Cell-Phone Use -- But Not Music -- Reduces Pedestrian Safety

05 dec 2009--Two new studies of pedestrian safety found that using a cell phone while hoofing it can endanger one's health. Older pedestrians, in particular, are impaired when crossing a busy (simulated) street while speaking on a mobile phone, the researchers found.

The studies, in which participants crossed a virtual street while talking on the phone or listening to music, found that the music-listeners were able to navigate traffic as well as the average unencumbered pedestrian. Users of hands-free cell phones, however, took longer to cross the same street under the same conditions and were more likely to get run over.

Older cell-phone users, especially those unsteady on their feet to begin with, were even more likely to become traffic casualties.

"Many people assume that walking is so automatic that really nothing will get in the way," said University of Illinois psychology professor Art Kramer, who led the research with psychology professor Jason McCarley and postdoctoral researcher Mark Neider. "And walking is pretty automatic, but actually walking in environments that have lots of obstacles is perhaps not as automatic as one might think."

The first study, in the journal Accident Analysis and Prevention, found that college-age adults who were talking on a cell phone took 25 percent longer to cross the street than their peers who were not on the phone. They were also more likely to fail to cross the street in the 30 seconds allotted for the task, even though their peers were able to do so.

Each participant walked on a manual treadmill in a virtual environment, meaning that each encountered the exact same conditions - the same number and speed of cars, for example - as their peers.

The second (and not yet published) study gave adults age 60 and above the same tasks, and included some participants who had a history of falling. The differences between those on and off the phone were even more striking in the older group, Kramer said.

"Older adults on the phone got run over about 15 percent more often" than those not on the phone, he said, and those with a history of falling fared even worse.

"So walking and talking on the phone while old, especially, appears to be dangerous," he said.

Kramer is a researcher at the Beckman Institute for Advanced Science and Technology at Illinois.

Source: Diana Yates
University of Illinois at Urbana-Champaign

Apathy common in dementia patients with brain changes

Dementia patients with a certain type of changes in their brain's white matter are more likely to be apathetic than those who do not have these changes, reveals a patient study carried out by the Sahlgrenska Academy and Sahlgrenska University Hospital.

04 dec 2009--Changes in the brain's white matter are common among the elderly and dementia patients, and often appear as blurred patches on CT and MRI images.

"A likely explanation for the changes is that the small blood vessels that supply the white matter are not working as they should," says Michael Jonsson, PhD-student at the Sahlgrenska Academy and consultant psychiatrist at Sahlgrenska University Hospital's memory clinic. "This results in that the long nerve fibres and their fatty sheaths degenerate."

Apathy is one of the most common psychological problems associated with dementia. Just over half of all dementia patents are emotionally blunted and lack motivation and initiative. This new study shows that this apathy is far more common in patients who have the characteristic changes in the brain. This discovery suggests that there is a common biological reason behind this apathy, irrespective of which type of dementia a patient has. The changes are located deep in the brain and primarily affect the neural pathways that run from this part of the brain to the frontal lobes, which are important for taking the initiative and the ability to plan.

"Even though we think we know a bit about which pathways are affected in cases of apathy, we still need to find out more about the anatomy and chemistry behind the development of these symptoms," says Jonsson. "This is vital if we are to develop medication to treat apathy."

The study involved 176 patients with Alzheimer's, vascular dementia or mixed dementia. 82 per cent of the patients with changes in their white matter were apathetic, while 58 per cent of all of the dementia patients were apathetic.

Given that apathy reduces quality of life for patients with dementia and increases the risk of institutionalisation, a great deal of research is under way to find a treatment. Treatments that do not involve medication, such as increased physical exercise, cognitive stimulation and massage, do not seem to work.

"Some studies have shown that the medicines currently used for Alzheimer's can have a positive impact on apathy in other types of dementia too," says Jonsson. "Other medicines may also be of interest, but we need to carry out more research in this area."

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DEMENTIA

The most common symptoms of dementia are forgetfulness, impaired speech and problems with recognition and orientation. It is a condition that can affect all our mental faculties and that is more common as we get older. Around seven per cent of the Swedish population over the age of 65 and just over 20 per cent of the over-80s have severe dementia.

Loneliness can be contagious

People who feel lonely spread that feeling to others

04 dec 2009--Loneliness, like a bad cold, can spread among groups of people, research at the University of Chicago, the University of California-San Diego and Harvard shows.

Using longitudinal data from a large-scale study that has been following health conditions for more than 60 years, a team of scholars found that lonely people tend to share their loneliness with others. Gradually over time, a group of lonely, disconnected people moves to the fringes of social networks.

“We detected an extraordinary pattern of contagion that leads people to be moved to the edge of the social network when they become lonely,” said University of Chicago psychologist John Cacioppo, one member of the study team and one of the nation’s leading scholars of loneliness. “On the periphery people have fewer friends, yet their loneliness leads them to losing the few ties they have left.”

Other members of the study team were James Fowler, Associate Professor of Political Science at the University of California-San Diego, and Nicholas Christakis, Professor of Medicine and Professor of Medical Sociology in the Harvard Medical School.

Before relationships are severed, people on the periphery transmit feelings of loneliness to their remaining friends, who also become lonely. "These reinforcing effects mean that our social fabric can fray at the edges, like a yarn that comes loose at the end of a crocheted sweater," said Cacioppo, the Tiffany & Margaret Blake Distinguished Service Professor in Psychology.

Because loneliness is associated with a variety of mental and physical diseases that can shorten life, Cacioppo said it is important for people to recognize loneliness and help those people connect with their social group before the lonely individuals move to the edges.

The scholars' findings were published in the article, "Alone in the Crowd: The Structure and Spread of Loneliness in a Large Social Network," published in the December issue of the Journal of Personality and Social Psychology.

For the study, the team examined records of the Framingham Heart Study, which has studied people in Framingham, Mass. since 1948. The original group, including more than 5,209 people, was originally studied for the risks of cardiovascular disease.

The study has since been expanded to include about 12,000 people, as the children and the grandchildren of the original group and others have been included to diversify the population sample. The Framingham study now includes more tests, including measures of loneliness and depression. The second generation in the study, which includes 5,124 people, was the focus of the loneliness research.

Because the study is longitudinal, researchers kept in touch with the subjects every two to four years and accordingly collected names of friends who knew the subjects. Those records became an excellent source of information about the people's social networks.

By constructing graphs that charted the subjects' friendship histories and information about their reports of loneliness, researchers were able to establish a pattern of loneliness that spread as people reported fewer close friends. The data showed that lonely people "infected" the people around them with loneliness, and those people moved to the edges of social circles.

The team found that the next-door neighbors in the survey who experienced an increase of one day of loneliness a week prompted an increase in loneliness among their neighbors who were their close friends. The loneliness spread as the neighbors spent less time together.

Previous work suggested that women rely on emotional support more than men do, and in this study women were more likely than men to report “catching” loneliness from others. People's chances of becoming lonely were more likely to be caused by changes in friendship networks than changes in family networks.

Research also shows that as people become lonely, they become less trustful of others, and a cycle develops that makes it harder for them to form friendships. Societies seem to develop a natural tendency to shed these lonely people, something that is mirrored in tests of monkeys, who tend to drive off members of their groups who have been removed from a colony and then reintroduced, Cacioppo said.

That pattern makes it all the more important to recognize loneliness and deal with it before it spreads, he said.

"Society may benefit by aggressively targeting the people in the periphery to help repair their social networks and to create a protective barrier against loneliness that can keep the whole network from unraveling," he said.

The research was supported by a grant from the National Institute on Aging.

"Previous research has shown that loneliness and lack of social connection can have a significant negative effect on the overall health and well-being of older people," said Richard Suzman, Ph.D., director of the NIA's Division of Behavioral and Social Research, which funded the research. "This pioneering research into the connections of individuals within their social networks has important implications for the larger issue of social interactions and health."

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Additional media contacts:

Inga Kiderra, Director of Communications - Social Sciences, Arts and Humanities
UC San Diego University Communications and Public Affairs
858-822-0661, office 619-787-9095, cell, ikiderra@ucsd.edu

Life expectancy in Brazil over 72, survey indicates

BRASILIA, 02 dec 2009-- The life expectancy of the Brazilian population increased from 69.66 years in 1998 to 72.86 years in 2008, according to the Brazilian Institute of Geography and Statistics (IBGE) and Tuesday's Brazilian Official Gazette.

Men's life expectancy was 69.11 years and women's was 76. 71 years last year. The data indicate a significant progress compared with 45.50 years in 1940.

According to the IBGE, Brazil will need some time to catch up with Japan, Hong Kong (China), Switzerland, Iceland, Australia, France and Italy, where the average life expectancy is already over 81. Research has shown that Brazil would achieve that level by 2040.

The data came from the IBGE's Complete Mortality Tables for Brazil's population, which have been published annually since 1999. They are used by the Ministry of Social Security as one of the parameters for the retirement fund factor under the General System of Social Security.

Vitamin B Niacin Offers No Additional Benefit To Statin Therapy In Seniors Already Diagnosed With Coronary Artery Disease

01 dec 2009--The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.

In tests on 145 Baltimore-area men and women with existing atherosclerosis, all over age 65, researchers found that after 18 months of drug therapy, reductions in arterial wall thickness were measurably no different between the half who took dual niacin-statin therapy and the rest who remained on statin therapy alone.

The results were the same whether they took any one of the three leading statin medications: atorvastatin (Lipitor), simvistatin (Zocor) or rosuvastatin (Crestor). Seniors on dual drug therapy had an average 5.4 cubic millimeter per month scale back in plaque buildup in the main neck artery, while those taking just a cholesterol-lowering statin medication came down by 4 cubic millimeters per month, a difference that researchers say is not statistically significant.

The team will present its findings Nov. 18 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando.

According to senior study investigator and Johns Hopkins cardiologist João Lima, M.D., the lack of any discernible advantage occurred despite promising gains in bad (LDL) and good (HDL) blood cholesterol levels in those taking vitamin B niacin. Results showed that in the group taking both niacin and a statin, blood levels of LDL-cholesterol fell 5 percent more than in the group taking only statin medications. And levels of HDL jumped 14 percent more than in the statin-only group.

"Our findings tell us that improved cholesterol levels from taking combination vitamin B niacin and statin therapy do not necessarily translate into observable benefits in reversing and stalling carotid artery disease," says Lima, a professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. "This does not mean that niacin therapy may not have other cardiovascular benefits, but any such benefits are independent of reducing the amount of plaque buildup and patients should be aware of that."

"Our recommendation to physicians is that current national treatment guidelines, which recommend mainly statin therapy tailored to the severity of atherosclerosis for preventing arteries from reclogging and narrowing, appear to be sufficient and accurate for physicians and patients to follow," says Lima.

However, Lima cautions that an ongoing national study of the long-term vascular benefits of dual therapy and whether extended-release niacin, also known as nicotinic acid, lowers death rates from heart disease should provide more definitive data. Hopkins is participating in that research, as well. He also notes that extended-releases niacin used in this study is a prescription medication, and that it is not sold over the counter like many other vitamin B products.

"The real value in initially studying this particular group of people is that these seniors are the ones who I am most likely to see in the hospital, the group most vulnerable to coronary artery disease and most at risk of suffering an arterial blockage, heart attack, or stroke," says lead study investigator Christopher Sibley, M.D. Nearly 17 million American adults are estimated to have some form of coronary artery disease, resulting in more than 400,000 deaths each year.

"Practically speaking, carotid MRI scans are an option to assess the risk of patients based on the amount of plaque in their arteries, to better determine who needs aggressive statin therapy and to monitor how well they respond to treatment," says Sibley, an adjunct assistant professor at Johns Hopkins, as well as a staff clinician at the National Institutes of Health Clinical Center.

All study participants had one or more preexisting cardiovascular health issues, such as a previous heart attack, stroke, coronary artery bypass grafting to resupply blood to the heart, severe chest pain, or angioplasty with the placement of wire stents to keep arteries open.

At the start of the study, participants received an MRI scan of their carotid artery, and again every six months thereafter. The four sets of carotid images provided what Sibley says is "an important window" into what is going on in the body's network of veins and arteries. He notes that the neck artery is important not just because it serves as the main blood supply to the brain, but also because narrowing in the carotid artery reflects the risk of future heart attack.

Sibley says that the team has begun to analyze blood samples collected as part of the study, searching for chemicals that might also signal a change in arterial plaque buildup and progressive arterial narrowing.

Funding support for the study, conducted solely at Johns Hopkins, was provided by the National Institute on Aging, a member of the National Institutes of Health. The nicotinic acid (Niaspan) used in the study was provided by its manufacturer, Abbott Laboratories, based in Abbott Park, Ill.

Other Hopkins researchers involved in this study were Ilan Gottlieb, M.D.; Christopher Cox, Ph.D.; Gustavo Gudoy, M.D.; Amy Spooner, M.D.; and David Bluemke, M.D., Ph.D., who is now at the National Institutes of Health.

(Presentation title: Comparative effect of statin versus niacin on MRI-measured regression of carotid atherosclerosis in a randomized clinical trial, the National Institute on Aging Plaque Study.)

Source
Johns Hopkins Medicine

Microembolic Events Linked to Sudden Cardiac Death

Plaque erosion is dominant histopathology in clot embolization causing sudden cardiac death

01 dec 2009-- Microemboli and microvascular obstruction are common in acute coronary thrombosis and sudden cardiac death, according to a study in the Dec. 1 issue of the Journal of the American College of Cardiology.

Robert S. Schwartz, M.D., of the Minneapolis Heart Institute and Foundation, and colleagues studied 44 hearts from sudden coronary death patients who died at a mean age of 51 years.

The researchers identified 26 plaque ruptures and 21 erosions, and a mean of 4.5 microemboli per heart. They found that eroded plaques were primarily responsible for microemboli and microvascular obstruction and that the left anterior descending coronary artery was the most common site for microemboli and occluded intramyocardial vessels. They also found that all vessels contained fibrin and platelets.

"Although mechanisms were not evident from this study, the implications are that epicardial atherosclerotic plaque structure and morphology may preferentially predispose to microembolic events," the authors write. "Similarly, iatrogenic plaque disruption occurs with percutaneous coronary intervention of acute coronary syndromes, and microembolic microvascular obstruction is a major clinically recognized cause of angiographic no-reflow."

Abstract
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Microembolic Events Linked to Sudden Cardiac Death


Plaque erosion is dominant histopathology in clot embolization causing sudden cardiac death

01 dec 2009-- Microemboli and microvascular obstruction are common in acute coronary thrombosis and sudden cardiac death, according to a study in the Dec. 1 issue of the Journal of the American College of Cardiology.

Robert S. Schwartz, M.D., of the Minneapolis Heart Institute and Foundation, and colleagues studied 44 hearts from sudden coronary death patients who died at a mean age of 51 years.

The researchers identified 26 plaque ruptures and 21 erosions, and a mean of 4.5 microemboli per heart. They found that eroded plaques were primarily responsible for microemboli and microvascular obstruction and that the left anterior descending coronary artery was the most common site for microemboli and occluded intramyocardial vessels. They also found that all vessels contained fibrin and platelets.

"Although mechanisms were not evident from this study, the implications are that epicardial atherosclerotic plaque structure and morphology may preferentially predispose to microembolic events," the authors write. "Similarly, iatrogenic plaque disruption occurs with percutaneous coronary intervention of acute coronary syndromes, and microembolic microvascular obstruction is a major clinically recognized cause of angiographic no-reflow."

Abstract
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Chronic pain found to increase risk of falls in older adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gingko Biloba May Not Prevent Cardiovascular Disease

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

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

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

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

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

Abstract
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Effect of Dietary Restriction on Lifespan Explained


Factors mediating enhancement of lifespan and reduction of disease pathology identified

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

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

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

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

Full Text

Guidelines for cancer screening differ by group

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

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

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

Breast cancer:

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

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

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

Cervical cancer:

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

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

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

Prostate cancer:

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

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

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

Colon cancer:

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

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

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On the Net:

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

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

Diet, Cognitive Ability May Play Role in Heart Disease

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

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

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

The analysis revealed that:

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

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

More information

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

Alcohol Associated With Lower Heart Disease Risk


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

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

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

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

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

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Slow Eating Raises Response to Appetite Control Hormones

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

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

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

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

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

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New guidelines push back age for Pap smears

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

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

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

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

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

AVOIDING UNNECESSARY PROCEDURES

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

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

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

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

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

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

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

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

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

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

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

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

Surgery not linked to memory problems in older patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AHA: Proton Pump Inhibitors May Up Post-PCI Mortality


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

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

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

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

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

Two co-authors reported financial relationships with pharmaceutical companies.

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AHA: Niacin Can Affect Carotid Intima-Media Thickness


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

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

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

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

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

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

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New Study Identifies Sources For Surgical Complications In Older Patients

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

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

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

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

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

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

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

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

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

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

Source
American College of Surgeons (ACS)

Don't blame fast food: Mummies had heart disease

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

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

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

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

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

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

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

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

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

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

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

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

Recruiting participants now for Phase 2 clinical trial

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

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

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

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

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

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

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

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

New study links vitamin D deficiency to cardiovascular disease and death

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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