Research shows why low vitamin D raises heart disease risks in diabetics

27 aug 2009-- Low levels of vitamin D are known to nearly double the risk of cardiovascular disease in patients with diabetes, and researchers at Washington University School of Medicine in St. Louis now think they know why.

They have found that diabetics deficient in vitamin D can't process cholesterol normally, so it builds up in their blood vessels, increasing the risk of heart attack and stroke. The new research has identified a mechanism linking low vitamin D levels to heart disease risk and may lead to ways to fix the problem, simply by increasing levels of vitamin D.

"Vitamin D inhibits the uptake of cholesterol by cells called macrophages," says principal investigator Carlos Bernal-Mizrachi, M.D., a Washington University endocrinologist at Barnes-Jewish Hospital. "When people are deficient in vitamin D, the macrophage cells eat more cholesterol, and they can't get rid of it. The macrophages get clogged with cholesterol and become what scientists call foam cells, which are one of the earliest markers of atherosclerosis."

Macrophages are dispatched by the immune system in response to inflammation and often are activated by diseases such as diabetes. Bernal-Mizrachi and his colleagues believe that in diabetic patients with inadequate vitamin D, macrophages become loaded with cholesterol and eventually stiffen blood vessels and block blood flow.

Bernal-Mizrachi, an assistant professor of medicine and of cell biology and physiology, studied macrophage cells taken from people with and without diabetes and with and without vitamin D deficiency. His team, led by research assistants Jisu Oh and Sherry Weng, M.D., exposed the cells to cholesterol and to high or low vitamin D levels. When vitamin D levels were low in the culture dish, macrophages from diabetic patients were much more likely to become foam cells.

In the Aug. 25 issue of the journal Circulation, which currently is available online, the team reports that vitamin D regulates signaling pathways linked both to uptake and to clearance of cholesterol in macrophages.

"Cholesterol is transported through the blood attached to lipoproteins such as LDL, the 'bad' cholesterol," Bernal-Mizrachi explains. "As it is stimulated by oxygen radicals in the vessel wall, LDL becomes oxidated, and macrophages eat it uncontrollably. LDL cholesterol then clogs the macrophages, and that's how atherosclerosis begins."

That process becomes accelerated when a person is deficient in vitamin D. And people with type 2 diabetes are very likely to have this deficiency. Worldwide, approximately one billion people have insufficient vitamin D levels, and in women with type 2 diabetes, the likelihood of low vitamin D is about a third higher than in women of the same age who don't have diabetes.

The skin manufactures vitamin D in response to ultraviolet light exposure. But in much of the United States, people don't make enough vitamin D during the winter — when the sun's rays are weaker and more time is spent indoors.

The good news is when human macrophages are placed in an environment with plenty of vitamin D, their uptake of cholesterol is suppressed, and they don't become foam cells. Bernal-Mizrachi believes it may be possible to slow or reverse the development of atherosclerosis in patients with diabetes by helping them regain adequate vitamin D levels.

"There is debate about whether any amount of sun exposure is safe, so oral vitamin D supplements may work best," he says, "but perhaps if people were exposed to sunlight only for a few minutes at a time, that may be an option, too."

He has launched a new study of diabetics who are both deficient in vitamin D and have high blood pressure. He wants to learn whether replacing vitamin D will lower blood pressure and improve blood flow.

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Oh J, Weng S, Felton SK, Bhandare S, Riek A, Butler B, Proctor BM, Petty M, Chen Z, Schechtman KB, Bernal-Mizrach L, Bernal-Mizrachi C. 1,25 (OH) vitamin D inhibits foam cell formation and suppresses macrophage cholesterol uptake in patients with type 2 diabetes mellitus. Circulation, vol. 120(8);pp. 687-698. Aug. 25. 2009. Published online August 10, 2009 doi:10.1161/CIRCULATIONAHA.109.856070

What Britney Spears Can Reveal About Alzheimer's Disease

27 aug 2009--One of the many tragedies of Alzheimer's disease is that patients don't know until it's too late that they actually have the condition. By the time the first signs of forgetfulness and confusion set in, experts believe, the disease has already been ravaging the brain for a decade or more, causing irreversible damage.

But researchers at the Cleveland Clinic report that they may have found a way to identify those most at risk of developing the neurological disorder long before symptoms develop - simply by asking them whether they recognize celebrities such as Britney Spears and Johnny Carson. It turns out that when people who are at highest risk of Alzheimer's try to recognize a famous name, their brains activate in very different ways from those of people who aren't at risk. And scientists can actually see this difference using functional magnetic resonance imaging, or fMRI. (Read "Gingko Biloba Does Not Prevent Alzheimer's.")

In the journal Neurology, a team led by Stephen Rao, a brain-imaging specialist, describes a study of 69 healthy men and women aged 65 to 85. The researchers divided the group into three: those who had no risk factors for Alzheimer's, those who had a family history of the disease but no genetic indicators of it themselves and those who had both family members with Alzheimer's as well as a version of a gene for a protein called apolipoprotein E4 (ApoE4) that has been linked to the condition. They slid all of the subjects into an fMRI machine, and while the volunteers were there, they saw names of both famous and not-so-famous people flashed in front of them.

Rao's team found that when volunteers saw names such as Britney Spears, George Clooney, Albert Einstein and Marilyn Monroe, those who were at the highest risk of developing Alzheimer's - those with both the genetic makeup and a family history - showed high levels of activity in the hippocampus, posterior cingulate and regions of the frontal cortex, all areas involved in memory. The control group showed the opposite pattern. Their brains became more excited when they saw unfamiliar names, which included Irma Jacoby, Joyce O'Neil and Virginia Warfield.

That could mean that the at-risk people were working harder to recognize the well-known celebrities, compensating for already damaged or destroyed neurons that were no longer functioning, while the control group had to struggle only when trying to place the names of noncelebrities, recruiting more nerve cells and connections, racking their memory banks and recall centers. Significantly, in neither group did pictures of the brain designed to pick up structural changes associated with dementia, like signs of atrophy and dead neurons, show any differences - at least not yet. (Read "Can Language Skills Ward Off Alzheimer's? A Nuns' Study.")

"This pushes the envelope further in attempting to detect dysfunction in the brain at a stage earlier than any detectable clinical measurement of cognitive decline," says Dr. Ralph Nixon, a psychiatrist at New York University and vice chair of the medical and scientific advisory council of the Alzheimer's Association. "We all know that the brain is changing metabolically at a very early stage of the disease, well before clinical symptoms. This type of technique validates that concept."

While doctors can now test for the presence of ApoE4, you have to have two copies of a particular form of the gene to be at real risk of Alzheimer's. If you do have them, your chances of developing the disease increase 10- to 20-fold. So far, the Alzheimer's Association does not recommend widespread screening for the gene, even among those with a family history of Alzheimer's, since most people who have the risky version of ApoE4 don't have the necessary gene copies. But looking more closely at people who have a family history of the disease by adding an fMRI scan such as the one Rao conducted to the genetic screen could help doctors select those who do seem to be in the greatest danger of being claimed by the disorder. (Read "Warning Signs: A New Test to Predict Alzheimer's.")

The idea is not necessarily to diagnose Alzheimer's earlier, says Rao. But imaging studies can help to identify those most vulnerable to cognitive decline so they can participate in clinical trials of new drugs designed to postpone or reduce symptoms. "If we can delay the onset of Alzheimer's by five years," he says, "by some estimates we can cut the incidence of Alzheimer's in half. If we can delay the disease by 10 years, we could almost eliminate it because people would die from other conditions first."

Obese People Have 'Severe Brain Degeneration'

A new study finds obese people have 8 percent less brain tissue than normal-weight individuals. Their brains look 16 years older than the brains of lean individuals, researchers said today.

26 aug 2009--Those classified as overweight have 4 percent less brain tissue and their brains appear to have aged prematurely by 8 years.

The results, based on brain scans of 94 people in their 70s, represent "severe brain degeneration," said Paul Thompson, senior author of the study and a UCLA professor of neurology.

"That's a big loss of tissue and it depletes your cognitive reserves, putting you at much greater risk of Alzheimer's and other diseases that attack the brain," said Thompson. "But you can greatly reduce your risk for Alzheimer's, if you can eat healthily and keep your weight under control."

The findings are detailed in the online edition of the journal Human Brain Mapping.

Obesity packs many negative health effects, including increased risk of heart disease, Type 2 diabetes, hypertension and some cancers. It's also been shown to reduce sexual activity.

More than 300 million worldwide are now classified as obese, according to the World Health Organization. Another billion are overweight. The main cause, experts say: bad diet, including an increased reliance on highly processed foods.

Obese people had lost brain tissue in the frontal and temporal lobes, areas of the brain critical for planning and memory, and in the anterior cingulate gyrus (attention and executive functions), hippocampus (long-term memory) and basal ganglia (movement), the researchers said in a statement today. Overweight people showed brain loss in the basal ganglia, the corona radiata, white matter comprised of axons, and the parietal lobe (sensory lobe).

"The brains of obese people looked 16 years older than the brains of those who were lean, and in overweight people looked 8 years older," Thompson said.

Obesity is measured by body mass index (BMI), defined as the weight in kilograms divided by the square of the height in meters. A BMI over 25 is defined as overweight, and a BMI of over 30 as obese.

The research was funded by the National Institute on Aging, National Institute of Biomedical Imaging and Bioengineering, National Center for Research Resources, and the American Heart Association.

Don't Forget About Granny: Older Adults Experience Better Reported Health When Connected With Family And Friends

26 aug 2009--Older adults who have stronger social support networks are more likely to report better overall health compared to their counterparts lacking adequate social interactions and emotional support.

A new study examines the difference that social support may have on how U.S. community-dwelling elders self-report their health status. The study sample included 3,476 adults aged 60 years and older, which was collected from the 1999-2002 National Health and Nutrition Examination Survey. Researchers found that older persons who reported that they needed more support also reported having poorer health; whereas older persons, who were satisfied with the support available to them, reported better health.

The study's authors conclude, "With an estimated 7.6 million older adults feeling the need for more emotional support in America, awareness of the ongoing potential scope of the problem helps evaluate whether providers of health and social services to older persons are adequately prepared to address these health needs."

From: "Social Support and Self-Reported Health Status of Older Adults in the United States."

Source
American Journal of Public Health

Keeping Toddlers From Developing Negative Age Stereotypes By Visiting Nana

It's easy to list the negative stereotypes attributed to the elderly: they are considered forgetful, hard-of-hearing, absent-minded and confused.

25 aug 2009--What's unsettling is that those stereotypes can be present in children as young as two or three.

Research conducted by the University of Alberta's Sheree Kwong See, a psychology researcher, has identified that those stereotypes exist in some children at that age, which could adversely affect them when they are older.

"We've been able to show really early on that kids, when they're just starting to talk, have established beliefs about older people," said Kwong See. "We're seeing what we could call ageism by about age three."

In a recent study to be published in the journal Educational Gerontology, Kwong See and fellow researcher Elena Nicoladis measured the reactions of young children after being quizzed on vocabulary words by either an older or younger adult. Results showed that children who had less exposure to older adults had a stronger language bias against the older person in the experiment than those who had more exposure to older people.

"If you are interacting with 'nana' more frequently, you'll start to see that she's a pretty good teacher of words even though she's old," said Kwong See. "When you have little contact dominant negative cultural stereotypes emerge. You think an older person isn't as alert or in-the-know as a young person and maybe is not as good a teacher."

However, before making frantic trips to grandmother's house to curb the bias, Kwong See cautions that this is not the sole factor from which these biases can develop.

"They're getting negative images of aging from cartoons, from their story books, from watching how other people interact with seniors," she said. "But, they're also starting to pick up some of the positive images as well if they get lots of good interactions."

The long-term implications for these biases can be damaging in their interaction with and treatment of the elderly throughout their lives and in their own self concept as they age..

"Eventually those same children, once they know those stereotypes, may find that the stereotypes become a self-fulfilling prophecy," said Kwong See. "They will become their stereotypes as they grow older."

Source:
Jamie Hanlon
University of Alberta

Anti-aging gene linked to high blood pressure

Scientists reduce hypertension, reverse kidney damage

OKLAHOMA CITY, 25 aug 2009-- – Researchers at the University of Oklahoma Health Sciences Center have shown the first link between a newly discovered anti-aging gene and high blood pressure. The results, which appear this month in the journal Hypertension, offer new clues on how we age and how we might live longer.

Persistent hypertension, or high blood pressure, is a risk factor for stroke, heart attack, heart failure, arterial aneurysm and is the leading cause of chronic kidney failure. Even a modest elevation of arterial blood pressure leads to shortened life expectancy.

Researchers, led by principal investigator Zhongjie Sun, tested the effect of an anti-aging gene called klotho on reducing hypertension. They found that by increasing the expression of the gene in laboratory models, they not only stopped blood pressure from continuing to rise, but succeeded in lowering it. Perhaps most impressive was the complete reversal of kidney damage, which is associated with prolonged high blood pressure and often leads to kidney failure.

"One single injection of the klotho gene can reduce hypertension for at least 12 weeks and possibly longer. Klotho is also available as a protein and, conceivably, we could ingest it as a powder much like we do with protein drinks," said Sun, M.D., Ph.D., a cardiovascular expert at the OU College of Medicine.

Scientists have been working with the klotho gene and its link to aging since 1997 when it was discovered by Japanese scientists. This is the first study showing that a decline in klotho protein level may be involved in the progression of hypertension and kidney damage, Sun said. With age, the klotho level decreases while the prevalence of hypertension increases.

Researchers used one injection of the klotho gene in hypertensive research models and were able to markedly reduce blood pressure by the second week. It continued to decline steadily for the length of the project – 12 weeks. The klotho gene was delivered with a safe viral vector that is currently used for gene therapy. The virus is already approved by the U.S. Food and Drug Administration for use in humans.

Researchers are studying the gene's effect for longer periods to test its ability to return blood pressure levels to normal. They also are looking at whether klotho can prevent hypertension.

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The research, which was funded by the National Institutes of Health and the Reynolds Oklahoma Center on Aging at the OU Health Sciences Center, is available online at http://hyper.ahajournals.org/cgi/content/abstract/HYPERTENSIONAHA.109.134320v1.

Living longer and happier

MU researchers find 'longevity' gene that enhances exercise performance

COLUMBIA, Mo.,25 aug 2009-- —A new study from the University of Missouri may shed light on how to increase the level and quality of activity in the elderly. In the study, published in this week's edition of Public Library of Science – ONE, MU researchers found that gene therapy with a proven "longevity" gene energized mice during exercise, and might be applicable to humans in the future.

"Aging is one of the biggest challenges to a modern society. A pressing issue in the elderly is the loss of activity. What one really wants is not a simple lifespan prolongation but rather a health span increase," said Dongsheng Duan, an associate professor of molecular microbiology and immunology. "After gene therapy with a 'longevity' gene, we studied how well the mice performed on treadmill exercises. We found that the gene therapy worked well and the mice functioned better after the treatment."

Earlier studies have found that mice would live longer when their genome was altered to carry a gene known as mitochondria-targeted catalase gene, or MCAT. However, such approaches would not be applicable to human. Duan and Dejia Li, a post-doctoral researcher working with Duan, took a different approach and placed the MCAT gene inside a benign virus and injected the virus into the mice.

Once injected, Duan and Li tested the mice and found that they could run farther, faster and longer than mice of the same age and sex. Duan attributes this performance enhancement to the MCAT and believes the gene is responsible for removing toxic substances, known as free radicals, from the mitochondria, the powerhouse of the cell. By using this specific gene therapy vector, the virus, to introduce the longevity gene, Duan and Li opened the possibility of human treatment.

"Our results suggest similar therapy may one day improve the life quality of the elderly" Duan said. "This could have important implications for many diseases, such as muscular dystrophy, heart disease, diabetes and neurodegenerative diseases. These patients typically have too many toxic free radicals in their cells."

Palliative Care Experts Focus On Comfort Before Death

Palliative care specialists study how to manage a patient's last months to give comfort. One expert says end-of-life consultations are just what Americans need to deal with death.

23 aug 2009--The New York Times reports on "palliative care specialists, who have made death their life's work. They study how to deliver bad news, and they do it again and again. They know secrets like who, as a rule, takes it better. They know who is more likely to suffer silently, and when is the best time to suggest a do-not-resuscitate order." This field has "become a recognized subspecialty, with fellowships, hospital departments and medical school courses aimed at managing patients' last months. It has also become a focus of attacks on plans to overhaul the nation's medical system.... Many physicians dismiss these complaints as an absurd caricature of what palliative medicine is all about."

"Still, as an aging population wrangles with how to gracefully face the certainty of death, the moral and economic questions presented by palliative care are unavoidable: How much do we want, and need, to know about the inevitable? Is the withholding of heroic treatment a blessing, a rationing of medical care or a step toward euthanasia? A third of Medicare spending goes to patients with chronic illness in their last two years of life; the elderly, who receive much of this care, are a huge political constituency. Does calling on one more team of specialists at the end of a long and final hospital stay reduce this spending, or add another cost to already bloated medical bills?" (Hartocollis, 8/19).

Meanwhile, Newsweek interviews Dr. Diane Meier, a palliative-medicine specialist at Mount Sinai Medical Center in New York and director of the Center to Advance Palliative Care, about end-of-life consultations. "Ninety percent of Americans say they would prefer to die at home, yet more than half of us die in hospitals," the magazine reports. "The 'death panel' rumors of the last few weeks have obscured some uncomfortable but important facts: everyone dies, and end-of-life care will always be a part of medicine, whether we like it or not" (Yarett, 8/19).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

Sleep-Disordered Breathing May Raise Mortality Risk

Problem independently predicted mortality; effect was significant in men ages 40 to 70 years

23 aug 2009-- Sleep-disordered breathing may be associated with higher all-cause and cardiovascular-related mortality in middle-aged and older people, particularly men, according to research published online Aug. 18 in PLoS Medicine.

Naresh M. Punjabi, M.D., of Johns Hopkins University in Baltimore, and colleagues analyzed data from 6,441 men and women ages 40 years and older who underwent home polysomnography. Subjects -- none of whom was being treated for sleep-disordered breathing with common therapies -- were followed for an average of 8.2 years.

The researchers found that subjects with severe sleep-disordered breathing had higher risk of all-cause mortality (adjusted hazard ratio, 1.46). This increased risk of death was significant in men ages 40 to 70 years, but not in men older than 70 years or in women.

"In conclusion, the Sleep Heart Health Study shows that sleep-disordered breathing is an independent predictor of mortality and that this association is not attributable to age, obesity, or other chronic medical conditions. Although the degree of nocturnal hypoxemia was an independent predictor of mortality, arousal frequency and occurrence of central apneas were not," the authors write. "Given the high and likely increasing prevalence of sleep-disordered breathing in the general population, additional research in the form of randomized clinical trials should be undertaken to assess if treatment can reduce premature mortality associated with this common and chronic disorder."

Several co-authors reported financial relationships with makers of medical equipment.

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High Urinary Albumin Affects Death Risk for Heart Failure

Urinary albumin to creatinine ratio may offer prognostic guide to stratify risk for these patients

23 aug 2009-- An elevated urinary albumin to creatinine ratio (UACR) is a predictor of cardiovascular events and death in heart failure patients and may offer clinicians a prognostic guide for risk stratification, according to a study reported in the Aug. 15 issue of The Lancet.

Colette E. Jackson, of the University of Glasgow in the United Kingdom, and colleagues measured UACR at baseline and in follow-up for 2,310 heart failure patients. To determine if UACR had prognostic value, microalbuminuria and macroalbuminuria were correlated with the study's outcomes of death from any cause or a composite outcome including death from cardiovascular causes or hospitalization with worsening heart failure.

At study end point, the researchers found that 704 patients (30 percent) had microalbuminuria and 257 (11 percent) had macroalbuminuria, with both conditions increasing the risk of death and the composite outcome. For death, the adjusted hazard ratio was 1.62 for microalbuminuria versus normal albumin and 1.76 for macroalbuminuria versus normal albumin. For the composite outcome, the hazard ratio was 1.43 for microalbuminuria versus normal albumin and 1.75 for macroalbuminuria versus normal albumin.

"The prevalence of elevated UACR in patients with heart failure was high and was associated with a substantially increased risk of adverse clinical outcomes, including death. Even after adjustment for other risk factors in a multivariable model, microalbuminuria or macroalbuminuria remained strong independent predictors," the authors conclude.

Several of the study authors are employees of AstraZeneca or reported receiving research funding, lecture fees and consulting fees from the pharmaceutical firm, which funded the study.

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Framingham Risk Factors' Value Seems to Decrease With Age

Conventional risk factors appear to have lower predictive ability for CVD in older adults

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22 aug 2009-- The predictive value of conventional risk factors for cardiovascular disease (CVD) appears to decrease in older adults, with C-reactive protein (CRP) providing little additional value, according to research published in the Aug. 15 issue of the American Journal of Cardiology.

Mark Hamer, Ph.D., of the University College London, and colleagues analyzed data from 5,944 individuals without existing CVD. Participants were followed for an average of 7.1 years, and were classified as young (ages 35 to 50 years), middle-aged (51 to 65 years), and older (65 years and older).

The researchers found that, in predicting CVD events, the area under the curve for the Framingham risk factor model was higher in the younger and middle-aged groups (receiver operating characteristic curves, 0.78 and 0.72, respectively) than the older group (0.59). Adding the CRP data didn't substantially increase the discriminative ability.

"Our main findings showed that conventional risk factors using the Framingham model appear to have lower discriminative power in older adults, although the prediction of CVD events was not substantially improved by adding CRP, despite an independent association between CRP and the risk of clinical events in Cox proportional hazards models," the authors write. "Our findings are largely consistent with the results of recent studies of elderly cohorts, in which the prediction of CVD events was not substantially improved by the addition of CRP to conventional risk factors."

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Magnetic Resonance Imaging Has Role in Cardiac Workup

Imaging modality may sometimes replace imaging with invasive angiography or ionizing radiation

22 aug 2009-- Patient workup using cardiovascular magnetic resonance (CMR) imaging is indicated for several major cardiac conditions and can have a substantial impact on diagnosis and patient management, according to a study published online Aug. 12 in the Journal of the American College of Cardiology.

Oliver Bruder, M.D., of Elisabeth Hospital in Essen, Germany, and colleagues studied 11,040 patients from 20 medical centers in the European Cardiovascular Magnetic Resonance registry to evaluate the routine use of CMR, including indications for use, image quality, safety, and impacts on patient management.

The researchers found that the indications for CMR included myocarditis and cardiomyopathy (32 percent), risk assessment in suspected coronary artery disease and ischemia (31 percent), and assessment of myocardial viability (15 percent). CMR image quality was good in 90.1 percent of cases, moderate in 8.1 percent, and unsatisfactory in 1.8 percent. Patient management was affected in 62 percent of cases, and in 16 percent the final diagnosis based on CMR was different from the pre-CMR diagnosis, resulting in a major change in management.

"Consequently, CMR stress testing for risk stratification in suspected coronary artery disease may have the potential to significantly bring down the number of diagnostic coronary angiographies that do not result in intervention or surgery in the future. In addition, nearly 700 noninvasive procedures involving the use of ionizing radiation, such as SPECT imaging, could also be avoided on the basis of the CMR results," the authors write.

The EuroCMR Registry is funded by unrestricted educational grants from Medtronic Inc., Novartis International AG, Servier Societe, and Siemens Healthcare.

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Alarm Symptoms Often Do Not Result in Timely Diagnosis

Many evaluated for hematuria, hemoptysis, other conditions lack definite diagnoses after three years

22 aug 2009-- Many patients who present with certain alarm symptoms, including hematuria and rectal bleeding, do not receive a diagnosis in a reasonable amount of time, according to a study published online Aug. 13 in BMJ.

Roger Jones, M.D., of the King's College London School of Medicine, and colleagues tracked 762,325 patients aged 15 years and older who presented to one of 128 general practitioner sites in the United Kingdom with their first episodes of hematuria, hemoptysis, dysphagia or rectal bleeding from 1994 to 2000.

The researchers found that the proportions of patients who received a cancer or non-cancer diagnosis within 90 days were 17.5 percent of women and 18.3 percent of men who had presented with hematuria, 25.7 and 24 percent for hemoptysis, 17.2 and 22.6 percent for dysphagia, and 14.5 and 16.7 percent for rectal bleeding. After three years, more than three-fourths of patients presenting with rectal bleeding did not have a definite diagnosis. The figures were comparable for dysphagia (67 percent), hematuria (64 percent), and hemoptysis (46 percent). The authors estimated that for every four to seven patients evaluated for these four conditions, relevant diagnoses will be identified in one of them within 90 days.

"We believe that these data provide additional information to help clinicians manage patients presenting with symptoms suggestive of serious disease," Jones and colleagues conclude.

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U.S. Life Expectancy Reaches 77.9 Years

Age-adjusted death rate drops to 760.3 deaths per 100,000 population

Life expectancy in the United States has increased again, from 77.7 to 77.9 years -- a new record -- according to statistics released Aug.19 by the U.S. Centers for Disease Control and Prevention.

21 aug 2009--Jiaquan Xu, M.D., and colleagues at the CDC's National Center for Health Statistics issued the new report, "Deaths: Preliminary Data for 2007," which is based on nearly 90 percent of death certificates in the United States. The report states that life expectancy increased from 77.7 years in 2006 to 77.9 years in 2007. It increased by 1.4 years since 1997, when it was 76.5 years. In addition, the age-adjusted death rate dropped to 760.3 deaths (from 776.5) per 100,000 population -- also a record.

According to the report, both males and females reached record high life expectancies in 2007 (75.3 and 80.4 years, respectively), and life expectancy for black males reached 70 years for the first time. In addition, heart disease and cancer accounted for 48.5 percent of all deaths.

"All of the sex, race, and Hispanic origin groups described in this report showed significant decreases in the age-adjusted death rate in 2007 from 2006, with the exception of American Indian or Alaska Native males, who experienced a decrease that was not statistically significant," the authors write.

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Seizures Uncommon in Alzheimer's Disease Patients

Less than 2 percent developed seizures during follow-up; younger age linked to risk

21 aug 2009 -- Seizures appear uncommon in patients with Alzheimer's disease, but they may be more likely to occur in younger patients, according to research published in the August issue of the Archives of Neurology.

Nikolaos Scarmeas, M.D., of the Columbia University Medical Center in New York City, and colleagues analyzed data from 453 patients with Alzheimer's disease who were followed for up to 14 years, starting at early disease stages. Informants periodically reported whether the patient had recently had a seizure -- defined as a convulsion, fainting, or "funny" spell -- or had been diagnosed or treated for epilepsy or seizures.

The researchers found that 52 patients had positive responses to at least one of these questions, and seven (1.5 percent) were judged to have had seizures. Being at a younger age was associated with a higher risk of seizures (hazard ratio, 1.23 for each additional year of age). No other predictor, including educational achievement, duration of illness, or time-dependent use of cholinesterase inhibitors, was found to be significant.

"Most seizures were generalized convulsions and non-recurrent. The observed incidence corresponds to less than one patient with a seizure for every 200 patients with Alzheimer's disease followed up over the course of one year. Therefore, we conclude that although seizures are more common in patients with Alzheimer's disease compared with the general population, they are a quite uncommon feature of Alzheimer's disease," the authors write.

A co-author reported financial relationships with Ortho-McNeil Janssen Scientific Affairs and Johnson & Johnson.

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Drug-Eluting Stents Fare Well Versus Bare-Metal Stents

Drug-eluting stent in left main coronary artery disease decreases risk of cardiovascular events

21 aug 2009-- Implantation of a drug-eluting stent following percutaneous coronary intervention for unprotected left main coronary artery disease (ULMCA) decreases the risk of cardiovascular events and stroke compared to a bare-metal stent, according to a study published online Aug. 19 in the Journal of the American College of Cardiology.

Pawel E. Buszman, M.D., of Medical University of Silesia in Katowice, Poland, and colleagues followed up 252 patients from the Left Main Coronary Artery Stenting Registry who underwent percutaneous coronary intervention and stenting for ULMCA between 1997 and 2008. Bare-metal stents were used in 158 patients and drug-eluting stents in 94 patients. The researchers looked at major adverse cardiovascular and cerebral events (MACCE) at 30 days, one year, and long-term (one to 11 years, mean of 3.8 years).

The researchers found that 12 patients suffered a MACCE during the 30-day period following percutaneous coronary intervention, including four deaths. At one-year, restenosis had occurred in 17 patients, while over the long term, there were 64 MACCE incidents and 35 deaths. The authors further note that there was a significantly lower incidence of MACCE in drug-eluting stent patients compared to bare-metal stent patients (14.9 and 25.9 percent, respectively).

"A drug-eluting stent implantation for ULMCA decreases the risk of long-term MACCE and particularly improves survival in patients with distal ULMCA disease. These findings are encouraging and support the need for long-term follow-up of patients with ULMCA randomized to drug-eluting stent or coronary artery bypass grafting in large trials," the authors write.

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Editorial

Pioglitazone Linked to Lower Risks in Older Diabetics

Head-to-head comparison shows reduced risk of heart failure and death compared to rosiglitazone

20 aug 2009-- In elderly diabetics, pioglitazone may be associated with a significantly lower risk of heart failure and death than rosiglitazone, according to a study published online Aug. 18 in BMJ.

David N. Juurlink, M.D., of the Sunnybrook Health Sciences Centre in Toronto, and colleagues used an insurance claims database to study 39,736 patients ages 66 years and older who began taking rosiglitazone or pioglitazone between April 2002 and March 2008.

Compared to rosiglitazone, the researchers found that pioglitazone was associated with a reduced risk of heart failure and overall mortality (adjusted hazard ratios, 0.77 and 0.86, respectively) but not myocardial infarction (adjusted hazard ratio, 0.95).

"Given the accumulating evidence of harm with rosiglitazone treatment and the lack of a distinct clinical advantage for the drug over pioglitazone, questioning whether ongoing use of rosiglitazone is justified in any circumstance is reasonable," the authors conclude. "Pending the availability of additional data on the benefits and harms of these drugs and a clarification of their role in the pharmacotherapy of type 2 diabetes, we believe that clinicians should re-evaluate the appropriateness of new or ongoing treatment with rosiglitazone."

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Personality Type Linked to Increased Mortality

Type D personality assessment may identify high-risk patients with peripheral arterial disease

20 aug 2009-- In patients with peripheral arterial disease, Type D personality -- which is characterized by negative emotions and inhibited self-expression during social interactions -- is an independent predictor of all-cause mortality, according to a pilot study published in the August issue of the Archives of Surgery.

Annelies E. Aquarius, Ph.D., of Tilburg University in the Netherlands, and colleagues conducted a baseline psychological assessment of 184 patients (mean age, 64.8 years), of whom 16 died during a follow-up of up to four years.

The researchers found that independent predictors of all-cause mortality included traditional clinical risk factors such as age, diabetes, and renal disease (odds ratios, 1.1 to 2.3). Even after adjusting for these risk factors, however, they found that Type D personality was associated with more than a tripled risk of death (odds ratio, 3.5).

"Hence, in light of the challenge of optimizing risk management in peripheral arterial disease, a personality-based approach may be useful," the authors conclude. "Previous research has already shown that Type D personality predicts prognosis in cardiac patients and impaired quality of life. This study suggests that attention on personality variables may also improve the detection of high-risk patients with peripheral arterial disease."

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Post-Heart Attack Mortality Rate Has Declined Since 1995

Study also finds decrease in the between-hospital variance for 30-day mortality in patients over 65

20 aug 2009 -- The 30-day mortality rate for older patients released from the hospital after acute myocardial infarction has declined since 1995, according to a study in the Aug. 19 issue of the Journal of the American Medical Association.

Harlan M. Krumholz, M.D., of the Yale University School of Medicine in New Haven, Conn., and colleagues examined data on 2,755,370 patients (ages 65 years and older) and 3,195,672 discharges from nonfederal U.S. acute care hospitals from 1995 to 2006. The data was analyzed to determine hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with acute myocardial infarction.

The researchers found that the 30-day RSMR decreased from 18.8 percent in 1995 to 15.8 percent in 2006. There were also fewer differences in the rates between hospitals, as the between-hospital variance decreased from 4.4 to 2.9 percent and the interquartile range decreased from 2.8 to 2.1 percent.

"Our study reveals a marked reduction in hospital-level 30-day RSMRs in the United States from 1995 through 2006. In this period, the average hospital-specific 30-day RSMR decreased approximately 3 percent, a nearly one-sixth relative reduction in short-term mortality," the authors conclude.

Several study authors reported contractual relationships with the Colorado Foundation for Medical Care, the American College of Cardiology, and the Oklahoma Foundation for Medical Quality. Two co-authors reported membership on a UnitedHealthcare scientific advisory board.

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Herbal Remedy May Be Effective in Rheumatoid Arthritis

Response rate for Tripterygium wilfordii Hook F extract is doubled compared to sulfasalazine

19 aug 2009-- In patients with active rheumatoid arthritis, treatment with peeled roots of the Chinese herbal remedy Tripterygium wilfordii Hook F (TwHF) may be effective and safe, according to a study published in the Aug. 18 issue of the Annals of Internal Medicine.

Raphaela Goldbach-Mansky, M.D., of the National Institute of Arthritis and Musculoskeletal and Skin Diseases in Bethesda, Md., and colleagues randomly assigned 121 patients to receive either daily TwHF extract or sulfasalazine. Participants were allowed to use stable doses of oral prednisone and nonsteroidal anti-inflammatory drugs as needed.

After 24 weeks, the researchers found that TwHF was associated with a significantly higher rate of achievement of 20 percent improvement than sulfasalazine (65 versus 32.8 percent) in the 62 patients who completed the study. They also found that there were no significant group differences in rates of adverse events.

"The rapid improvement in function and pain and the profound effect on inflammation may make this extract an attractive and affordable alternative to currently available agents," the authors conclude. "The long-term effects and toxicities and the potential combination of TwHF with other antirheumatic therapies need to be addressed in further studies."

One author reported two patents related to the use of TwHF. Authors also reported financial relationships with the pharmaceutical industry.

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