and bruises from a fall were more likely to have high blood levels of tumor necrosis factor-α, a protein involved in the inflammatory process, and were also more likely to experience memory loss or other types of cognitive decline than people who did not have infections and who had low levels of the protein.

The blood levels and cognitive abilities of 222 people with Alzheimer's disease with an average age of 83 were measured at the beginning of the study and three more times over six months. Caregivers were interviewed to determine whether the participants had experienced any infections or accidental injury that could lead to inflammation.

A total of 110 people experienced an infection or injury that led to inflammation during the study. Those people experienced memory loss that was at twice the rate of those who did not have infections or injuries.

People who had high levels of the protein in their blood at the beginning of the study, which may indicate chronic inflammation, had memory loss at four times the rate of those with low levels of the protein at the start of the study. Those who had high levels of the protein at the start of the study who also experienced acute infections during the study had memory loss at 10 times the rate of those who started with low levels and had no infections over the six-month period.

"One might guess that people with a more rapid rate of cognitive decline are more susceptible to infections or injury, but we found no evidence to suggest that people with more severe dementia were more likely to have infections or injuries at the beginning of the study," said study author Clive Holmes, MRCPsych, PhD, of the University of Southampton in the United Kingdom. "More research needs to be done to understand the role of tumor necrosis factor-alpha in the brain, but it's possible that finding a way to reduce those levels could be beneficial for people with Alzheimer's disease."

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The study was supported by the Alzheimer's Society in London, UK.

Study of huge numbers of genetic mutations point to oxidative stress as underlying cause

CORVALLIS, Ore., 08 sept 2009 – A study that tracked genetic mutations through the human equivalent of about 5,000 years has demonstrated for the first time that oxidative DNA damage is a primary cause of the process of mutation - the fuel for evolution but also a leading cause of aging, cancer and other diseases.

The research, just published in Proceedings of the National Academy of Sciences, also indicated that natural selection is affecting the parts of the genome that don't contain genes – supposedly "junk" DNA that increasingly appears to have important roles in life processes that are very poorly understood.

The analysis was done by scientists at Oregon State University, Indiana University, the University of Florida and University of New Hampshire, in studies supported by the National Institutes of Health.

This research was unusual, scientists say, because the model animal used for the study, a type of roundworm called C. elegans, was tracked through 250 generations and in that period of time accumulated 391 genetic mutations through normal life processes. That's more than 10 times as many mutations as have ever before been tracked in a study such as this.

Several Nobel Prizes have been awarded based on studies done with this roundworm, which was the first animal to have its entire genome sequenced. And despite their vast evolutionary separation as life forms, this tiny roundworm and humans still share comparable forms of DNA maintenance.

"Genetic mutations in animals are actually pretty rare, they don't happen very often unless they are induced by something," said Dee Denver, an assistant professor of zoology at OSU and principal investigator on the study. "The value of using this roundworm is that it reaches reproductive age in about four days, so we can study changes that happen through hundreds of generations, using advanced genome sequencing technology."

Genetic mutations can take various forms, such as a disruption in the sequence of DNA bases, larger deletions of whole sections of DNA, or other events. They are a fundamental part of the biological process of life and the basis of evolution, allowing organisms to change – sometimes in ways that are good and lead to greater survival value, sometimes bad and leading to decline or death. But the process is difficult to study and a real understanding of the driving forces behind mutation, its frequency, and the types of mutation that happen most often has been elusive, researchers say.

A primary finding of the new study is that a predominant number of genetic mutations – most, but not all of them – are linked to guanine, one of the four basic nucleotides that make up DNA and form the genetic code of life. Guanine is known to be particularly sensitive to oxidative damage.

"Most life on Earth depends in some form on oxygen, which is great at the production of energy," Denver said. "But we pay a high price for our dependence on oxygen, because the process of using it is not 100 percent efficient, and it can result in free oxygen radicals that can damage proteins, fats and DNA. And this process gets worse with age, as free radicals accumulate and begin to cause disease."

This is one of the first studies, Denver said, that is clearly demonstrating the effects of oxidative damage at a genome-wide scale.

"The research showed that the majority of all DNA mutations bear the signature of oxidative stress," Denver said. "That's exactly what you would expect if you believe that oxidative stress is an underlying cause of aging and disease."

Beyond that, however, the study also found that mutation and natural selection is also operating in the "junk DNA" parts of the roundworm, which actually comprises about 75 percent of its genome but traditionally was not thought to play any major role in life and genetic processes. This suggests that these poorly-understood and little appreciated parts of the genome may have important biological roles that are not yet known, Denver said.

Oxidative stress for decades has been suspected as a mechanism for some of the processes that lead to aging and disease, and it has been studied extensively for that reason. This research provides a better fundamental understanding of the genetic impacts of oxidative stress and its role in both genetic disease and evolution, researchers say.

Cancer drug may improve memory in Alzheimer's patients

NEW YORK,08 sept 2009 - A drug now used to treat cancer may also be able to restore memory deficits in patients with Alzheimer's disease, according to a new study conducted by scientists at Columbia University Medical Center, which appeared in the September issue of The Journal of Alzheimer's Disease: Volume 18:1.

The loss of short, day-to-day memories is often the first sign of Alzheimer's - a disease that is expected, by the year 2050, to afflict 120 million people worldwide.

"People often joke that they must have Alzheimer's because they can't remember where they put their keys, but for a person with the disease, this type of short-term memory loss is extremely debilitating," says the study's lead author, Ottavio Arancio, Ph.D., associate professor of pathology and cell biology in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center.

Dr. Arancio says that the cancer drug targets a previously unknown defect in the brains of mice with Alzheimer's.

The reason why the drug improves memory lies in the way the brain records new memories. To create new memories, the neurons in the brain must manufacture new proteins. The first step is to open up and read the DNA, which contains instructions for making the proteins.

To read the DNA, the neuron attaches a chemical reactive group to the spool around which DNA is tightly wound. "These groups, called acetyls, unwind the DNA to make it more accessible," says co-author Yitshak Francis, Ph.D., a postdoctoral research scientist at Columbia. "It's like unwinding knitting wool from its spool."

This unwrapping step, the researchers found, is impaired in mice with a form of Alzheimer's disease. The mice with Alzheimer's attached about half as many acetyls to DNA as normal mice and had poorer memory.

The researchers then discovered that they could improve memory in the Alzheimer's-afflicted mice with a cancer drug from a family of compounds, called HDAC inhibitors, which increase the DNA's spool acetylation and gene transcription. The drug improved memory performance to the level found in normal mice.

"Because this type of drug has already been approved for some cancer patients," says co-author Mauro Fà, Ph.D., associate research scientist in Columbia's Taub Institute, "we hope that clinical trials for Alzheimer's disease can start in about three to four years."

"For making memories, you need transcription and protein synthesis at the cellular level. If you don't have that, you don't have memory," said Dr. Francis.

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This work was supported in part by Alzheimer Disease Research Zenith Award ZEN-07-58977, National Institutes of Health Grant R01 NS049442 (to O.A.) and by United Kingdom Alzheimer's Research Trust Pilot Grant, The International Sephardic Educational Foundation (ISEF) Scholarship, The Lewis Family Trust Scholarship, The Sidney & Elizabeth Corob Charitable Trust Scholarship, the Charlotte and Yule Bogue Research Fellowships (to Y.I.F).

Authors of The Journal of Alzheimer's Disease study include: Yitshak I Francis, Mauro Fà, Haider Ashraf, Hong Zhang, Agnieszka Staniszewski, David S. Latchman and Ottavio Arancio.

The Journal of Alzheimer's Disease (http://www.j-alz.com) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer's disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. Groundbreaking research that has appeared in the journal includes novel therapeutic targets, mechanisms of disease and clinical trial outcomes. The Journal of Alzheimer's Disease has an Impact Factor of 5.101 according to Thomson Reuters' 2008 Journal Citation Reports. The Journal is published by IOS Press (http://www.iospress.nl).

Genetic Cause For Type Of Deafness Identified By Scripps Research Scientists

07 sept 2009--A team led by scientists from The Scripps Research Institute has discovered a genetic cause of progressive hearing loss. The findings will help scientists better understand the nature of age-related decline in hearing and may lead to new therapies to prevent or treat the condition.

The findings were published the September 3, 2009, in an advance, online issue of the American Journal of Human Genetics, a publication of Cell Press.

"It is thought that mutations in several hundred genes can lead to deafness," said team leader Ulrich Mueller, a professor in the Department of Cell Biology and member of the Skaggs Institute for Chemical Biology at Scripps Research. "However, for many forms of deafness, we don't know what effects the genes have. In this new research, we have linked a previously uncharacterized gene to deafness, first in mice and then in humans."

The team found that the gene responsible for the hearing loss - called Loxhd1 - is necessary for maintaining proper functioning hair cells in the inner ear. Mutations in Loxhd1 lead to degradation of the hair cells and a disruption of the process that enables hearing.

Tracking Down a New Gene

In the new study, members of the Mueller lab used a technique called forward genetics in their quest to better understand the genetic basis of hearing and hearing loss.

In forward genetics, scientists make mutations at random in germ cells, screen the resulting models for physical characteristics of interest (in this case hearing impairment), then amplify these traits through the breeding of several generations. The gene responsible for the trait is then identified through positional cloning.

In this case, the scientists were able to generate a new mouse line with hearing impairment that they called samba and then clone the gene responsible, Loxhd1, which had never before been associated with deficits in hearing. When the mice inherited two copies of the mutated gene, they were profoundly deaf shortly after birth.

The scientists' next task was to determine why.

Normally, "hair cells" or stereocilia in the inner ear respond to fluid motion or fluid pressure changes caused by sound waves that enter the outer ear, travel down the ear canal into the middle ear, then strike the eardrum, which vibrates and moves a set of delicate bones that communicate with the inner ear. There, the movement of the stereocilia transmits signals to sensory neurons, sending signals to the brain and eventually resulting in hearing.

The scientists found that mutations in the Loxhd1 gene did not appear to affect the initial development of the stereocilia. However, these mutations did impair the function and maintenance of these essential structures, eventually leading to their degradation and to hearing loss.

But one essential question remained - was there a parallel gene in humans that also caused hearing impairment?

To find out, the Mueller lab reached out to Professor Richard J. H. Smith, the Sterba Hearing Research Professor at Carver College of Medicine, Iowa State University. Smith had been spearheading an effort to collect DNA samples from deaf families for years, and had hundreds of groups of samples in which to search for Loxhd1. Indeed, when the analysis was completed, the team found that mutations in the Loxhd1 gene were present in some of these families with hearing loss.

Clues to Age-Related Deafness

This is the third hearing-related gene that the Mueller lab has discovered, and one he is particularly excited about.

"In humans, the prevailing difficulty is progressive hearing loss," he said. "As you age, you lose your hearing slowly. Since this mutation can lead to progressive hearing loss, it provides us with more information on the genetic underpinnings of this condition and gives us clues as to how it might be corrected."

Mueller's lab is currently investigating the possibility that a therapeutic drug could be effective in reversing the molecular problems that result from the defective gene.

The first authors of the paper, "Mutations in LOXHD1, an evolutionarily conserved stereociliary protein, disrupt hair cell function in mice and cause progressive hearing loss in humans," are Nicolas Grillet and Martin Schwander of Scripps Research.

In addition to Mueller, Smith, Grillet, and Schwander, authors of the paper include: Michael S. Hildebrand of the University of Iowa City; Anna Sczaniecka, Anand Kolatkar, and Peter Kuhn of Scripps Research; Janice Velasco of the Translational Genomics Research Institute; Jennifer A. Webster, Kimia Kahrizi, and Hossein Najmabadi of the University of Social Welfare and Rehabilitation, Iran; William J. Kimberling of the Boys Town National Research Hospital; Dietrich Stephan of the Genome Institute of the Novartis Research Foundation, Arizona Alzheimer's Consortium and Banner Alzheimer's Institute; Melanie Bahlo of The Walter and Eliza Hall Institute of Medical Research, Australia; and Tim Wiltshire and Lisa M. Tarantino of the University of North Carolina, Chapel Hill.

The research was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health and the Skaggs Institute for Chemical Biology, as well as a fellowship from the Bruce Ford and Anne Smith Bundy Foundation, an Australian National Health and Medical Research Council (NHMRC) Career Development Award, and a NHMRC Overseas Biomedical Fellowship.

Source:
Keith McKeown
Scripps Research Institute

Gene trawl boosts hope in fight against Alzheimer's

PARIS , 07 sept 2009 – Scientists working in seven countries announced on Sunday they had uncovered variants of three genes which play a role in Alzheimer's, a discovery that should throw open many new avenues for tackling this tragic, mind-killing disease.

The biggest cause of dementia, Alzheimer's has a strong heritability -- nearly one in four cases are believed to have a genetic cause -- but precisely which genes are to blame and how their fiendish mechanism works remain elusive.

So far, three culprit genes have been found in "familial" Alzheimer's, a rare, early-onset form in which the disease shows up before the age of 60. This type accounts for less than three percent of all cases.

Of the far more common "sporadic" type, where there is no readily identifiable family history of the disease, just a single gene, APOE4, has come to light -- and it was spotted way back in 1993.

But hopes are now rising that a few of the many knowledge gaps may now be filled.

In two papers published in the journal Nature Genetics, a team based in Britain and the other in France report that a trawl through the DNA of 36,000 individuals has added three new genes, whose telltale variants showed up among people with Alzheimer's.

That finding could be useful in the search for a diagnostic tool, helping people with a heightened susceptibility to Alzheimer's make lifestyle decisions, even if a cure for the disorder remains beyond the far horizon.

Farther afield, it could help tease out a pharmaceutical weapon to interfere with the action of the faulty genes.

In Alzheimer's, clumps of protein called amyloid plaques and tau tangles proliferate in the brain, especially the cortex and hippocampus, destroying brain cells and their connections.

A progressive, degenerative disease, it causes forgetfulness and confusion, disturbs thinking, emotions and behaviour, eventually leading to death.

The role of the three newly-identified genes remains unknown.

Two of them, called CLU and CR1, may be involved in the elimination of amyloid plaques, so faulty variants may allow the toxic compound to build up, the scientists believe.

The other, called PICALM, controls brain chemicals that are important at synapses -- the connection between neurons -- and is involved in the transport of molecules into and inside nerve cells, thus helping to form memories and other brain functions.

"These findings are a leap forward for dementia research," Rebecca Wood, chief executive of the Alzheimer's Research Trust, a British charity that funded research encompassing universities in Britain, Belgium, Germany, Greece, Ireland and the United States.

"At a time when we are yet to find ways of halting this devastating condition, this development is likely to spark off numerous ideas, collaborations and more in the race for a cure."

The other paper was authored by a team from France's National Institutional of Health and Medical Research (Inserm).

The team "has about 10 other genes that may be possible targets" but further work is needed to confirm this, lead researcher Philippe Amouyel, of the Institut Pasteur in Lille, told AFP.

There is no cure at present for Alzheimer's, although some researchers are confident that a first generation of drugs that will slow or block the spread of the disease is not far away.

Present drugs have only a temporary effect. They inhibit an enzyme that reduces acetylcholine, a vital chemical used in communication between brain cells.

A breakthrough is urgently needed.

Alzheimer's primarily surfaces among people beyond their mid-60s, thus as the world's population ages, case numbers will surge, badly straining hospital systems.

According to an estimate published by the journal The Lancet in December 2005, the number of people with dementia will more than triple by 2040, reaching 81 million. China and South Asia will see the biggest increases.

Antioxidant pills do not prevent metabolic syndrome

NEW YORK,07 sept 2009– People who want to forestall heart disease and diabetes may do better by choosing antioxidant-rich foods instead of antioxidant supplements, a new study suggests.

Researchers found that among more than 5,200 middle-aged adults, antioxidant supplements had no effect on the risk of developing metabolic syndrome over seven-plus years.

Metabolic syndrome refers to a collection of risk factors for type 2 diabetes, heart disease and stroke -- including high blood pressure, abdominal obesity, low levels of "good" HDL cholesterol, elevated triglycerides and high blood sugar. The condition is diagnosed when a person has at least three of those risk factors.

The current findings, reported in the American Journal of Clinical Nutrition, suggest that taking antioxidants in capsule form may not thwart metabolic syndrome.

On the other hand, men and women who began the study with relatively high blood levels of certain antioxidants -- particularly vitamin C and beta-carotene -- were less likely than those with lower levels to develop metabolic syndrome.

The implication is that even though antioxidant supplements might not cut the risk of metabolic syndrome, antioxidant-rich foods just might, according to the researchers, led by Dr. Sebastien Czernichow of the French national research institute INSERM, in Paris.

Blood levels of vitamin C and beta-carotene are "rather good surrogate markers" of people's fruit and vegetable intake, Czernichow told Reuters Health in an email.

"This reinforces the guidelines for an adequate intake of this food group and goes against the regular use of antioxidant pills," he said.

The study included 5,220 adults with an average age of 49 who were randomly assigned to take either a mix of vitamins C and E, beta- carotene, selenium and zinc in capsule form or inactive placebo capsules.

After an average of 7.5 years, 263 study participants had been diagnosed with metabolic syndrome. There was no significant difference in risk between the supplement and placebo groups.

There were differences, though, when the researchers looked at participants' antioxidant blood levels at the study's outset. The one-third with the highest vitamin C levels had about half the risk of metabolic syndrome as those with the lowest levels.

Similarly, the third with the highest beta-carotene levels had only one-third of the risk of metabolic syndrome as those with the lowest beta-carotene concentrations.

In contrast, higher zinc levels in the blood were linked to an increased risk of metabolic syndrome. It's not clear why this is, but the researchers speculate that high zinc levels might, in some people, reflect heavy consumption of red meat -- one of the prime food sources of the mineral.

Good food sources of vitamin C include citrus fruits, strawberries and cantaloupe, and vegetables such as red peppers, broccoli and tomatoes.

Beta-carotene, which is converted in the body into vitamin A, is found in foods such as carrots and sweet potatoes, and leafy greens like spinach and kale.

SOURCE: American Journal of Clinical Nutrition, August 2009.

Pain In People With Dementia Often Undiagnosed

06 sept 2009--The elderly who suffer from dementia aren't able to say when something hurts or is sore. They may demonstrate their pain through behaviours like rocking or striking out, and we often dismiss these actions as symptoms of the dementia instead of pain, which is usually from a different problem. Arthritis, diabetic neuropathy, fractures, muscular contractures, bruises, abdominal pain and mouth ulcers are among the list of common ailments that go undetected. It is important for those who live or work with persons with dementia to know how to identify when an elderly person is experiencing pain - and receive treatment sooner rather than later.

The University of Alberta's Cary Brown, PhD, has a new tool to help. She has developed an online workshop and toolkit for caregivers, health-care providers, family members and friends of people with dementia.

The researcher from the Faculty of Rehabilitation Medicine created an evidence-based website with a narrated presentation on pain and dementia, a downloadable resource pack for family members, a downloadable pain log and a facilitator's toolkit with background material, a planning guide, promotional material and supplemental information for organizations who wish to put on a workshop.

The online workshop and toolkit are available at: http://www.painanddementia.ualberta.ca

Source:
Laurie Wang
University of Alberta

Probing Aging And Disease Processes With Powerful New 'Molecular GPS'

06 sept 2009--Scientists in Michigan are reporting the development of a powerful new probe for identifying proteins affected by a key chemical process important in aging and disease. The probe works like a GPS or navigation system for finding these proteins in cells. It could lead to new insights into disease processes and identify new targets for disease treatments, the researchers say. Their study is scheduled for the Sept. 18 issue of ACS Chemical Biology, a monthly journal.

Kate Carroll and colleagues note that scientists have known for years that the excess build-up of highly-reactive oxygen-containing molecules in cells can contribute to aging and possibly to disorders such as cancer and Alzheimer's disease. Scientists believe that a diet rich in antioxidants, which are abundant in fruits and vegetables, may help deter this cell-damaging process by blocking the accumulation of these molecules, also known as reactive oxygen species (ROS). But until now, scientists have lacked the proper tools to study the effects of these molecules in detail.

The researchers developed a new molecule called DAz-2, which they say functions like a tiny GPS device for quickly finding specific proteins that are affected by ROS. The molecules do this by chemically "tagging" sulfenic acid. Formed in cells, sulfenic acid indicates that a protein has undergone a type of reaction - called oxidation - caused by ROS. In lab studies using cultured cells, the scientists identified more than 190 proteins that undergo this reaction. The study may lead to better strategies for fighting the wide range of diseases that involve these excessive oxidation reactions, the researchers say.

ARTICLE:
"Mining the Thiol Proteome for Sulfenic Acid Modifications Reveals New Targets for Oxidation in Cells" http://pubs.acs.org/stoken/presspac/presspac/full/10.1021/cb900105q

Source:
Michael Woods
American Chemical Society

Atrial fibrillation: Drugs or ablation?

5 sept 2009--Barcelona, Spain: Atrial fibrillation ablation is one of the fastest growing techniques in cardiology and due to the very high number of patients that might be candidates to this procedure, a significant number of resources will have to be devoted to it to be able to treat them in the following years.

Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia. Its prevalence increases with age affecting more than 5% of the population older than 75 years of age. Overall it is estimated that more than 3.000.000 patients in Europe suffer from atrial fibrillation. Atrial fibrillation doubles the possibility of death mainly due to the higher incidence of thromboembolic events and occurrence of heart failure in patients suffering this arrhythmia.

One treatment objective is directed to avoid the negative consequences of the arrhythmia by trying to maintain normal sinus rhythm. Two strategies exist to obtain this result:

1. Chronic treatment with antiarrhythmic drugs (AAD)

2. Catheter ablation of atrial fibrillation

1. AAD treatment tries to block or modulate the electrical activity of the heart avoiding initiation and perpetuation of the arrhythmia. It is effective in about 60% of patients and requires long-term treatment. Many of the drugs used have side effects, some of them disabling for the patient. Many drugs are available and combination of them might be used in case of failure. Compliance of the treatment is basic for long-term success.

2. Catheter ablation has emerged as an alternative to obtain stable sinus rhythm in this population. It has been demonstrated that a significant number of AFepisodes initiate in the area of the pulmonary veins located in the left atrium. Using one or several catheters inserted through the femoral veins, they are inserted into the heart and brought to the left atrium through a transseptal approach. Once in the left atrium energy (radiofrequency, cold) is delivered in different areas (mainly around the pulmonary veins) to create lesions that block the electrical activity responsible for the arrhythmia. The effectiveness of this technique is around 70% and in about 25% a second procedure is needed to finish the ablation lines. As any invasive procedure some major complications may occur like cardiac tamponade (1%), thromboembolic events (0.5%) or atrio-esophageal fistula (1/1000). In case of success the patient does not requires continuation with AAD and the arrhythmia is cured.

The decision of which treatment to be used will have to be based on a number of considerations: type of patient, willingness of the patient, experience of the centre in ablative techniques, etc.

It is estimated than more than 10.000 atrial fibrillation ablation procedures are performed annually in Europe and the number is increasing exponentially since over the last years availability of more sophisticated techniques and equipment has produced a marked increase in the number of centres performing atrial fibrillation ablation. Three dimensional mapping systems, robotic techniques, new energy sources and new and more reliable catheters are easing the procedure and improving efficacy and safety.

Scientists begin to untangle root cause of Alzheimer's disease

New research in the FASEB Journal suggests that a fragment of a protein that increases production of a causative agent of Alzheimer's points to new drug targets

05 sept 2009--"N60" might not be the first thing that comes to mind when people think of Alzheimer's disease, but thanks to researchers from the United States, South Korea and France, this might change. That's because these researchers have found that the N60 section of a protein called "RanBP9" might be the key that unlocks an entirely new class of Alzheimer's drugs, and with them, hope. In a research report published online in The FASEB Journal (http://www.fasebj.org), these scientists describe how the N60 fragment of the RanBP9 protein increases the production of the amyloid beta protein, which is present in excessive amounts in the brains of people with Alzheimer's disease.

Most experts believe that if the creation of amyloid beta protein can be halted or slowed, the devastating effects of Alzheimer's disease may also be stopped or slowed too. Knowing which portion of the RanBP9 protein to target is particularly important because it gives researchers a more specific focus for developing new Alzheimer's drugs.

According to David Kang, assistant professor of neurosciences at the University of California, San Diego, and one of the researchers involved in the work, "Our study suggests that targeting RanBP9 expression and/or N60 fragment generation may lead to novel strategies to combat this devastating disease."

To make this discovery, Kang and colleagues examined extracts from brains with Alzheimer's disease and age-matched healthy controls and found that the N60 section of RanBP9 was increased in Alzheimer's brain. When control DNA, full-length RanBP9 DNA, and RanBP9-N60 DNA were individually expressed in cultured cells, they found that cells expressing the full length RanBP9 protein had an increased amount of the amyloid beta protein that was 3-fold over control, and cells expressing the RanBP9 protein and N60 section had an increased amount of the amyloid beta protein that was 5-fold over control.

"Alzheimer's might seem hopeless to some, but this research shows that we're closer than ever to unraveling both the protein tangles and mysteries surrounding this devastating disease," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal.

According to the U.S. Centers for Disease Control and Prevention, Alzheimer's disease is the most common form of dementia among older adults, affecting as many as 5 million Americans. Alzheimer's disease involves parts of the brain that control thought, memory, and language and can seriously affect a person's ability to carry out daily activities. The disease usually begins after age 60, and risk goes up with age. About 5 percent of men and women ages 65 to 74 have Alzheimer's disease, and nearly half of those aged 85 and older may have the disease.

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Receive monthly highlights from The FASEB Journal by e-mail. Sign up at http://www.faseb.org/fasebjournalreaders.htm. The FASEB Journal (http://www.fasebj.org) is published by the Federation of the American Societies for Experimental Biology (FASEB). The journal has been recognized by the Special Libraries Association as one of the top 100 most influential biomedical journals of the past century and is the most cited biology journal worldwide according to the Institute for Scientific Information. FASEB comprises 22 nonprofit societies with more than 80,000 members, making it the largest coalition of biomedical research associations in the United States. FASEB advances biological science through collaborative advocacy for research policies that promote scientific progress and education and lead to improvements in human health.

Waist-hip Ratio Better Than BMI For Gauging Obesity In Elderly

Body mass index (BMI) readings may not be the best gauge of obesity in older adults, according to new research from UCLA endocrinologists and geriatricians. Instead, they say, the ratio of waist size to hip size may be a better indicator when it comes to those over 70.

04 sept 2009--In a new study published online in the peer-reviewed journal Annals of Epidemiology, researchers from the David Geffen School of Medicine at UCLA found that the waist-to-hip circumference ratio was a better yardstick for assessing obesity in high-functioning adults between the ages of 70 and 80, presumably because the physical changes that are part of the aging process alter the body proportions on which BMI is based.

"Basically, it isn't BMI that matters in older adults it's waist size," said Dr. Preethi Srikanthan, UCLA assistant professor of endocrinology and the study's lead investigator. "Other studies have suggested that both waist size and BMI matter in young and middle-aged adults and that BMI may not be useful in older adults; this is one of the first studies to show that relative waist size does matter in older adults, even if BMI does not matter."

Using data from the MacArthur Successful Aging Study a longitudinal study of high-functioning men and women between the ages of 70 and 79 researchers examined all-cause mortality risk over 12 years by BMI, waist circumference and waist-hip ratio. They adjusted for gender, race, baseline age and smoking status. The average age of participants was 74.

Obesity is often associated with premature mortality because it leads to an increased risk of diabetes, heart attack, stroke and other major health problems, the study authors say.

The researchers found no association between all-cause mortality and BMI or waist circumference; the link was only with waist-hip ratio. In women, each 0.1 increase in the waist-hip ratio was associated with a 28 percent relative increase in mortality rate (the number of deaths per 100 older adults per year) in the group sampled. Thus, if the waist-hip ratio rose from 0.8 to 0.9 or from 0.9 to 1.0, it would mean a 28 percent relative increase in the death rate. Put another way, if hip size is 40 inches, an increase in waist size from 32 to 36 inches signaled a 28 percent relative death-rate increase.

The relationship was not graded in men. Instead there was a threshold effect: The rate of dying was 75 percent higher in men with a waist-hip ratio greater than 1.0 that is, men whose waists were larger than their hips relative to those with a ratio of 1.0 or lower. There was no such relationship with either waist size or BMI.

The study may have some limitations, the authors noted. For instance, participants' BMI may be underestimated because height and weight were self-reported and older adults tend to report those numbers from their younger, peak years. Also, waist-hip ratios, waist circumference and BMI numbers were based on single measurements, limiting the researchers' ability to gauge how changing body size in old age can affect mortality risk.

Teresa Seeman and Arun S. Karlamangla, both also of UCLA, were co-authors on the study.

The National Institute on Aging funded this research.

The UCLA Division of Geriatrics, within the department of medicine at the David Geffen School of Medicine at UCLA offers comprehensive outpatient and inpatient services at several convenient locations and works closely with other UCLA programs to improve and maintain the quality of life of seniors. UCLA geriatricians are specialists in managing the overall health of people age 65 and older and treating medical disorders that frequently affect the elderly, including falls and immobility, urinary incontinence, memory loss and dementia, arthritis, high blood pressure, heart disease, osteoporosis, and diabetes. UCLA geriatricians can knowledgably consider and address a broad spectrum of health-related factors including medical, psychological and social when treating patients.

Source: University of California, Los Angeles

Primary Angioplasty May Be More Effective Than Thrombolysis In Very Elderly Patients With AMI: Results From The TRIANA Trial

Primary angioplasty is superior to thrombolysis in the treatment of very old patients with acute myocardial infarction (AMI), according to results from the TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos*) study, a randomised trial sponsored by the Spanish Society of Cardiology.

04 sept 2009--The trial was designed to compare the two principal available treatments to open blocked coronary arteries in AMI patients: immediate primary PCI with angioplasty, and thrombolysis with clot-dissolving drugs. The trial was performed in 226 patients all aged 75 years or older and all with AMIs of less than six hours' evolution. They were recruited in 23 Spanish hospitals between 2005 and 2007.

The study, which was closed prematurely because of slow patient recruitment, found no differences between the two groups in its primary endpoint - the incidence of death, reinfarction or disabling stroke at 30 days (25.4% in the thrombolysis group and 18.9% in the primary angioplasty group, p=0.21). Despite the higher-than-anticipated rate of events in both arms, the study became underpowered to detect such differences because of its reduced recruitment. However, in a pre-specified secondary endpoint there was a significantly lower need of new catheterisation for recurrent cardiac ischemia in the primary angioplasty arm (0.8% versus 9.7%, p<0.001).

Reviewing the findings principal investigator Professor Héctor Bueno from the Hospital General Universitario "Gregorio Marañón" in Madrid reported that:

• the effect of primary angioplasty on reducing recurrent ischemia was so strong that it could still be easily detected in the study, despite its limited statistical power
  
  
• contrary to what might have been anticipated, there was no clear evidence that thrombolysis, which is considered controversial in older patients because of their increased bleeding risk, was unsafe in a population whose median age was 81 years; the study found no intracranial bleeding directly related to the use of thrombolysis, and no significant differences between groups in major bleeding (4.5% versus 3.8%; p=0.78), or need for transfusions (3% vs 5.3%, p=0.35)
  
  
• and similarly, there was no increase in renal failure associated with primary angioplasty (6.1% versus 7.5% with thrombolysis), a feared complication of catheterisation in older patients

Professor Bueno added: "All efficacy outcomes showed concordant trends in favour of primary angioplasty, suggesting that the potential advantage of an invasive strategy over thrombolysis in very old patients is because of its greater efficacy rather than its superior safety. However, patients in both groups tended to have a comparable prognosis one year later."

* Treatment of acute myocardial infarction in the elderly.

** The TRIANA study was funded by the Fondo de Investigaciones Sanitarias (Instituto Carlos III, Ministry of Health, Spain), and unrestricted grants from Sanofi, Medtronic, Boston Scientific, Guidant, and Johnson & Johnson.

By Professor Hector Bueno

Source:
Jacquelline Partarrieu
European Society of Cardiology

How much omega-3 fatty acid do we need to prevent cardiovascular disease?

New research in the FASEB Journal identifies the 'Goldilocks dose' of DHA that is 'just right' for preventing oxidative stress in men

03 sept 2009--A team of French scientists have found the dose of DHA (docosahexaenoic acid) that is "just right" for preventing cardiovascular disease in healthy men. In a research report appearing in the September 2009 print issue of The FASEB Journal (http://www.fasebj.org), the scientists show that a 200 mg dose of DHA per day is enough to affect biochemical markers that reliably predict cardiovascular problems, such as those related to aging, atherosclerosis, and diabetes. This study is the first to identify how much DHA is necessary to promote optimal heart health.

"This study shows that regularly consuming small amounts of DHA is likely to improve the health status of people, especially in regards to cardiovascular function," said Michel Lagarde, co-author of the study.

To determine the optimal dose of DHA, Lagarde and colleagues examined the effects of increasing doses of DHA on 12 healthy male volunteers between ages of 53 and 65. These men consumed doses of DHA at 200, 400, 800, and 1600 mg per day for two weeks for each dose amount, with DHA being the only omega-3 fatty acid in their diet. Blood and urine samples were collected before and after each dose and at eight weeks after DHA supplementation stopped. The researchers then examined these samples for biochemical markers indicating the effects of each dose on the volunteers.

"Now that we have a very good idea about how much DHA is just right, the next step is to try it out in an expanded clinical trial that involves many more people," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "Until then, I'll stick with tasty foods that contain DHA, like fish, rather than getting a quick fatty-acid fix at the local vitamin store."

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Receive monthly highlights from The FASEB Journal by e-mail. Sign up at http://www.faseb.org/fasebjournalreaders.htm. The FASEB Journal (http://www.fasebj.org) is published by the Federation of the American Societies for Experimental Biology (FASEB). The journal has been recognized by the Special Libraries Association as one of the top 100 most influential biomedical journals of the past century and is the most cited biology journal worldwide according to the Institute for Scientific Information. FASEB comprises 22 nonprofit societies with more than 80,000 members, making it the largest coalition of biomedical research associations in the United States. FASEB advances biological science through collaborative advocacy for research policies that promote scientific progress and education and lead to improvements in human health.

Prostate-Specific Antigen Test May Increase Overdiagnosis

Over a million more men have been diagnosed with prostate cancer since test was introduced

03 sept 2009-- Since the prostate-specific antigen (PSA) test was introduced, many men have been overdiagnosed with prostate cancer, according to a study published online Aug. 31 in the Journal of the National Cancer Institute.

H. Gilbert Welch, M.D., of Dartmouth Medical School in Hanover, N.H., and Peter C. Albertsen, M.D., of the University of Connecticut School of Medicine in Farmington, analyzed data on age-specific incidence and initial course of treatment for prostate cancer from 1986, the year before the PSA test was introduced, to 2005.

The researchers estimate that 1,305,600 additional men have been diagnosed with prostate cancer since 1986, of whom 1,004,800 underwent treatment for the disease. For every man who was presumed to benefit from PSA screening, more than 20 had to be diagnosed, the investigators note.

"Estimating the trade-off between a mortality benefit and an overdiagnosis is problematic when there is uncertainty about whether the benefit exists at all," the authors write. "Although no single formula can determine the correct course of action when facing this trade-off, it is important that we begin to explicitly communicate to men who are considering screening the relative magnitude of number of deaths averted to the number overdiagnosed and make clear the harms of overdiagnosis."

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Editorial

ESC: Effects of Combining PPIs and Thienopyridines Examined

Coadministration of PPI with clopidogrel or prasugrel may not increase heart risks

03 sept 2009-- In patients receiving clopidogrel or prasugrel, use of proton-pump inhibitors (PPIs) is not associated with an increased risk of cardiovascular events, according to a study published online Sept. 1 in The Lancet and presented at the European Society of Cardiology Congress 2009, held from Aug. 29 to Sept. 2 in Barcelona, Spain.

Michelle L. O'Donoghue, M.D., of Brigham and Women's Hospital in Boston, and colleagues analyzed two trials: the PRINCIPLE-TIMI 44 trial, in which 201 patients undergoing elective percutaneous coronary intervention were randomly assigned to prasugrel or high-dose clopidogrel; and the TRITON-TIMI 38 trial, in which 13,608 patients with an acute coronary syndrome were randomly assigned to prasugrel or clopidogrel.

In the first trial, the researchers found that PPI use was associated with significantly lower inhibition of platelet aggregation after clopidogrel loading, but a more modest inhibition of platelet aggregation after prasugrel loading. In the second trial, they observed no association between PPI use and the primary end point -- a composite of cardiovascular death, myocardial infarction, or stroke -- for patients treated with clopidogrel or prasugrel (adjusted hazard ratios, 0.94 and 1.00, respectively).

"Although only a randomized trial of PPI use can definitively establish the clinical implications of combining a PPI with a thienopyridine, our findings do not support the need to avoid concomitant use of PPIs for gastric protection in patients receiving thienopyridine therapy who are at increased risk for gastrointestinal bleeding," the authors conclude.

Daiichi Sankyo and Eli Lilly sponsored the two trials; several co-authors reported financial relationships with the companies.

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Eating less red meat can prevent cancer, heart attacks and global warming

02 sept 2009--Barcelona, Spain : Raising livestock also accounts for around 18% of greenhouse gases. It is therefore possible to act against climate change and reduce cardiovascular and cancer deaths, by cutting the production and consumption of 'red meat' from these animals. The World Cancer Research Fund and the American Institute for Cancer Research have recommended that an individual should eat no more than 500 grams of red meat per week.

Cardiovascular disease and cancer are two human diseases caused by similar factors influencing climate change. Others are the infectious disease influenza and salmonella, which are also related to animal elevation (zoonoses). Further examples not specifically related to agriculture, are respiratory diseases resulting from the burning of fossil and other fuels for transport and heating.

A different group of diseases cannot be said to share the causes of global warming. Instead they are caused by, or exacerbated by global warming. Examples are thermal stress, accidental and intentional injuries, and malnutrition or famine, all of which are expected to occur more frequently as the planet warms up and the climate becomes less stable. Health care systems all over the world will have to adapt to these changes.

Human disease and global warming are therefore related in several ways, and the World Health Organization (WHO) as well as national medical associations, have adopted policies to take these interrelationships into account. In contrast, professional societies within cardiovascular medicine and research have not yet addressed the relationships of climate change to cardiovascular disease, but they should consider doing so for at least two reasons.

The first is the relationship already described: risk of cardiovascular disease can be reduced by interventions which also reduce the risk of climate change. For example recommendations could be given regarding the consumption of red meat such as those already made by oncology institutions.

The second is advocacy. Physicians and biomedical researchers have the training to understand the physics, chemistry and statistics used in the climatological research that has demonstrated the gravity of the climate problem. Sea levels were for example, at least 15 to 25 meters higher than they are now when the earth's atmosphere last had the same CO2 capacity as now (about 387 parts per million) which was three million years ago. Atmospheric CO2 concentrations are currently rising at 2 ppm / year.

It is difficult for politicians in democratic countries to make the necessary changes in national and international policies for energy, transport, agriculture, urban planning, family planning, etc, without general public understanding of the issues. Physicians and scientists devoted to understanding, preventing and treating cardiovascular disease also have the ability to understand the climate issue. Most importantly, they have the authority to promote this understanding through private and public debate. Not least because they can make statements, backed up by science, demonstrating that reducing the risk of heart attack can also impact upon climate change.

Mediterranean Diet May Be Best for Type 2 Diabetes

02 sept 2009-- The Mediterranean diet, long touted as a healthy eating plan, may help people with type 2 diabetes stay off blood sugar-lowering medications, as well as help them lose weight and lower cardiovascular risk factors.

Those are the major findings from Italian researchers who found that while 70 percent of people with type 2 diabetes following a low-fat diet eventually needed diabetes medications, just 44 percent of those following the Mediterranean diet needed such drugs.

"Eating Mediterranean prevented anti-hyperglycemic drug therapy in about one-third of patients," said study author Dr. Dario Giugliano, a professor of endocrinology and metabolic diseases at the Second University of Naples in Italy. He called the diet, "a safe and tasty means to delay the introduction of anti-diabetic drug therapy in newly diagnosed type 2 diabetic people."

Beyond its ability to help control blood sugar, "the Mediterranean diet has been associated with a number of healthful outcomes, including reduced risk of cardiovascular disease, cancer and mortality," Giugliano added. "Given that patients with type 2 diabetes still have a twofold risk of death as compared to the non-diabetic population, these potential benefits are intriguing," he noted.

Results of the study are published in the September issue of the Annals of Internal Medicine.

Type 2 diabetes is fast becoming a pandemic, with as many as 380 million cases estimated by 2025, according to background information in the study. However, lifestyle changes can help prevent the disease and possibly reverse its course when instigated soon after diagnosis. Regular exercise and changes in diet are among the most important lifestyle changes that can help manage type 2 diabetes.

Although dietary modification is recommended, little research has compared low-fat diets to low-carbohydrate diets in the management of type 2 diabetes, according to the study.

To assess which type of diet might help people with type 2 diabetes better manage their condition, Giugliano and his colleagues compared 107 people on a low-fat diet to 108 who were eating a Mediterranean diet.

"The Mediterranean-type diet is a diet high in plant foods, such as fruits, nuts, legumes and cereals, and fish, with olive oils as the primary source of monounsaturated fat and low to moderate intake of wine, as well as low intake of red meat and poultry," he said.

All of the study participants had just recently been diagnosed with type 2 diabetes, and they stayed in the study for four years. This study wasn't "blinded," which means that the researchers who were responsible for prescribing medications also knew who was in which dietary group.

After four years, 26 percent fewer people needed to go on diabetes medication in the Mediterranean diet, compared to the low-fat group. That translates into a 37 percent decreased risk of needing medication for the Mediterranean diet group, according to the study.

At the end of the study, weight as measured by body-mass index (BMI) was down 1.2 points for those in the Mediterranean diet group compared to 0.9 for the low-fat diet group, the study found. Cholesterol levels and blood pressure readings were also more improved in the Mediterranean diet group vs. the low-fat group.

"Everyone is looking for a magic bullet, but really the only magic bullet for diabetes is carbohydrate counting," said registered dietician and certified diabetes educator Carolyn Grubb, from the Scott & White Specialty Clinic, in Round Rock, Texas. "You need to find something you can live with and stay with. There's no one-size-fits-all in diabetes. Most patients do best with as little change as possible."

So, if you like these foods and think a Mediterranean diet might work for you, that's great, she said. But, if this would represent a huge change for you, it might not work as well. Grubb recommended that all people with diabetes work with a dietician to come up with an individualized eating plan that takes into account likes and dislikes.

Giugliano said he would recommend the Mediterranean diet for people with type 2 diabetes because in addition to being lower in carbohydrates, the diet seems to have an effect on insulin sensitivity beyond its carbohydrate composition.

Prostate cancer screening: More harm than good?

CHICAGO02 sept 2009– Routine screening for prostate cancer has resulted in more than 1 million U.S. men being diagnosed with tumors who might otherwise have suffered no ill effects from them, U.S. researchers said on Monday.

They said prostate cancer screening is a double-edged sword, catching serious cancers in a few but causing needless worry and expense for the majority of men, who may be getting treatment for tumors growing too slowly to do any harm.

The team looked to see how many additional men have been diagnosed with prostate cancer since the introduction in 1986 of a widely used blood test for prostate cancer that looked for a prostate-cancer specific antigen, or PSA.

"Our estimate is that number is about 1.3 million people in the United States. That is a huge effect," said Dr. H. Gilbert Welch of the VA Outcomes Group in White River Junction, Vermont, whose study appears in the Journal of the National Cancer Institute.

More than 1 million of those were treated, they found.

"These are men who could not be helped by treatment because their cancer was not destined to cause them symptoms or death," Welch said in a telephone interview.

The increased diagnosis rate more than tripled in men aged 50 to 59 and increased more than a sevenfold in men under age 50.

And while prostate cancer deaths have declined since the introduction of PSA testing, Welch said about 20 men had to be diagnosed and treated for every one who benefited.

Prostate cancer is the second most common cancer in men worldwide after lung cancer, killing 254,000 men a year globally. Doctors have routinely recommended PSA screening in men over 50 based on the assumption that early diagnosis and treatment is better than standing by and doing nothing.

All current forms of treatment -- surgery, radiation or hormone therapy -- can cause harm, resulting in impotence and incontinence in about a third of patients, Welch said.

Just being told you have cancer can do harm, causing anxiety and feelings of vulnerability. And having a cancer diagnosis can mean some people cannot get health insurance, Welch said.

A U.S. expert panel last year urged doctors to stop screening men over 75, but doctors still disagree about the right approach to PSA screening. Two large studies -- one in Europe and one in the United States -- that aimed to settle the matter produced conflicting results.

Instead of discarding the PSA test, one solution may to simply watch and wait for signs the tumor is growing. A study of more than 51,000 men published on Monday in the Journal of Clinical Oncology found men diagnosed with low-risk tumors who waited were still doing fine an average of eight years after diagnosis -- and some as many as 20 years later.

If that were the standard approach for low-risk cancers, ".... it might help us avoid throwing the baby out with the bath water when it comes to the PSA test," Dr. Martin Sanda of Harvard Medical School, who worked on the study, said in a statement.

Welch said the right answer is not clear, but added that men should be fully informed about the risks of PSA testing.

"People have to weigh the small chance of a big benefit against the rather larger chance of a harm -- and that harm being told you have cancer unnecessarily and treating it unnecessarily," he said.

Carbon monoxide linked to heart problems in elderly

New Haven, Conn., 01 sept 2009—Exposure to carbon monoxide, even at levels well below national limits, is associated with an increased risk of hospitalization for the elderly with heart problems, according to a study published today in Circulation: Journal of the American Heart Association.

The nationwide study of 126 urban communities, funded by the Environmental Protection Agency (EPA) and the National Institute of Environmental Health Sciences, found that an increase in carbon monoxide of 1 part per million in the maximum daily one-hour exposure is associated with a 0.96 percent increase in the risk of hospitalization from cardiovascular disease among people over the age of 65.

This link holds true even when carbon monoxide levels are less than 1 part per million, which is well below the EPA's National Ambient Air Quality Standard of 35 parts per million. This finding suggests an under-recognized health risk to seniors. Currently, the EPA is evaluating the scientific evidence on the link between carbon monoxide and health to determine whether the health-based standard should be modified.

"This evidence indicates that exposure to current carbon monoxide levels may still pose a public health threat," said Michelle Bell, the study's lead investigator and associate professor of environmental health at the Yale School of Forestry & Environmental Studies. "Higher levels of carbon monoxide were associated with higher risk of hospitalizations for cardiovascular heart disease."

Bell and researchers from the Johns Hopkins Bloomberg School of Public Health and the University of Southern California's Keck School of Medicine based their findings on an analysis of hospital records for 9.3 million Medicare recipients and data on air pollution levels and weather gathered between 1999 and 2005. Their analysis took into account the health effects of other traffic-related pollutants, including nitrogen dioxide, fine particles and elemental carbon.

"We found a positive and statistically significant association between same-day carbon monoxide levels and an increased risk of hospitalization for cardiovascular disease in general, as well as for multiple, specific cardiovascular disease outcomes, including ischemic heart disease, heart rhythm disturbances, heart failure and cerebrovascular disease," Bell said.

Carbon monoxide is a tasteless, odorless gas that is a component of automobile exhaust. The researchers acknowledged that additional research is needed to investigate whether carbon monoxide or a combination of it and other traffic-related pollutants are the cause of the increased risk of cardiovascular hospitalizations in seniors.

Results from the TRIANA trial

Primary angioplasty may be more effective than thrombolysis in very elderly patients with AMI: results from the TRIANA trial

Barcelona, Spain, 01 sept 2009: Primary angioplasty is superior to thrombolysis in the treatment of very old patients with acute myocardial infarction (AMI), according to results from the TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos*) study, a randomised trial sponsored by the Spanish Society of Cardiology.**

The trial was designed to compare the two principal available treatments to open blocked coronary arteries in AMI patients: immediate primary PCI with angioplasty, and thrombolysis with clot-dissolving drugs. The trial was performed in 226 patients all aged 75 years or older and all with AMIs of less than six hours' evolution. They were recruited in 23 Spanish hospitals between 2005 and 2007.

The study, which was closed prematurely because of slow patient recruitment, found no differences between the two groups in its primary endpoint ― the incidence of death, reinfarction or disabling stroke at 30 days (25.4% in the thrombolysis group and 18.9% in the primary angioplasty group, p=0.21). Despite the higher-than-anticipated rate of events in both arms, the study became underpowered to detect such differences because of its reduced recruitment. However, in a pre-specified secondary endpoint there was a significantly lower need of new catheterisation for recurrent cardiac ischemia in the primary angioplasty arm (0.8% versus 9.7%, p<0.001).

Reviewing the findings principal investigator Professor Héctor Bueno from the Hospital General Universitario "Gregorio Marañón" in Madrid reported that:

• the effect of primary angioplasty on reducing recurrent ischemia was so strong that it could still be easily detected in the study, despite its limited statistical power
• contrary to what might have been anticipated, there was no clear evidence that thrombolysis, which is considered controversial in older patients because of their increased bleeding risk, was unsafe in a population whose median age was 81 years; the study found no intracranial bleeding directly related to the use of thrombolysis, and no significant differences between groups in major bleeding (4.5% versus 3.8%; p=0.78), or need for transfusions (3% vs 5.3%, p=0.35)
• and similarly, there was no increase in renal failure associated with primary angioplasty (6.1% versus 7.5% with thrombolysis), a feared complication of catheterisation in older patients

Professor Bueno added: "All efficacy outcomes showed concordant trends in favour of primary angioplasty, suggesting that the potential advantage of an invasive strategy over thrombolysis in very old patients is because of its greater efficacy rather than its superior safety. However, patients in both groups tended to have a comparable prognosis one year later."

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* Treatment of acute myocardial infarction in the elderly.

** The TRIANA study was funded by the Fondo de Investigaciones Sanitarias (Instituto Carlos III, Ministry of Health, Spain), and unrestricted grants from Sanofi, Medtronic, Boston Scientific, Guidant, and Johnson & Johnson.

New European guidelines on syncope revise diagnostic definitions and re-evaluate extent of risk

Barcelona, Spain, 01 sept 2009: A new definition of syncope – most commonly perceived as an episode of fainting – makes its diagnosis more precise and now dependent on a specific cause. New 2009 ESC Guidelines for the Diagnosis and Management of Syncope define syncope as "a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery".(1)

The definition, says Professor Angel Moya from the University Hospital Vall d'Hebrón in Barcelona and Chair of the Guideline Task Force, now includes an aetiological requirement of reduced cerebral blood flow, which is new to the 2009 Guidelines. Indeed, he explains, a sudden cessation of cerebral blood flow for as short as six to eight seconds is sufficient to cause complete loss of consciousness. "Without this diagnostic addition," he says, "the definition of syncope becomes wide enough to include other disorders such as epileptic seizures and concussion - in fact, would be nothing more than 'loss of consciousness', irrespective of mechanism and duration."

The Guidelines note that syncope is also associated with a decrease in systolic blood pressure to 60 mmHg or lower, which in turn is determined by cardiac output and total vascular resistance; a fall in either can cause syncope, but a combination of both mechanisms is often present.

The new definition helps provide – for the first time – a clearer picture of who and how many are affected by this common condition, and what its longer-term health implications are. The Guidelines identify three common types of syncope, all with the same presentation (sudden loss of consciousness) but with different causes and different risk profiles.

• Reflex syncope occurs when cardiovascular reflexes normally used to control circulation become suddenly altered, resulting in a fall in blood pressure and cerebral blood flow. This type includes the common faint ("vasovagal syncope", VVS), which is usually preceded by emotional stress and its attendant symptoms (sweating, nausea). The classical form of VVS nearly always begins in young people as an isolated, benign episode, which makes it distinct from other forms of syncope; for example, episodes starting in older age are often associated with cardiovascular or neurological disorders (such as orthostatic hypotension as described below)
• Orthostatic hypotension, sometimes known as "postural hypotension", unlike reflex syncope is usually a recurring event: blood pressure always falls on standing up, and syncope occurs. The cause, say the Guidelines, is a "circulatory abnormality" of which syncope is just one of several other symptoms (dizziness, fatigue, palpitations, visual disturbance and even back pain). Classically, systolic BP falls by at least 20 mmHg within three minutes of standing, and diastolic BP by at least 10 mmHg.
• Cardiac syncope is most commonly caused by arrhythmias, which reduce cardiac output and cerebral blood flow. In such cases, the Guidelines stress that, "when an arrhythmia is the primary cause of syncope, it should be specifically treated".

Applying these definitions to everyday prevalence, Professor Richard Sutton of St Mary's Hospital, Imperial College, London, and Co-chair of the Guidelines Task Force, describes reflex syncope as "common" in the general population, with around 50% of us experiencing a VVS over a lifetime.(2) Prognosis is nearly always good.

Despite this broad prevalence, he says, many subjects with loss of consciousness are wrongly diagnosed and wrongly treated, with the potential for missing more serious conditions. However, with the right diagnosis, he adds, treatments for reflex syncope have improved in recent years: "We can provide the means to combat the symptoms of syncope. There is now evidence that physical treatments as well as 'tilt training' [extended periods of upright posture] are emerging as the new front-line treatment of reflex syncope. Two recent clinical trials have shown that isometric leg-crossing, hand grip and arm tensing exercises can induce a significant increase in blood pressure during the phase of impending syncope, which avoids or delays the loss of consciousness in most cases."

The Guidelines also put new emphasis on the increasing role of a diagnostic strategy based on prolonged monitoring, and not just on conventional laboratory testing. Implantable loop recorders, for example, which have a battery life of up to 36 months and a memory which stores ECG recordings, have already been shown to be cost-effective in the diagnosis of unexplained syncope, with a high correlation between symptoms and stored ECG data.

Both Professors Moya and Sutton thus believe there are three strong reasons for the new Guidelines: to prevent misdiagnosis (and inappropriate treatment, which is often expensive); to improve quality of life; and to recognise and reduce longer-term risk (especially in cardiac syncope). Because of the multifactorial nature of syncope as identified in the new diagnostic definitions, the Guidelines underline the important role of a dedicated multi-skilled "syncope unit", which would provide guideline-based assessment, risk stratification and treatment.

Driving

Among the quality of life questions addressed specifically by the Guidelines is whether those with syncope should drive. The new data "suggest that the risk of vehicle accident in patients with a history of syncope is not different from the general population of drivers without syncope". The Guidelines recommend for non-professional drivers:

• no restrictions following single or mild reflex syncope events
• no restrictions after recurrent and severe reflex syncope events once symptoms are controlled
• but restrictions in cardiac syncope until successful treatment has been established (with modifications for those with an implanted pacemaker or cardioverter-defibrillator)

For public safety, say the Guidelines, "the risk of syncope-mediated driving accidents (0.8% per year) appeared to be substantially less than in young (16󈞄 years) and in elderly drivers (high risk accident groups)".

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Notes for editors

1. The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology. Guidelines for the Diagnosis and Management of Syncope. Eur Heart J 2009; doi 10.1093/eurheartj/ehp298. The Guidelines will be presented simultaneously at the ESC Congress 2009 in Barcelona, 29 August – 2 September.

2. Most first faints occur between the ages of 10 and 30 years (around the age of 15 in 47% of females and 31% males), though 1% of toddlers in one study had VVS.