Gerontologists say research and data should drive policy, budget decisions

America's top authorities on aging spent the last week at The Gerontological Society of America's Annual Scientific Meeting in San Diego detailing workable solutions to the challenges presented by a rapidly aging population, including the demand for affordable health care, high rates of disease, and retirement security.

20 nov 2012--With the backdrop of the recent presidential and congressional elections, the so-called "fiscal cliff," and its real threats to social service and entitlement programs for older adults, the timing of the GSA conference—which brought more than 3,900 researchers, educators, practitioners, and policy experts together—has rarely been so ideal. Attendees brought forward new data and scholarship on how to understand the aging process, treat those with age-related disease, and most effectively and efficiently serve older Americans.

"As Congress and the president face the challenge of reducing the deficit, those of us who work in the field of aging have real concerns that short term savings will have long term negative effects," said GSA Policy Advisor Brian Lindberg, MMHS, who serves as director of the Consumer Coalition for Quality Health Care in Washington, DC. "For example, reducing our commitment to the National Institutes of Health and the National Institute on Aging and its aging-related research, including Alzheimer's disease, could cost our nation billions in care costs in the future."

Lindberg chaired a symposium, "Critical Aging Policy Discussions for the 113th Congress," which explored the significant issues around health care and retirement security that legislators will confront and how aging organizations such as GSA and AARP are presenting their research to mobilize their members and influence senators and representatives.

He was joined by GSA member Cheryl Matheis, AARP's senior vice president for policy, strategy, and international affairs at AARP.

"AARP has spent the last six months engaging our members and the public in a conversation about the future of Social Security and Medicare, and asking them to tell us and their elected officials what they think needs to be done to assure that these programs are there to meet the needs of today's seniors and future generations," Matheis said. "The data we are collecting will provide useful information to Congress on the views of the American people who rely on these programs."

Another session in San Diego focused on new service delivery modes for treating individuals with multiple chronic illnesses. Brad Stuart, MD, chief medical officer of Sutter Care at Home, provided data on the cost savings and high patient ratings for their approach to advanced care, which focuses on understanding what the patient truly wants, care coordination, and reducing unnecessary treatments.

Stuart said that using Sutter's model for providing advanced care will lead to tremendous savings for Medicare both in California and, eventually, on a national level.

GSA's meeting—the country's largest interdisciplinary conference in the field of aging—took place at the San Diego Convention Center from November 14 to 18. The program schedule contained more than 500 scientific sessions featuring research presented for the first time.

Provided by The Gerontological Society of America

Exercise protects against heart failure even at advanced ages 

Among older adults, physical activity may protect against heart failure, as indicated by lower levels of N-terminal pro-B-type natriuretic peptide and cardiac troponin T, according to a study published online Nov. 14 in the Journal of the American College of Cardiology.

18 nov 2012—Among older adults, physical activity may protect against heart failure, as indicated by lower levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT), according to a study published online Nov. 14 in the Journal of the American College of Cardiology.

Christopher R. deFilippi, M.D., of the University of Maryland School of Medicine in Baltimore, and colleagues measured levels of NT-proBNP and cTnT at baseline and after two to three years in 2,933 community-dwelling adults aged 65 and older who were free of heart failure. The authors sought to assess the association between physical activity and changes in levels of these markers and the subsequent risk of heart failure.

The researchers identified an inverse correlation between biomarker concentration at baseline and follow-up visits and physical activity score. After adjustment for comorbidities and baseline levels, participants with the highest score were 50 percent less likely to have an increase in NT-proBNP and 70 percent less likely to have an increase in cTNT levels compared to those with the lowest physical activity scores. Overall, an increase in either biomarker indicated a higher risk of heart failure, and higher physical activity scores were associated with a lower long-term incidence of heart failure.

"Our findings raise the possibility that the trajectory of biomarker change and the subsequent heart failure risk associated with increasing levels may be modifiable by changes in lifestyle even at an advanced age," the authors write.

Several authors disclosed financial ties to Roche Diagnostics and Abbott.

More information: Abstract
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Pilates is beneficial adjunctive therapy in heart failure

Pilates exercises may be a beneficial adjunctive treatment for patients with heart failure, offering functional capacity improvements, according to a study published in the December issue of Cardiovascular Therapeutics.

16 nov 2012—Pilates exercises may be a beneficial adjunctive treatment for patients with heart failure, offering functional capacity improvements, according to a study published in the December issue of Cardiovascular Therapeutics.

To examine the efficacy of Pilates in patients with heart failure, Guilherme Veiga Guimarães, M.D., of the Universidade de São Paulo in Brazil, and colleagues conducted a study involving 16 patients with New York Heart Association class I or II heart failure who were randomly assigned to 30 minutes of aerobic exercise followed by 20 minutes of either mat Pilates training or a conventional cardiac rehabilitation program for 16 weeks.

At 16 weeks, the researchers found that patients in both groups showed a significant increase in exercise time, with a larger increase for the Pilates group (11.9 ± 2.5 to 17.8 ± 4 minutes and 11.7 ± 3.9 to 14.2 ± 4 minutes, respectively). Only the Pilates training exhibited significant increases from baseline in ventilation, peak oxygen consumption (VO₂), and O₂ pulse. Compared with the conventional group, peak VO₂ was significantly improved in the Pilates group.

"The results of this study demonstrate the feasibility of a combined aerobic training and mat Pilates method by its safe and functional capacity improvements in patients with heart failure," the authors write.

More information: Abstract 
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Cancer: Exercise reduces tiredness

Aerobic exercise can help relieve the fatigue often associated with cancer and cancer treatment, according to Cochrane researchers. Their updated systematic review strengthens findings from an earlier version on cancer-related fatigue published in The Cochrane Library.

15 nov 2012--Fatigue is a common and potentially long-lasting side-effect of cancer and cancer treatment. It may last for months or years. Dealing with cancer-related fatigue is crucial because those who suffer its effects may be less inclined to continue with treatment.

Although in the past, people with cancer-related fatigue have been advised to rest, long periods of inactivity may lead to muscle wasting and increased tiredness, whereas balancing rest with physical activity may help to reduce fatigue. A 2008 Cochrane systematic review on the benefits of exercise found some benefits of physical activity for fatigue in cancer based on limited studies.

The new review adds a further 28 studies to those included in the 2008 review. Altogether, 56 studies involving a total of 4,068 people with cancer were included. Half of the studies were carried out in people with breast cancer. Those with solid tumours benefited from aerobic exercise, such as walking or cycling, both during and after cancer treatment. Other forms of exercise, including resistance training, did not significantly reduce fatigue.

"The evidence suggests that exercise may help reduce cancer-related fatigue and should therefore be considered as one component of a strategy for managing fatigue that may include a range of other interventions and education," said lead researcher Fiona Cramp of the Faculty of Health & Life Sciences at the University of the West of England in Bristol, UK. "This updated review provides a more precise conclusion, showing specifically that aerobic exercise, both during and after cancer treatment, can be beneficial."

It remains to be seen how cancer treatment alters the beneficial effects of exercise on cancer-related fatigue. Further research is also needed to understand how the frequency and duration of exercise, and type of cancer, affect the results.

"Twenty eight of the studies we included were carried out in breast cancer patients, so we need to know more about how exercise can help people with a broad range of diagnoses, including patients with advanced disease," said Cramp.

More information: Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD006145. DOI: 10.1002/14651858.CD006145.pub3

Provided by Wiley

Study demonstrates that earlier end of life care discussions are linked to less aggressive care in final days of life

A large population- and health systems-based prospective study reports earlier discussions about end of life (EOL) care preferences are strongly associated with less aggressive care in the last days of life and increased use of hospice care for patients with advanced cancer. The study, published November 13 in the Journal of Clinical Oncology, provides the first-of-its –kind scientific evidence that timing of EOL care discussions affects decisions about EOL care.

14 nov 2012--The findings suggest that initiating EOL care discussions before the last month of life provides the patients opportunity to make decisions regarding their EOL care preferences in a way that late discussions don't seem to do. Patients need time to process the information with their family and make good plans based on that information.

National guidelines recommend that oncologists initiate discussions about EOL care soon after a diagnosis of advanced cancer in order to ensure care aligns with patient goals and wishes. Current guidelines state that conversations should happen "during periods of relative medical stability rather than acute deterioration, and with physicians that know the patient well." In addition, ASCO's own recommendations for patients with advanced cancer include prioritizing discussions related to advanced cancer care preference upon diagnosis. This year ASCO also offered guidance on when oncologists should prioritize palliative and supportive care for patients with advanced cancer who have certain disease characteristics.

"Research has shown that choosing less aggressive care at the end of life offers important benefits for both patients and their caregivers. Patients have a better quality of life in their final days because there is a greater focus on symptom management, and they are more often able to receive care in their homes," said lead author Jennifer W. Mack, MD, MPH, a pediatric hematologist/oncologist at Dana-Farber/Children' Hospital Cancer Center. "This is also important because studies have shown that aggressive care is associated with a higher risk of depression among bereaved caregivers of cancer patients."

In the study, investigators identified discussions about hospice and resuscitation from with 1,231 patients (or surrogates of patients who were deceased or too ill to participate) with end-stage lung or colorectal cancer and via review of their medical records. They found that, on average, EOL discussions were initiated 33 days before death and 39 percent of those discussions occurred within the last 30 days.

Nearly half of all the study participants received at least one form of aggressive care, including chemotherapy in the last 14 days of life, intensive care unit (ICU) care in the last 30 days of life, and acute, hospital-based care in the last 30 days of life. However, compared with cases where EOL discussions took place within the last 30 days of life, cases with earlier EOL discussions were associated with less frequent use of aggressive care (34-45 percent vs. 65 percent) and increased use of hospice care (68-77 percent vs. 49 percent).

"Most patients who recognize that their cancer is terminal want to receive less aggressive care at the end of life," said Dr. Mack. However, aggressive care is still common in this setting, in part because discussions about the end of life are often postponed because they are difficult for both physicians and patients. This study also found that 17 percent of patients or surrogates did not recall EOL care discussions even though they were documented in the medical records, suggesting they may not have fully comprehended the content of the discussion.

The authors emphasize that more research is needed to explore how content of EOL care discussions affects patients' comprehension of the information and subsequent decisions made. In addition, the study underscores a need for a national emphasis from ASCO and many other professional and patient groups on advanced cancer care planning in physician education and training programs.

More information: www.jco.ascopubs.o… ull.pdf+html

Helpful Links from Cancer.Net, ASCO's cancer information website:

Guides to Cancer: http://www.cancer.net/cancer

Advanced Cancer Care Planning: http://www.cancer.net/coping/advanced-cancer-care-planning

Preparation at the End of Life: http://www.cancer.net/coping/end-life-care/preparation-end-life

Hospice Care: http://www.cancer.net/coping/end-life-care/preparation-end-life

When Caregiving Ends: http://www.cancer.net/publications-and-resources/oncologists-perspective/end-life-issues

Cancer.Net Podcast: The Art of Oncology – End-of-Life Care: http://www.cancer.net/coping/end-life-care/preparation-end-life

End-of-Life Issues: http://www.cancer.net/publications-and-resources/oncologists-perspective/end-life-issues

Provided by American Society of Clinical Oncology

Head injury + pesticide exposure = Triple the risk of Parkinson's disease

A new study shows that people who have had a head injury and have lived or worked near areas where the pesticide paraquat was used may be three times more likely to develop Parkinson's disease. The study is published in the November 13, 2012, print issue ofNeurology, the medical journal of the American Academy of Neurology. Paraquat is a herbicide commonly used on crops to control weeds. It can be deadly to humans and animals.

13 nov 2012--"While each of these two factors is associated with an increased risk of Parkinson's on their own, the combination is associated with greater risk than just adding the two factors together," said study author Beate Ritz, MD, PhD, of UCLA's Fielding School of Public Health. "This study suggests that the physiological process that is triggered by a head injury may increase brain cells' vulnerability to attacks from pesticides that can be toxic to the brain or the other way around, for example, chronic low dose exposure to pesticides may increase the risk of Parkinson's after a head injury."

The study involved 357 people with Parkinson's disease and 754 people without the disease, all of whom lived in an agricultural area in central California. The participants reported any head injuries they had ever received with a loss of consciousness for more than five minutes.

The researchers determined participants' exposure to the weed killer based on a 500-meter area around their home and work addresses, using a geographic information system (GIS) that combined data on paraquat use collected by the state of California's Pesticide Use Reporting system with land use maps.

People with Parkinson's disease were twice as likely to have had a head injury with loss of consciousness for more than five minutes as people who did not have the disease. Of the 357 people with Parkinson's disease, 42, or 12 percent, reported ever having had such a head injury, compared to 50 of the 754 people without the disease, or 7 percent.

People with Parkinson's disease were 36 percent more likely to have exposure to paraquat than those who did not have the disease. Of those with Parkinson's, 169 had exposure to the weed killer, or 47 percent, compared to 291 of those without the disease, or 39 percent.

Provided by American Academy of Neurology

Older adults who are frail much more likely to be food insufficient, according to national study

A national study of older Americans shows those who have limited mobility and low physical activity – scientifically categorized as "frail" – are five times more likely to report that they often don't have enough to eat, defined as "food insufficiency," than older adults who were not frail.

12 nov 2012--The nationally representative study of more than 4,700 adults older than age 60 in the United States uses data from the Third National Health and Nutrition Examination Survey. The results are online today in the British Journal of Nutrition.

Lead author Ellen Smit, an epidemiologist at Oregon State University, said food insufficiency occurs when people report that they sometimes or often do not have enough food to eat. Food-insufficient older adults have been shown to have poor dietary intake, nutritional status and health status.

"Although little is known about food insufficiency as it relates to frailty, conceivably we thought if food insufficiency is associated with poorer nutritional status, it may also be associated with physical functioning and frailty," she said.

Frailty is a state of decreased physical functioning and a significant complication of aging that increases the risk for incident falls, fractures, disability, health care expenditures, and premature mortality. People in this study are diagnosed as frail when they meet two of the following criteria: slow walking, muscular weakness, exhaustion and low physical activity.

Smit said as the population ages, with more than 20 percent of Americans expected to be older than 65 by 2030, the need for identifying clinical and population-based strategies to decrease the prevalence and consequences of frailty are needed. In her study, almost 50 percent of people were either frail, or "pre-frail," meaning that they were at risk for decreased physical functioning.

Frail people were older, less educated, at lower income levels, more likely to be female, more likely to be smokers, and less likely to be white than adults who were not frail. Frail people were also more likely to be either underweight or obese, while at the same time eating fewer calories than people who were not frail.

"We need to target interventions on promoting availability and access to nutritious foods among frail older adults," Smit said. "It is also important to improve nutritional status while not necessarily increasing body weight."

Frail adults may have difficulty leaving the house, for instance, and accessing fresh fruits and vegetables. Smit said communities could work on identifying programs or nonprofit organizations that can deliver nutritious meals or fresh produce to older frail adults.

Provided by Oregon State University

Researchers quantify how many years of life are gained by being physically active

This bar graph displays the years of life gained when participants in a study by the National Cancer Institute met various percentages of physical activity guidelines recommended by the US Department of Health and Human Services. Credit: National Cancer Institute

In a new study from Brigham and Women's Hospital, in collaboration with the National Cancer Institute, researchers have quantified how many years of life are gained by being physically active at different levels, among all individuals as well as among various groups with different body mass index.

11 nov 2012--We all know that exercise is good for you, but how good? While previous studies have shown the link between physical activity and a lower risk of premature mortality, the number of years of life expectancy gained among persons with different activity levels has been unclear—until now. In a new study from Brigham and Women's Hospital (BWH), in collaboration with the National Cancer Institute, researchers have quantified how many years of life are gained by being physically active at different levels, among all individuals as well as among various groups with different body mass index (BMI).

The study will be published on November, 2012 in PLOS Medicine.

Researchers from Brigham and Women’s Hospital have quantified how many years of life are gained, by being physically active at different levels, among all individuals as well as among various groups with different body mass index (BMI). Credit: Courtesy of BWH

"We found that adding low amounts of physical activity to one's daily routine, such as 75 minutes of brisk walking per week, was associated with increased longevity: a gain of 1.8 years of life expectancy after age 40, compared with doing no such activity," explained I-Min Lee, MD, associate epidemiologist in the Department of Preventive Medicine at BWH and senior author on this study. "Physical activity above this minimal level was associated with additional gains in longevity. For example, walking briskly for at least 450 minutes a week was associated with a gain of 4.5 years. Further, physical activity was associated with greater longevity among persons in all BMI groups: those normal weight, overweight, and obese."

In pooled data from six prospective cohort studies, the researchers examined associations of leisure-time physical activity of a moderate to vigorous intensity with mortality. They analyzed data from more than 650,000 subjects and followed subjects for an average of ten years- analyzing over 82,000 deaths. The large sample size allowed them to estimate years of life gained after the age of 40 among persons with different levels of physical activity and BMI.

This bar graph displays years of life loss at various body weights and levels of activity. A study by the National Cancer Institute found that physical activity increased life expectancy, regardless of body weight. Credit: National Cancer Institute

The findings show that physical activity was associated with longer life expectancies across a range of activity levels and BMI groups. Participation in a low level of leisure time physical activity of moderate to vigorous intensity, comparable to up to 75 min of brisk walking per week, was associated with a 19 percent reduced risk of mortality compared to no such activity.

Assuming a causal relationship, which is not specifically demonstrated in this research, this level of activity would confer a 1.8 year gain in life expectancy after age 40, compared with no activity. For those who did the equivalent to 150 min of brisk walking per week—the basic amount of physical activity currently recommended by the federal government—the gain in life expectancy was 3.4 years. These benefits were seen in both men and women, and among white and black participants. Importantly, they were also observed among persons who were normal weight, overweight, and obese. Participants faring best were those who were both normal weight and active: among normal weight persons who were active at the level recommended by the federal government, researchers observed a gain in life expectancy of 7.2 years, compared to those with a BMI of 35 or more who did no leisure time physical activity (a 5 ft 5 in tall person with BMI of 35 weighs 210 lb).

"Our findings reinforce prevailing public health messages promoting both a physically active lifestyle and a normal body weight," explained Dr. Steven C. Moore, PhD, research fellow at the National Cancer Institute (NCI) and lead author of this study. This findings may also help convince currently inactive persons that even being modestly active is ''worth it'' for greater longevity, even if it may not result in weight control.

More information: Moore SC, et al. Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. PLoS Medicine. November 6, 2012. doi: 10.1371/journal.pmed.1001335

Provided by Brigham and Women's Hospital

Physical exercise improves gait speed, muscle strength, fitness in patients with Parkinson's disease

Physical exercise, including treadmill, stretching and resistance exercises, appears to improve gait speed, muscle strength and fitness for patients with Parkinson disease (PD), according to a report of a randomized clinical trial published Online First by Archives of Neurology, a JAMA Network publication.

10 nov 2012--Gait impairment is associated with functional decline in patients with PD and current therapies are inadequate at preserving mobility as PD progresses. There is growing interest in the use of exercise to improve mobility and function, the authors write in the study background.

Lisa M. Shulman, M.D., of the University of Maryland School of Medicine, Baltimore, and colleagues conducted a randomized clinical trial of three types of physical exercise to compare the effectiveness of treadmill, stretching and resistance exercises in improving gait speed, strength and fitness for patients with PD.

The study included 67 patients with PD who had gait impairment and were randomly assigned to one of three groups in the trial: a higher intensity treadmill exercise (30 minutes at 70 percent to 80 percent of heart rate reserve); a lower-intensity treadmill exercise (50 minutes at 40 percent to 50 percent of heart rate reserve); and stretching and resistance exercises (two sets of 10 repetitions on each leg on three resistance machines). Patients performed the exercises three times a week for three months.

"The effects of exercise were seen across all three exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength and fitness for patients with Parkinson disease," the study notes.

According to the study results, all three types of exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12 percent increase), stretching and resistance exercises (9 percent increase) , and higher-intensity treadmill exercises (6 percent increase). Both types of treadmill training improved cardiovascular fitness, whereas stretching and resistance had no effect. Only stretching and resistance improved muscle strength (16 percent increase).

"The fact that the lower-intensity treadmill exercise is the most feasible exercise for most patients with PD has important implications for clinical practice. Although treadmill and resistance training are beneficial for gait, fitness and muscle strength, these benefits were not accompanied by improvements in disability and quality of life," the authors conclude. "Future directions for study include trials of combinations of exercise types, longer training periods and investigation of the potential for exercise to modify the trajectory of disease progression over time."

In an editorial, Liana S. Rosenthal, M.D., and E. Ray Dorsey, M.D., M.B.A., of The Johns Hopkins University School of Medicine, Baltimore, Md., write: "In this issue of the journal, Shulman and colleagues offer compelling evidence that exercise can improve gait and fitness among individuals with PD."

"This research adds to the evidence regarding the value of interventions for PD beyond medications and surgery and offers an opportunity for patients to be active participants in their care," they continue.

"Exercise programs among those with neurological disorders increase the patients' sense of self-efficacy, their sense of involvement in their care and overall belief in their abilities to perform certain activities," they conclude. "In essence, exercise puts the patient – not a pill – at the center of care, which is exactly where patients want and ought to be."

More information: 
Arch Neurol. Published online November 5, 2012. doi:10.1001/jamaneurol.2013.646 
Arch Neurol. Published online November 5, 2012. doi:10.1001/jamaneurol.2013.772

Provided by JAMA and Archives Journals

Controlling vascular disease may be key to reducing prevalence of Alzheimer's disease

Over the last 15 years, researchers have found a significant association between vascular diseases such as hypertension, atherosclerosis, diabetes type 2, hyperlipidemia, and heart disease and an increased risk of Alzheimer's disease. In a special issue of the Journal of Alzheimer's Disease, leading experts provide a comprehensive overview of the pathological, biochemical, and physiological processes that contribute to Alzheimer's disease risk and ways that may delay or reverse these age-related abnormalities.

09 nov 2012--"Vascular risk factors to Alzheimer's disease offer the possibility of markedly reducing incident dementia by early identification and appropriate medical management of these likely precursors of cognitive deterioration and dementia," says Guest Editor Jack C. de la Torre, MD, PhD, of the University of Texas, Austin. "Improved understanding coupled with preventive strategies could be a monumental step forward in reducing worldwide prevalence of Alzheimer's disease, which is doubling every 20 years."

The issue explores how vascular disease can affect cerebral blood flow and impair signaling, contributing to Alzheimer's disease (AD). The diagnostics of cardiovascular risk factors in AD are addressed, as are potential therapeutic approaches.

Paradoxically, the presence of vascular risk factors in middle age is associated with the development of AD more strongly than late-life vascular disease. In fact, some research suggests that vascular symptoms later in life may have a protective effect against the development of the disease. The physiopathological mechanisms that may underlie this phenomenon are discussed.

To date, trials that target major cardiovascular risk factors in the prevention of AD remain inconclusive but have become an important focus of international research as described by contributors of this special volume in their overviews. The multifactorial nature of AD and the need to identify the proper time window for intervention when designing possible interventions, and methodological issues that will have to be addressed to achieve an optimal design of new randomized controlled trials, are discussed. Promising avenues for treatment, such as the potential of low-level light therapy to increase the rate of oxygen consumption in the brain and enhance cortical metabolic capacity, and the possibility that some antihypertensive drug classes reduce the risk and progression of AD more than others, are discussed.

Dr. de la Torre notes that the presence of vascular risk factors is not an absolute pathway to dementia, and it may be as important to study how or why individuals who are cognitively normal but have vascular risk are able to avoid dementia. "Reducing Alzheimer's disease prevalence by focusing right now on vascular risk factors to Alzheimer's disease, even with our limited technology, is not a simple or easy task. But the task must begin somewhere and without delay because time is running out for millions of people whose destiny with dementia may start sooner rather than later," he concludes.

More information: "Physiopathology of Vascular Risk Factors in Alzheimer's Disease," Guest Edited by Jack C. de la Torre. Journal of Alzheimer's Disease, Volume 32, Issue 3 (October 2012).

Provided by IOS Press

Healthy living adds 14 years to your life

If you have optimal heart health in middle age, you may live up to 14 years longer, free of cardiovascular disease, than your peers who have two or more cardiovascular disease (CVD) risk factors, according to a new Northwestern Medicine study.

08 nov 2012--The study was published Nov. 5 in the Journal of the American Medical Association (JAMA).

"We found that many people develop cardiovascular disease as they live into old age, but those with optimal risk factor levels live disease-free longer," said John T. Wilkins, M.D., first author of the study. "We need to do everything we can to maintain optimal risk factors so that we reduce the chances of developing cardiovascular disease and increase the chances that we'll live longer and healthier."

Wilkins is an assistant professor in medicine, cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital.

For the study, researchers pulled data from five different cohorts included in the Cardiovascular Lifetime Risk Pooling Project and looked at the participants' risk of all forms of fatal and nonfatal cardiovascular disease from ages 45, 55 and 65 through 95 years of age.

All participants were free of CVD at entry into the study and data on the following risk factors was collected: blood pressure, total cholesterol, diabetes and smoking status. The primary outcome measure for the study was any CVD event (including fatal and nonfatal coronary heart disease, all forms of stroke, congestive heart failure, and other CVD deaths).

Key results from the study: 

• Individuals with optimal risk factor profiles lived up to 14 years longer free of total CVD than individuals with at least two risk factors.
• Men in middle age had lifetime risks of approximately 60 percent for developing cardiovascular disease.
• Women in middle age had lifetime risks of approximately 56 percent for developing cardiovascular disease.
• Lifetime risks for cardiovascular disease were strongly associated with risk factor burden in middle age. 

Provided by Northwestern University

Strong tobacco control policies in Brazil credited for more than 400,000 lives saved

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This is an example of a health warning placed on cigarette packages in Brazil. Credit: Ministerio da Saude

High cigarette prices, smoke-free air laws, marketing restrictions and other measures, all part of Brazil's strong tobacco control policies, are credited for a 50 percent reduction in smoking prevalence between 1989 and 2010. The reduction contributed to an estimated 420,000 lives saved during that time period. Those are the findings of a new study published today in PLOS Medicine by a team of researchers from Georgetown Lombardi Comprehensive Cancer Center and the Brazilian National Cancer Institute.

07 nov 2012--Adding to the dramatic conclusion of the study, which used modeling to determine projections, the researchers say the Latin American country's policies could result in as many as 7 million lives saved by 2050.

Tobacco kills up to half its users—more than 5 million smokers die every year in the world from tobacco-related causes, says David Levy, Ph.D., a professor of oncology at Georgetown Lombardi. It also kills more than half a million non-smokers annually who have been exposed tosecond-hand smoke.

Brazil has played a pioneering role among low and middle income countries in providing support for tobacco control measures. It introduced its first cigarette-specific tax in 1990, and in 1996 placed the first warnings on cigarette packages and introduced smoke-free air laws. Many of these measures have subsequently been strengthened, including stronger advertising restrictions, higher taxes and bold and graphic warnings.

To determine the impact of these measures on smoking prevalence and deaths, researchers developed the Brazil SimSmoke Policy Simulation Model. Using policy and population and smoking data for Brazil, the model assesses the effect of several initiatives on premature deathsincluding cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs and restrictions to youth access.

This is an example of a health warning image placed on cigarette packages in Brazil. Credit: Ministerio da Saude

The model estimated that the smoking prevalence in Brazil since 1989 was reduced by 46 percent by 2010, because of the introduction of tobacco control measures. Almost half of this reduction was explained by price increases, 14 percent by smoke-free laws, another 14 percent by marketing restrictions, 10 percent by cessation treatment programs, 8 percent by health warnings, and 6 percent by anti-smoking media campaigns.

Levy has developed similar models for 30 different nations. He says one distinguishing factor in Brazil's tobacco policies is its use of graphic health warnings on cigarette packages.

"While our model credits only eight percent of the reduction in smoking to health warnings, this is likely greatly underestimated because the value assigned in the model was based on current literature. We believe that value doesn't accurately represent the impact health warnings have in Brazil – particularly for youths." Levy continues, "Brazil has extensively tested its warnings with younger smokers and found a greater impact on reducing smoking than is found in the other studies."

He points out that the U.S. Court of Appeals for the District of Columbia rejected a government mandate requiring the use of nine specific graphic health warnings on cigarette packaging based, in part, on its views of the proper role of warning labels and its questioning of evidence presented on the effectiveness of graphic warning labels. Levy suggests rigorous testing with graphic warnings in the youth population in the U.S. might also demonstrate a significant impact on smoking behaviors.

Levy also noted that Brazil recently decided to ban menthol cigarettes, and that the U.S. Food and Drug Administration, which is charged with regulating product content, is considering a similar policy in this country.

While the U.S., particularly states such as California, have seen success in reducing smoking rates by implementing strong policies, none have had the kind of success seen in Brazil in such a short period of time.

"Everyone knows smoking exacts a devastating toll leading to premature death and suffering, but getting people to give up the habit or prevent it has proved challenging," Levy says. "Brazil's strong cigarette control policies should be a lesson to us all. If we are to implement policies here in the U.S. that will make a lasting impact we'll need the political will and the courts' support."

Levy conducted his research in collaboration with two scientists from the Brazilian National Cancer Institute including Liz Maria de Almeida, Ph.D., and André Szklo, Ph.D. The work in this study is supported by contracts with the Tobacco Control Research Branch of the National Cancer Institute and by Bloomberg Philanthropies. The authors report having no personal financial interests related to the study.

More information: Levy D, de Almeida LM, Szklo A (2012) The Brazil SimSmoke Policy Simulation Model: The Effect of Strong Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths in a Middle Income Nation. PLoS Med 9(11): e1001336. doi:10.1371/journal.pmed.1001336

Provided by Georgetown University Medical Center

Daily multivitamin use among men does not reduce risk of major cardiovascular events

In a randomized study that included nearly 15,000 male physicians who were middle-aged or older, daily multivitamin use for more than 10 years of treatment and follow-up did not result in a reduction of major cardiovascular events, heart attack, stroke, or death from cardiovascular disease, according to a study appearing in November 7 issue of JAMA, a theme issue on cardiovascular disease. The study is being released early online to coincide with its presentation at the American Heart Association's Scientific Sessions.

06 nov 2012--"Despite uncertainty regarding the long-term health benefits of vitamins, many U.S. adults take vitamin supplements to prevent chronic diseases or for general health and well-being," according to background information in the article. Individuals who believe they are deriving benefits from supplements may be less likely to engage in other preventive health behaviors. "Although multivitamins are used prevent vitamin and mineral deficiency, there is a perception that multivitamins may prevent cardiovascular disease (CVD). Observational studies have shown inconsistent associations between regular multivitamin use and CVD, with no long-term clinical trials of multivitamin use."

Howard D. Sesso, Sc.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues analyzed data regarding multivitamin use and major cardiovascular events from the Physicians' Health Study (PHS) II, a large-scale trial testing the effects of long-term use of a common multivitamin on the risk of major cardiovascular events and cancer. The Physicians' Health Study II is a randomized, placebo-controlled trial that began in 1997 with continued treatment and follow-up through June 1, 2011. A total of 14,641 male U.S. physicians initially 50 years of age or older (average, 64 years), including 754 men with a history of CVD at randomization, were enrolled. This analysis measured the composite end point of major cardiovascular events, including nonfatal myocardial infarction (MI; heart attack), nonfatal stroke, and death from CVD. Secondary outcomes included heart attack and stroke individually. Participants were randomized to multivitamin (n = 7,317) or placebo (n = 7,324).

During a median (midpoint) follow-up of 11.2 years, 1,732 men had major cardiovascular events, including 652 cases (first events) of heart attack and 643 cases of stroke, and 829 men had cardiovascular death, with some men experiencing multiple events. A total of 2,757 (18.8 percent) men died during follow-up (multivitamin, n = 1,345; placebo, n = 1,412). In an analysis of the rate of events for men in each group, the researchers found that there was no significant effect of a daily multivitamin on major cardiovascular events, or total MI or total stroke. Taking a daily multivitamin was not significantly associated with a reduction in CVD mortality. There were fewer total deaths among multivitamin users, but this difference was not statistically significant.

The authors also found no significant effect of a daily multivitamin on rates of congestive heart failure, angina, and coronary revascularization. Also, the effect of a daily multivitamin on total MI, total stroke, and other cardiovascular end points did not differ between men with and without CVD at the beginning of the study.

"The PHS II represents to our knowledge the only large-scale, randomized, double-blind, placebo-controlled trial testing the long-term effects of a commonly available multivitamin in the prevention of chronic disease," the authors write. "These data do not support multivitamin use to prevent CVD, demonstrating the importance of long-term clinical trials of commonly used nutritional supplements. Whether to take a daily multivitamin requires consideration of an individual's nutritional status, because the aim of supplementation is to prevent vitamin and mineral deficiency, plus consideration of other potential effects, including a modest reduction in cancer and other important outcomes in PHS II that will be reported separately."

In an accompanying editorial, Eva M. Lonn, M.D., M.Sc., of McMaster University and Hamilton General Hospital, Hamilton, Ontario, Canada, writes that "robust data from multiple trials clearly confirm that CVD cannot be prevented or treated with vitamins."

"Nonetheless, many people with heart disease risk factors or previous CVD events lead sedentary lifestyles, eat processed or fast foods, continue to smoke, and stop taking lifesaving prescribed medications, but purchase and regularly use vitamins and other dietary supplements, in the hope that this approach will prevent a future myocardial infarction or stroke. This distraction from effective CVD prevention is the main hazard of using vitamins and other unproven supplements. The message needs to remain simple and focused: CVD is largely preventable, and this can be achieved by eating healthy foods, exercising regularly, avoiding tobacco products, and, for those with high risk factor levels or previous CVD events, taking proven, safe, and effective medications."

More information: JAMA. 2012;308[17]:1751-1760. 
JAMA. 2012;308[17]:1802-1803.

Provided by JAMA and Archives Journals

Smoke-free workplace laws lead to decline in MI incidence

Following implementation of workplace smoke-free laws, the incidence of myocardial infarction decreased significantly in Olmsted County, Minn., according to a study published online Oct. 29 in the Archives of Internal Medicine.

05 nov 2012—Following implementation of workplace smoke-free laws, the incidence of myocardial infarction (MI) decreased significantly in Olmsted County, Minn., according to a study published online Oct. 29 in the Archives of Internal Medicine.

To evaluate the population impact of smoke-free laws, Richard D. Hurt, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues utilized data from the Rochester Epidemiology Project. The incidence of MI and sudden cardiac death in Olmsted County during the 18-month period before and after implementation of each smoke-free ordinance was assessed.

The researchers found that the incidence of MI declined significantly by 33 percent, from 150.8 to 100.7 per 100,000 population when comparing the 18 months before implementation of the smoke-free restaurant ordinance (implemented in 2002) with the 18 months after implementation of the smoke-free workplace law (implemented in 2007). During the same period, the incidence of sudden cardiac death decreased by 17 percent (P = 0.13), from 109.1 to 92.0 per 100,000 population. While the prevalence of smoking declined, the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased during the same period.

"The implementation of smoke-free workplace ordinances was associated with a substantial decrease in MI, the magnitude of which is not explained by concomitant community interventions or changes in cardiovascular risk factors, with the exception of smoking prevalence," the authors write. "Exposure to secondhand smoke should be considered a modifiable risk factor for MI."

More information: Abstract 
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Soy: No effect on menopausal hot flashes

04 nov 2012—A team of investigators led by UC Davis found that eating soy products such as soy milk and tofu did not prevent the onset of hot flashes and night sweats as women entered menopause.

Unlike previous studies investigating the relationship between soy and these menopausal symptoms, the current study included a very large population over a long period of time: more than 1,600 women over 10 years.

The article, titled "Phytoestrogen and Fiber Intakes in Relation to Incident Vasomotor Symptoms: Results from the Study of Women's Health Across the Nation," was published online today in Menopause: The Journal of The North American Menopause Society and will appear in the March 2013 print issue of the journal.

"Given that most women experience unpleasant symptoms, particularly hot flashes and night sweats, during menopause, we were hopeful that certain dietary intakes would provide good alternatives to hormone therapy," said Ellen Gold, lead author of the study and professor and chair of the UC Davis Department of Public Health Sciences. "Unfortunately, based on our study, soy-related foods did not turn out to be the 'magic bullet.'"

The study analyzed data from the Study of Women's Health Across the Nation (SWAN), which followed more than 3,000 premenopausal and early perimenopausal women with annual visits for 10 years. Women answered detailed questionnaires of their dietary habits at baseline, year five and year nine, and in each year were asked about the frequency of various menopausal symptoms, including hot flashes and night sweats.

The new study focused on the 1,651 women who had not yet had hot flashes and night sweats (called vasomotor symptoms) at the beginning of the study, because the investigators wanted to specifically evaluate the effect of dietary factors on preventing the onset of these symptoms.

The main dietary factor of interest in this study was phytoestrogens, also known as plant-based estrogens. Predominantly found in tofu, soy milk and other soy-containing foods, phytoestrogens have a chemical structure similar to estrogen and are believed to mimic the effects of the female hormone in the body. Since estrogen levels drop during menopause, the investigators hypothesized that a diet high in phytoestrogens would reduce menopause symptoms. They also evaluated the participants' consumption of fiber, because it is thought to increase the availability of estrogens in the body.

The study found no consistent correlations between dietary phytoestrogens or fiber and the onset of menopausal symptoms in women who were not yet postmenopausal when they started the study.

Although other studies have examined similar hypotheses, the outcomes have been somewhat inconsistent. Most previous studies evaluated women who were already postmenopausal and having symptoms. Also, a clear dose-response relationship—showing that the more phytoestrogens or fiber women consumed, the less likely they were to develop symptoms—has not been consistently found.

The authors conceded that to determine conclusively if a relationship exists between such dietary intakes and the onset of menopausal symptoms, a large, randomized, placebo-controlled trial would be needed with many years of follow-up. However, they stated that such a study would be costly and difficult, and their results indicate that finding a clinically significant or large effect would be unlikely.

The study had many advantages over earlier studies. It included detailed dietary information on a large number of women from across the U.S. who were followed over the course of a decade. SWAN also included women from different racial and ethnic groups, including white, African-American, Hispanic, Chinese and Japanese women.

"In general, women of Asian ancestry report fewer menopausal hot flashes than do women of European backgrounds," said Gail Greendale, a specialist in geriatric medicine with UCLA Health System and the UCLA principal investigator of the SWAN Phytoestrogen Study. "The 'Eastern' dietary pattern, which is high in phytoestrogens, has been one of the proposed explanations for the ethnic differences in hot flash occurrence. Our findings do not support the theory that higher phytonutrient intakes are associated with lower hot flash rates."

"This study contributes to the discussion about the effects of phytoestrogens on symptoms at menopause," added Gold, who was principal investigator of the UC Davis/Kaiser Permanente site of the SWAN study. "But it is not the final word. Other advantages to these compounds may exist, or it may be that a subset of women will benefit from phytoestrogen intake because of their genetic makeup, which could affect their metabolism of these dietary factors."

Led by UCLA, the SWAN Phytoestrogen Study investigators are also studying the effects of phytoestrogens on bone density and cognition, as well as whether the ability to produce a metabolite called equol when digesting phytoestrogens may have an effect. Equol appears to have greater biological potency as an estrogen mimic than other breakdown products of phytoestrogens, and Asians are more likely to be equol producers than non-Asians.

Provided by UC Davis

Regular physical activity reduces risk of dementia in older people

Regular physical activity may help older people reduce their chances of getting dementia.

03 nov 2012--In a new study published in the American Heart Association journal Stroke, older, non-disabled people who regularly engaged in physical activity reduced their risk of vascular-related dementia by 40 percent and cognitive impairment of any etiology by 60 percent.

The protective effect of regular physical activity remained regardless of age, education, changes in the brain's white matter and even previous history of stroke or diabetes, researchers said. The findings are based on a prospective multinational European study that included yearly comprehensive cognitive assessments for three years. The results are part of increasing evidence that regular physical activity promotes brain health, researchers said.

"We strongly suggest physical activity of moderate intensity at least 30 minutes three times a week to prevent cognitive impairment," said Ana Verdelho, M.D., lead author of the study and a neuroscience researcher at the University of Lisbon, Santa Maria Hospital in Portugal. "This is particularly important for people with vascular risk factors such as hypertension, stroke or diabetes."

The analysis included 639 people in their 60s and 70s; 55 percent were women and almost 64 percent said they were active at least 30 minutes a day three times a week. The activity included gym classes, walking and biking.

The American Heart Association recommends at least 150 minutes of moderate exercise every week or 75 minutes of vigorous exercise for optimal health.

Researchers performed magnetic resonance imaging (MRI) tests at the beginning and end of the study to gauge white matter changes in the brain, an indicator of possible cognitive decline.

"Damage of the cerebral white matter is implicated in cognitive problems including depression, walking difficulties and urinary complaints," Verdelho said. "White matter changes are very common in older people and mainly associated with vascular risk factors like hypertension and stroke."

Throughout the study, researchers asked participants in phone interviews and clinical visits about depression, quality of life and performing everyday activities.

At the end of the follow-up, 90 patients had dementia, including 54 with vascular dementia in which impaired blood flow to the brain causes cognitive decline, and 34 patients met criteria for Alzheimer's disease. Another 147 patients developed cognitive impairment, but not dementia.

Provided by American Heart Association

High levels of vitamin D in plasma protects against bladder cancer

High levels of vitamin D are associated with protection against bladder cancer, according to a multidisciplinary study coordinated by molecular biologists and epidemiologists from the Spanish National Cancer Research Centre (CNIO), the conclusions of which are being published today in the Journal of National Cancer Institute (JNCI) .

02 nov 2012--The study has been led by Núria Malats, head of the Genetic and Molecular Epidemiology Group, and Francisco X. Real, from the Epithelial Carcinogenesis Group, at the CNIO.

The authors of the study took blood samples from more than 2,000 individuals—including patients with bladder cancer and control subjects free from the disease—in 18 Spanish hospitals, making of this the largest study carried out to-date in this field. "We have seen that those subjects with the highest levels of 25(OH)D3, a stable form of vitamin D in the blood, are those who showed the lowest risk of suffering bladder cancer. These results indicate that high levels of this vitamin are associated with protection from the illness or, similarly, that low levels are associated with a higher risk of suffering from it", says Malats.

"We have also shown, using in vitro molecular analysis, that vitamin D regulates the expression of a protein—FGFR3—that takes part in the development of bladder cancer", adds Real.

According to the study, this protective effect is more obvious in those patients with more aggressive cancers. "We observe that high levels of vitamin D diminish, above all, the risk of developing invasive bladder cancer with low levels of FGFR3; which is to say those cancers with the highest probability of metastizing", says André FS Amaral, first author of the study.

The research results suggest that an increase in the dietary or supplementary intake of this vitamin, or via a controlled increase in sun exposure, might be beneficial for the patient in terms of prevention and treatment.

More than 11,000 new cases each year in spain

Bladder cancer represents a serious public health problem in many countries, especially Spain, where 11,000 new cases are registered each year, one of the highest rates anywhere in the world. In fact, it is the fourth most frequent type of tumour among Spanish males, after prostate, lung and colorectal cancers.

Following diagnosis, patients are continually observed with different follow-up techniques, among them cystoscopy, which requires the introduction of a small camera via the urethra to observe the bladder lining.

This type of follow-up affects the patients' quality of life and imposes heavy costs on healthcare authorities, thus further increasing the need to improve prevention strategies faced with this type of cancer.

Recent studies relate vitamin D levels with other types of cancer like breast or colon cancer. Despite this research, it is still not clearly understood which molecular routes are used by this vitamin to exercise its protective effect, or the role it plays in other types of tumours.

Provided by Centro Nacional de Investigaciones Oncologicas

Metabolic syndrome makes a difference in hormone therapy risk

A new analysis of the Women's Health Initiative (WHI) trials show that women who had metabolic syndrome before they started hormone therapy had a greatly increased risk of heart attack or dying of heart disease. Women who didn't have metabolic syndrome beforehand showed no increased risk. The study was published this month online in Menopause, the journal of the North American Menopause Society.

01 nov 2012--"Our findings emphasize the importance of assessing cardiovascular disease risk status when hormone therapy is considered for relief of menopausal symptoms," wrote the WHI investigators who authored the study.

Metabolic syndrome is a group of risk factors that occur together and increase the risk of heart disease, stroke, and diabetes. They include a large waistline, high blood pressure, high blood glucose or diabetes, high triglycerides, or low HDL—the "good cholesterol." Obesity is the key feature, which predisposes women to the others.

In this analysis, a woman was considered to have metabolic syndrome if she had three of any of the five metabolic syndrome features; 269 women met the criteria when they started the trial and were compared with 695 women who did not have metabolic syndrome.

The women who did not have metabolic syndrome showed no increased risk of heart disease, whether they took hormones or not. But the risk of a heart attack or dying of heart disease was more than double for women who had metabolic syndrome and took hormones (either combined estrogen-progestogen or estrogen alone if they had undergone hysterectomy) compared with women who had metabolic syndrome and did not take hormones. Women with metabolic syndrome who took estrogen alone had a smaller increase in risk, but they were still at significantly higher risk than women with metabolic syndrome who did not take hormones.

In the WHI, women took oral formulations of hormone therapy, which were common at the time. Today, smaller doses and other forms, such skin patches or gels, are being used. In addition, women in the WHI were older (average age 66 in this analysis) than the age women usually start hormone therapy for menopause symptoms, such as hot flashes and night sweats. Newer formulations and earlier use of hormone therapy may be safer, but more study needs to be done to find out if having metabolic syndrome makes a difference with these types of hormone therapy.

The study will be published in the March 2013 print edition of Menopause.

Provided by The North American Menopause Society