Study Ties Mini-Strokes to Memory Loss

19 aug 2009-- Screening for areas of damage from a possible mini-stroke could help predict memory loss in the elderly, say U.S. researchers.

Their finding comes from a study involving 679 people, aged 65 and older, who were tested for mild cognitive impairment, the stage between normal brain aging and dementia. The researchers used brain scans to check for white matter hyperintensities, which are small areas of damage caused by mini-stroke, and for areas of dead brain tissue caused by stroke.

People with mini-stroke damage were nearly twice as likely to have mild cognitive impairment that included memory loss, whereas those with stroke damage were more likely to have mild cognitive impairment that did not include memory loss, according to the report in the Aug. 11 issue of Neurology.

"The most interesting finding in this study was that white matter hyperintensities, or mini-strokes, predicted memory problems, while strokes predicted non-memory problems," study author Dr. Jose Luchsinger, of Columbia University Medical Center in New York City, said in a news release from the American Academy of Neurology.

"Traditionally, mini-strokes and strokes are thought to have a common origin and to more strongly predict non-memory cognitive problems," Luchsinger said. "There are an increasing number of studies challenging the idea that all white matter hyperintensities are similar to strokes."

The finding, he said, "could challenge traditional views that white matter hyperintensities are milder versions of stroke that are produced only by conditions such as high blood pressure."

Learning more about mini-strokes and being able to identify which are related to stroke and which are related to other conditions, such as Alzheimer's disease, could help find ways to prevent memory loss and other types of cognitive impairment, Luchsinger said.

More information

The American Academy of Family Physicians has more about age-related memory loss.

Triglyceride Level Can Predict Risk of Cardiovascular Events

But link largely disappears in heart disease patients when other variables are included

18 aug 2009-- Even slightly increased triglyceride levels are associated with a higher risk of recurring cardiovascular events in heart disease patients treated with statins, though that link is diminished when other variables are considered, according to a study in the Aug. 15 American Journal of Cardiology.

Ole Faergeman, M.D., of Arhus University Hospital in Denmark, and colleagues used data from the Incremental Decrease in End Points through Aggressive Lipid Lowering (IDEAL) and Treating to New Targets (TNT) trials to determine the ability of in-trial measurements of triglycerides to predict new cardiovascular events. The trials compared 80 mg/day of atorvastatin with moderate-dose statin therapy in patients with a history of myocardial infarction or clinically evident coronary heart disease.

The researchers found higher levels of triglycerides were associated with higher risks of cardiovascular events. Patients in the highest quintile for triglycerides had a 63 percent higher rate of cardiovascular events than those in the lowest. The relationship between triglycerides and risk was evident even in the normal range of triglycerides. The ability of triglyceride level to predict risk was abolished when other variables (diabetes, body mass index, glucose, hypertension and smoking) were included.

"The main finding of this post hoc analysis of data from two large trials of statin-treated patients was that measurements of plasma triglycerides allow us to differentiate between levels of risk of recurrence of cardiovascular events," the authors write. "The relation of triglyceride to cardiovascular risk largely disappeared when we took other variables into account."

The IDEAL and TNT studies were sponsored by Pfizer.

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High Inflammation, Low Heart Disease in Amazonian Tribe

New research finds inflammation, infection not always predictive of cardiovascular disease

18 aug 2009-- As shown by an Amazonian population with high rates of inflammation and infection but low adiposity and robust fitness, inflammation is not always a risk factor for arterial degeneration and cardiovascular disease, according to research published Aug. 11 in PLoS One.

Michael Gurven, Ph.D., of the University of California in Santa Barbara, and colleagues conducted a study of 258 Tsimane adults, an Amazonian forager-horticulturalist population. Several predictors of heart disease were measured, including hypertension, obesity, diet, and smoking habits.

Using markers including C-reactive protein and white blood cells, the researchers found high levels of inflammation and infection among the Tsimane. However, rates of obesity, smoking, and blood lipids (total cholesterol and low density lipoprotein) were lower among the Tsimane population compared with the U.S. population. The investigators found peripheral artery disease was absent among all the Tsimane adults included in the study. In addition, the overall rate of hypertension among the adult population was 3.5 percent, and although this increased with age it peaked at 23.5 percent, a rate much lower than that in the United States and other developed countries.

"Our study provides evidence that chronic low-grade inflammation in the absence of several other risk factors is not a determinant of cardiovascular disease in a subsistence population. Inflammation and infection may not accelerate arterial degeneration in the context of restricted caloric intake, parasitism, and daily physical activity that maintains low body mass index," the authors conclude.

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Admission Glucose in ACS Linked to Adverse Events

Higher fasting glucose linked to in-hospital mortality risk in acute coronary syndrome patients

18 aug 2009-- Elevated fasting glucose upon admission for acute coronary syndrome is associated with in-hospital and six-month adverse events, according to research published Aug. 15 in the American Journal of Cardiology.

Louis Kolman, M.D., of the University of Michigan Health System in Ann Arbor, and colleagues analyzed data from 1,541 patients admitted with a diagnosis of acute coronary syndrome whose fasting glucose level upon admission was available.

The researchers found that fasting glucose of 100 mg/dL or higher was associated with increased in-hospital mortality compared with subjects whose glucose was below 100 mg/dL. Those whose fasting glucose was 126 or more and who had no known history of diabetes had a higher risk of in-hospital adverse events (odds ratio, 3.37). The fasting glucose level was associated with an increased six-month mortality risk among non-diabetics (odds ratio, 3.03 for a glucose level of 100 to 125 mg/dL and 2.81 for 126 mg/dL or higher) but not diabetics.

"In the present study of patients with acute coronary syndrome, we observed that an elevated fasting admission glucose level was associated with adverse events both in-hospital and at the six-month follow-up point. Furthermore, the risk of adverse events associated with the fasting glucose level at admission was often greatest for non-diabetic patients with acute coronary syndrome," the authors conclude.

The study was partially supported by a grant from Sanofi-Aventis.

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Study IDs four ways to cut disease risks

NEW YORK, 17 aug 2009– Want to take health care reform into your own hands? Don't smoke, lose weight, get exercise, and stick to a good diet, says a new study. The advice may sound familiar, but people with those four habits have a dramatically lower risk of chronic diseases such as diabetes and heart disease.

"Living a healthy lifestyle -- never smoking, maintaining a recommended (weight), performing adequate amounts of physical activity, and adhering to healthy dietary principles -- has a tremendous beneficial impact in preventing or delaying major chronic diseases," said Dr. Earl Ford, of the Centers for Disease Control and Prevention.

To give a sense of the benefit, the rate of chronic diseases ranged from about a half a percent per person per year studied for those with all four habits to about 3% per person per year studied for those who had none of them.

Ford and his colleagues recently completed a study in more than 23,000 middle-aged Germans which showed that people who adhered to all four healthy habits had a 78 percent lower risk of developing a chronic disease compared to study participants without any of the healthy habits.

Encouragingly, Ford points out, "Although the largest reduction in risk is found among people who practice all four of these lifestyle factors, benefits are also gained by adding one healthy behavior at a time."

On average, for example, the presence of just one healthy behavior as compared with none cut the chronic disease risk in half.

Between 1994 and 1998, Ford and colleagues from the German Institute of Human worked with 23,153 adults between the ages of 35 to 65 years, the researchers looked for the following characteristics: never smoked; had a body mass index (a measure of the ratio of weight to height) lower than 30; did at least three and a half hours per week of physical activity; and adhered to healthy dietary principles (high intake of fruits, vegetables, and whole grains, and low meat consumption).

Most participants had one to three of these health factors, fewer than 4 percent had zero healthy factors and 9 percent had all four factors.

Then, roughly eight years later, the investigators analyzed the relationship between these habits and participants' risk of developing diabetes, heart attack, stroke, and cancer.

In the intervening years, 871 participants (3.7 percent of the total) developed new cases of diabetes, 868 (3.8 percent) developed cancer, 214 (0.9 percent) had a first heart attack, and 195 (0.8 percent) had a stroke.

In the Archives of Internal Medicine, the researchers report that people with all four healthy lifestyle factors at the start of the study had a 93 percent lower risk of developing diabetes, an 81 percent lower risk of a heart attack, half the risk of stroke, and a 36 percent lower risk of cancer compared to subjects without any healthy factors.

The reductions in risk were similar for men and women.

Various combinations of healthy behaviors also improved individuals' risks. For example, compared to having no healthy lifestyle factors, having a BMI lower than 30 and participating in physical activity for at least three and a half hours/week reduced the risk of developing a chronic disease by 64 percent. Similarly, physical activity and good dietary behavior reduced the risk by 66 percent.

Some factors appeared to protect more against specific diseases than others. A BMI lower than 30 was a particularly strong protective factor against development of diabetes, for instance. Physical activity protected more strongly against diabetes and heart attack than against cancer. Following good dietary principles provided a similar degree of protection against diabetes, stroke, and cancer.

The largest reduction in risk was associated with having a BMI lower than 30, followed by never smoking, at least 3.5 hours of physical activity and then adhering to good dietary principles.

Admittedly, Ford said, the researchers only looked at participants' behaviors at the beginning of the study, without checking to see whether their habits had improved or worsened. "Thus," he said, "our results are probably most applicable to people who do not often change their behaviors for the better or the worse."

He added, however, that other studies have shown that risks for disease are reduced as healthy behavior improves.

Furthermore, while the study was done in Germany, its results match those of studies done in the US, Ford said, so "it is not unreasonable to think that the lessons from our study apply to United States adults as well. The exact risk estimates might vary a bit, but then such risk estimates also vary among United States studies."

SOURCE: Archives of Internal Medicine, August 10/24, 2009.

Elderly Depression And Dementia

17 aug 2009--When senior citizens become depressed, agitated, or show signs of dementia, it is often difficult to know what the best ways to keep them healthy and happy are. Before you consider long-term care as a solution, there are things you can do to keep your loved ones in their homes.

According to the American Association for Geriatric Psychiatry (AAGP), nearly 20 percent of those who are 55 years and older have mental disorders that are not part of normal aging. Some of the most common illnesses are anxiety, severe cognitive impairment and mood disorders.

Jeffery Lafferman, M.D., a psychiatrist at Levindale Hebrew Geriatric Center and Hospital's Partial Hospitalization Program and Outpatient Services, says that too often mental health illnesses are underreported. "As people age, their health needs become more complicated. Medical problems, such as high blood pressure and arthritis, are common and can mask the emotional challenges that the elderly face, until it has reached a critical stage."

But there is help and hope available. One of the ways to keep an elderly loved one at home for as long as possible when they are experiencing depression, dementia, agitation and other emotional challenges is through day treatment programs.

"Some adult day services programs are specifically designed to help elders relearn how to again be a useful part of their communities. The programs have group and individual therapy sessions in a stimulating environment. In addition, participants can reminisce with people their own age, take part in activities designed to renew their enthusiasm for life and be in their own homes in the evening," says Dr. Lafferman.

Many people do not understand that clinical depression and other mental illnesses are treatable. Some of the symptoms to look for are a change in personality, a decline in memory, isolation from friends and family, excessive feelings of guilt or hopelessness, frequent crying, sleep problems, unexplained physical illnesses, loss of function, changes in appetite, loss of interest in personal hygiene and irritability, and anxiety.

However, Dr. Lafferman advises, "Before you entrust your loved one to any program, try to visit to see with your own eyes what the program is like. Although your elder loved one needs supervision, his or her dignity must be preserved. In addition, check to see if there are medical professionals on site, and if there are different therapies to engage them."

When a loved one is experiencing emotional issues, it can also affect the whole family, so giving caregivers a break during the day is also important.

Source: LifeBridge Health

Rich, Poor See Similar Declines in Old Age

17 aug 2009-- Socioeconomic status seems to make no difference in mental decline after the age of 70, according to new research.

The study, published in the Aug. 1 issue of the American Journal of Epidemiology, challenges claims that economic status and background have an impact on cognitive functioning among the elderly. Rather, the University of California, Los Angeles study found that rates of cognitive decline among people aged 70 and older depended on other factors and were similar across socioeconomic and racial/ethnic groups.

"It has been known that cognitive performance at any given age appears to depend on demographic characteristics; the more educated, for instance, perform better," said lead investigator Dr. Arun Karlamangla, associate professor of medicine at UCLA's David Geffen School of Medicine, in a university news release. "But though there are differences in the level of performance you start with in your late 60s, this study's surprise is that the rate of decline in your 70s is the same for every group."

The study authors looked at data collected from 6,476 people born before 1924 who took part in the study of Assets and Health Dynamics Among the Oldest Old. Participants were tested five times between 1993 and 2002 on various memory and cognition tasks, including word recall, subtraction, attention, language and knowledge of current affairs.

The researchers found that cognitive decline depended on how active people were earlier in life, whether or not they were widowed or ever married, and how old they were. Other social factors appeared to have little impact.

"The most consistent predictors of faster declines in cognitive functioning were being old and being single," the study authors wrote.

More information

The U.S. Centers for Disease Control and Prevention has more on cognitive health.

Baby Boomers Face Down Aging: 10 Most Common Medical Challenges

In the year 2030, the youngest members of the baby boomer generation will hit 65, making up nearly a quarter of the country's population, according to the U.S. Census Bureau. If current elderly Americans are a precursor of what is to come, they will experience health challenges such as diabetes, dementia, depression and functional disability in record numbers.

16 aug 2009--But their huge presence may also open up specialized emergency rooms and critical care units, encourage more research into the mysteries of the aging body and place a focus on specialized geriatric and end-of-life care.

According to researchers and clinicians in the Division of Geriatric and Palliative Medicine at The University of Texas Medical School at Houston, here is a snapshot of 10 of the challenges that may be staring back at baby boomers:

1. Functional decline: According to the U.S. Department of Agriculture, the body loses 1 percent of muscle mass a year beginning at age 45, which can result in sarcopenia as skeletal muscle is eventually replaced with fat and the body becomes weaker. Some research has linked protein deficiency with sarcopenia. For every week spent in the hospital, it takes an aging body a month to recover muscle strength with daily rehabilitation, says geriatrician Liliana Andrade, M.D., assistant professor of internal medicine at the UT Medical School at Houston. Exercise, including resistance and strength training, is absolutely essential for retaining muscle mass and strength. "For balance, tai chi is good," she says. "We also encourage patients to rent 'sit and be fit' videos that use hand and leg weights." A study published recently in Diabetes Care, a journal of the American Diabetes Association, found that older adults especially women with diagnosed or undiagnosed type 2 diabetes had a higher rate of skeletal muscle loss.

2. Depression: Considered as prevalent as the common cold in the elderly, depression can be the result of major life changes, including retirement, losing loved ones and loss of mobility and independence. It can show up differently in older people, says geriatrician Nasiya Ahmed, M.D., assistant professor of internal medicine at the UT Medical School at Houston. "There's not as much of a tendency toward tearfulness or feelings of hopelessness," she says. "Instead they have vague somatic complaints, increased pain, not sleeping or eating well or general apathy."

3. Disease: Chronic diseases associated with the aging process, including high blood pressure, stroke, cardiovascular disease, osteoporosis, chronic obstructive pulmonary disease, hypothyroidism, constipation, incontinence and arthritis, can take their toll. Preventive measures taken now such as quitting smoking, eating healthy food and exercising are all important steps toward a better quality of life. "Even quitting smoking at age 60 is better than not quitting at all," Andrade says.

4. Polypharmacy: A term geriatricians are using for the number of prescription and over-the-counter medications that elderly people are taking in alarming numbers is polypharmacy. "People go to five different doctors and none of the others know what is going on," Ahmed says. In some cases, seniors who wind up in the hospital may be prescribed a different medication for an existing condition such as high blood pressure because the hospital doesn't stock the particular one they've been taking in the past. The patient returns home with a new prescription from the hospital physician and continues taking the other medication as well, which can be deadly. "I've had patients come in who are taking 20 different medications," Andrade says. "A lot of them also take vitamins and herbal supplements that they don't need and that can interfere with medications." The solution, they say, is to have a written record of all prescriptions, supplements and vitamins that they can bring to their appointments and have a family practitioner or geriatrician who can be the lead physician in managing their care.

5. Falls: Low blood pressure, which can be a result of poorly managed hypertension or dehydration, can lead to dizziness. That dizziness, combined with a decreased ability of the vascular system to compensate for changes in position such as standing up, is the largest cause of falls, they say. "So many patients have told me that they take blood pressure medication when they feel like it's high instead of taking it as it is prescribed," Ahmed says. "I ask them how they know it's high and they give vague signs such as their nose tingles or their tremor worsening." Taking medications for sleep can also be dangerous. "Some take Benadryl to help them sleep and as people get older, that's not such a good thing because it causes confusion and they can fall because they're sleepy," Andrade says.

6. Abuse and neglect: These two problems, including self-neglect, will continue to afflict the elderly, says Carmel B. Dyer, M.D., professor and director of the geriatric and palliative medicine division at the UT Medical School at Houston and co-author of the book, "Elder Abuse Detection and Intervention." Education programs, such as the Houston Geriatric Education Center at The University of Texas Health Science Center at Houston, are needed now to train physicians to recognize the signs of abuse and neglect.

7. Financial exploitation: Vulnerable elderly people can easily become victims of family members or caregivers. "We see cases where grown children have moved back in with them and are depending on them financially. They use their resources, borrow the car, rely on them to baby sit, and it upsets the senior's ability to function," Ahmed says. "I had one patient in her early 80s whose leg had just been amputated and she was still babysitting her 11- and 12-year-old grandchildren, who were taunting her."

8. Dementia: Alzheimer's disease is the most common form of dementia, a gradual decline in a person's mental functioning, and is the fifth leading cause of death for Americans over age 65, according to the National Center for Health Statistics. The Alzheimer's Association reports that Alzheimer's disease and dementia triple healthcare costs for people over 65. But education about dementia and possible treatments including medications is lacking, Ahmed and Andrade say. "There are now more medications that are helpful. They can't cure it, but they can help," Andrade says. "Unfortunately, a lot of people are in denial. I had a 78-year-old patient who I knew was suffering from dementia because of the way he was managing his medications and health. But his son got upset when I started talking about it and they left the room."

9. Caregiver burnout: As baby boomers age, many will also be taking care of their own aging parents. That brings caregiver burden, which can lead to a higher risk for depression and other stress-related illnesses. Ahmed says caregivers should solicit health resources, such as daycares for seniors, to help them shoulder the stress. They should take advantage of support groups and ask social workers regularly about available community resources. Special units for acute care for the elderly (ACE units), such as the one at Memorial Hermann-Texas Medical Center where UT physicians see patients, can help make hospitalizations less stressful for the patient and family.

10. Death and dying: Baby boomers will have to decide how they want to live out the end of their lives and how they want to die. Cultural and religious beliefs will impact these decisions and physicians will need to be sensitive to that, Ahmed says. As patients age, the physician begins to play a larger role in a patient's life and strong physician-patient relationships will be important in determining a patient's wishes. People should make those wishes known to family members and caregivers and put them in writing.

Source: University of Texas Health Science Center at Houston

Breakthrough in Alzheimer's research

A combination of proteins in the cerebrospinal fluid can reliably identify which patients with early symptoms of dementia will subsequently develop full-blown Alzheimer's disease, a research team at the University of Gothenburg, Sweden, has found in a major international study. The results were published in this week's edition of the Journal of the American Medical Association (JAMA).

16 aug 2009--Alzheimer's is one of the most common dementia disorders. Around 160,000 people in Sweden currently suffer from dementia, and an estimated 60 per cent of them have Alzheimer's.

"There is currently no medication that can alter the course of the disease, but the medicines currently under development will probably have the greatest effect if they are used from an early stage, so methods are needed for early diagnosis of the disease," says Dr Niklas Mattsson, a member of Kaj Blennow's group at the Institute of Neuroscience and Physiology at the University of Gothenburg's Sahlgrenska Academy.

Changes in the brain are reflected in the cerebrospinal fluid (CSF) in the form of biomarkers. Previous smaller studies have shown that the proteins beta-amyloid, tau and phosphorylated tau in the CSF can be used to make an early diagnosis of Alzheimer's.

Now Mattsson and colleagues at hospitals in Sweden, elsewhere in Europe and the USA have confirmed this in a large multicentre study with more than 1,500 participants.

"These methods make it easier to identify the disease, which is essential for making a correct diagnosis early on," he says. "These biomarkers may be useful both in research to develop new medicines and in point-of-care diagnostics, where they can support clinical diagnostics."

So when will we see new medicines?

"I'm reluctant to speculate, but there is a lot of exciting research under way, and new medicines are under development."

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The results were published on 21 July in the prestigious Journal of the American Medical Association.

Formal education lessens the impact of Alzheimer's disease

Even if brain volume is already reduced

16 aug 2009--Munich, Germany, Amsterdam, The Netherlands, August 11, 2009 – Researchers at the Department of Psychiatry, Klinikum rechts der Isar, Technische Universität München, investigated the effects of formal education on the symptoms of Alzheimer's disease. They were able to show that education diminishes the impact of Alzheimer's disease on cognition even if a manifest brain volume loss has already occurred. The results are published in the current issue of the Journal of Alzheimer's Disease ("Education attenuates the effect of medial temporal lobe atrophy on cognitive function in Alzheimer's disease: The MIRAGE Study," Journal of Alzheimer's Disease, August 2009).

Dr. Robert Perneczky, Department of Psychiatry at Klinikum rechts der Isar explains: "We know that there is not always a close association between brain damage due to Alzheimer's disease and the resulting symptoms of dementia. In fact, there are individuals with severe brain pathology with almost no signs of dementia, whereas others with only minor brain lesions exhibit a considerable degree of clinical symptoms." These phenomena are often ascribed to the theoretical concept of cognitive reserve. A high level of cognitive reserve results in a strong individual resilience against symptoms of brain damage; cognitive reserve can therefore be seen as protective against brain damage.

In support of this, previous studies demonstrated that duration of formal education is associated with cognitive reserve such that comparison of individuals with the same degree of brain damage shows that those with more years of formal education suffer from less severe symptoms of dementia.

Prior to the current study, brain damage was assessed after death using brain autopsy measures or using very sensitive functional imaging measures in live individuals. Perneczky comments: "Our study is the first to show that formal education also modifies the association between brain damage and clinical symptoms of dementia in Alzheimer's disease if brain damage is defined as volume loss on magnetic resonance imaging scans. The relevance of our findings is strengthened by the large sample including 270 patients with Alzheimer's disease. Furthermore, factors with a potential negative influence on cognition and brain volume loss, such as genetic characteristics, age, gender, and brain infarction were also considered." These research results show for the first time that the modifying effect of formal education is robust enough to reduce the negative effects of structural brain damage on cognitive function. Further studies are planned that will include a larger patient cohort and more precise measurement of brain volume reduction.

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Reference: Perneczky R, Wagenpfeil S, Lunetta KL, Cupples LA, Green RC, Decarli C, Farrer LA, Kurz A. Education Attenuates the Effect of Medial Temporal Lobe Atrophy on Cognitive Function in Alzheimer's Disease: The MIRAGE Study. J Alzheimers Dis 17:4 (August 2009).

Healthy Lifestyle Helps Prevent Chronic Diseases

Adherence to four simple behaviors decreases risk of diabetes, heart attack, stroke and cancer

15 aug 2009-- Patients who practice four simple lifestyle behaviors -- never smoking, maintaining a body mass index lower than 30, engaging in at least 3.5 hours per week of physical activity, and consuming a diet rich in fruits, vegetables, and whole grains -- can significantly decrease their risk of chronic diseases, according to a study in the Aug. 10/24 issue of the Archives of Internal Medicine.

Earl S. Ford, M.D., of the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues followed 23,153 Germans, ages 35 to 65 years, for a mean of 7.8 years, during which 2,006 subjects developed new-onset diabetes, heart attack, stroke or cancer.

Compared to subjects who engaged in none of the healthy behaviors, the researchers found that those who engaged in all four had a 78 percent decreased risk of developing a chronic disease. A healthy lifestyle was associated with dramatically reduced risks of diabetes and heart attack (93 and 81 percent, respectively) and significantly decreased risks of stroke and cancer (50 and 36 percent, respectively).

"Our results and those of others emphasize the importance and urgency of continuing vigorous efforts to convince people to adopt healthy lifestyles," the authors conclude. "Because the roots of these factors often originate during the formative stages of life, it is especially important to start early in teaching the important lessons concerning healthy living."

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Weight Loss Method and Cardiac Health Examined

Study finds improvements observed whether weight loss occurred by diet or surgery

15 aug 2009-- Obese people with no known cardiovascular risk factors who lose a considerable amount of weight have significant improvements in cardiac health, according to a study in the Aug. 18 issue of the Journal of the American College of Cardiology.

Oliver J. Rider, of the University of Oxford in the United Kingdom, and colleagues performed cardiac magnetic resonance imaging in 37 obese and 20 normal weight subjects without known cardiovascular risk factors. Among the obese, imaging was performed again a year later in 30 subjects who achieved significant weight loss (17 by diet and 13 by bariatric surgery) and seven subjects who remained obese.

The researchers found that the obese had significant increases in left and right ventricular mass, left ventricular diastolic function impairment, and reduced aortic distensibility. All of these improved after weight loss to similar extents regardless of method, while no improvements were observed in subjects who remained obese.

"Irrespective of method, one year of weight loss leads to partial regression of cardiac hypertrophy and to reversal of both diastolic dysfunction and aortic distensibility impairment," Rider and colleagues conclude. "These findings provide a potential mechanism for the reduction in mortality seen with weight loss."

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Mindful Eating Linked to Yoga, Lower Body Mass Index

Newly developed mindful eating survey inversely linked with BMI, positively linked with yoga

15 aug 2009-- A mindful eating questionnaire (MEQ) is a useful and valid measurement of mindful eating, considered nonjudgmental awareness of physical and emotional sensations associated with eating, and is associated with age, body mass index (BMI), and yoga, according to a study in the August issue of the Journal of the American Dietetic Association.

Celia Framson, a registered dietitian from the Seattle Children's Hospital, and colleagues developed and validated an MEQ. The MEQ measures five factors, including disinhibition, awareness, external cues, emotional response, and distraction. The MEQ was validated through distribution to 510 individuals, with a response rate of 62 percent.

The researchers found that the mean MEQ score was 2.92±0.37 on a score of one to four (with four indicating a higher mindfulness). The adjusted MEQ mean score was inversely associated with BMI, and was found to be higher for participants with a lower BMI (3.02 for a BMI <25)>30). Individuals who were younger in age had lower mean scores than those individuals who were older. The authors further note that, although exercises such as walking or moderate or intense physical activity were not associated with a higher MEQ score, yoga practice was.

"The MEQ as developed here is a first step in characterizing and measuring mindful eating, and it may be useful both in clinical practice and research to understand and promote healthful dietary behavior," the authors write.

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Visceral Fat, Social Stress, Atherosclerosis Linked

Study shows social stress may exacerbate atherosclerosis by increasing visceral fat

14 aug 2009-- There is a direct relationship between coronary artery atherosclerosis, a high visceral to subcutaneous abdominal fat ratio, and social stress, supporting the hypothesis that social stress may worsen coronary artery atherosclerosis by increasing the amount of visceral fat in the body, according to research published in the August issue of Obesity.

Carol A. Shively, Ph.D., of the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues performed a study in adult female cynomolgus monkeys. These monkeys were chosen from a larger pool because they exhibited a higher plasma ratio of cholesterol to high-density lipoprotein following one month of a moderately atherogenic diet, and were considered to represent the subset of the female population at greatest risk for developing atherosclerosis. These 41 monkeys were then socially housed and continued on this diet for 32 months.

The researchers found that atherosclerosis was more extensive among female monkeys with a higher visceral to subcutaneous abdominal fat ratio. Females with a high ratio of visceral to subcutaneous abdominal fat were found to be relatively subordinate, socially isolated, received less grooming, and were subject to more aggression. Furthermore, the authors note, these monkeys were desensitized to circulating glucocorticoids, had impaired ovarian function, higher heart rates, and increased coronary artery atherosclerosis.

Shively and colleagues conclude that, "an effective strategy to reduce the detrimental effects of stress on coronary artery atherosclerosis may be to directly intervene on the social stressors promoting physiological stress responses including distribution of fat."

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Incontinence Treatment Trends Changed in the 1990s

Needle suspension became less common; rates of sling placements increased drastically

14 aug 2009 -- Trends in the surgical management of stress urinary incontinence among women in the United States changed rapidly from 1992 to 2001, according to a study in the August issue of Urology.

Jennifer T. Anger, M.D., of the University of California in Los Angeles, and colleagues analyzed data from a 5 percent national random sample of female Medicare beneficiaries aged 65 years and older. The data came from the Centers for Medicare and Medicaid Services' carrier and outpatient files from 1992, 1995, 1998 and 2001.

The number of surgical procedures for stress urinary incontinence increased over the period from 18,820 to 32,480. The researchers note that this was likely due to the growing number of Medicare beneficiaries. Needle suspension was the most commonly performed procedure in 1992 and 1995, but, by 1998, collagen injections had become most common. In addition, the investigators found that the numbers and rates of sling placements increased drastically from 1995 to 2001.

"As in previous years, we identified a trend toward minimally invasive approaches to surgery, without the presence of randomized controlled clinical trials to support these trends," the authors write. "We anticipate that the analysis of Medicare claims from 2004 onward will demonstrate an additional increase in the use of sling procedures."

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Optimism, Lower Hostility Linked to Reduced Mortality

Study finds optimistic women experience lower heart disease outcomes and mortality

14 aug 2009-- Both optimism and cynical hostility are independently associated with cancer and coronary heart disease outcomes, including mortality, according to research published online Aug. 10 in Circulation.

Hilary A. Tindle, M.D., of the University of Pittsburgh, and colleagues reported an analysis of the Women's Health Initiative study, in which 97,253 women, identified as being free of cancer and cardiovascular disease at study entry, were administered questionnaires at baseline to measure their optimism and cynical hostility. The study follow-up was approximately eight years.

The researchers found that age-adjusted rates of coronary heart disease increased significantly with decreasing levels of optimism and decreased significantly with decreasing levels of hostility. Compared with pessimists, optimists experienced reduced incidence of several health outcomes, including myocardial infarction, coronary heart disease, and all-cause mortality. Cynical hostility was independently associated with increased all-cause mortality and cancer-related mortality; these outcomes were more pronounced in the most hostile African-American women.

"Further research is needed to understand how and why optimism and cynical hostility affect health outcomes in women and how they develop in earlier stages of life, as well as to identify therapies to alter these attitudes in healthy ways," the authors write.

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Diet, Physical Activity and Risk of Alzheimer's Studied

Two studies explore role of eating pattern, physical activity in Alzheimer's, cognitive decline

13 aug 2009-- Following a Mediterranean diet and getting more physical activity may be associated with reduced risk of Alzheimer's disease and slower cognitive decline, according to the results of two studies in the Aug. 12 Journal of the American Medical Association.

In the first study, Nikolaos Scarmeas, M.D., of the Columbia University Medical Center in New York City, and colleagues analyzed data from older people free of dementia who were followed for a mean 5.4 years. Researchers assessed their physical activity and adherence to a Mediterranean-type diet. The Mediterranean-type diet (hazard ratio for high score versus low score, 0.60) and physical activity (hazard ratio for high activity versus no activity, 0.67) were associated with lower risk of Alzheimer's disease.

In the other study, Catherine Feart, Ph.D., of the Universite Victor Segalen Bordeaux 2 in France, and colleagues analyzed data from older adults without dementia at baseline who were re-examined at least once over five years. Greater adherence to a Mediterranean-type diet was associated with slower cognitive decline on the Mini-Mental State Examination but not several other cognitive tests.

"The scientific value of these studies cannot be disputed, but whether and how they can or should be translated into recommendations for the public is the question. For now, it is reasonable to nibble on these findings and savor them, but not to swallow them whole," writes the author of an accompanying editorial.

The study that generated data for the Feart article is conducted under a partnership agreement that includes Sanofi-Aventis; the editorial author reported financial relationships with several pharmaceutical companies and the American Academy of Neurology.

Abstract - Scarmeas
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Abstract - Feart
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Denosumab Linked to Lower Fracture Risk in Two Groups

Non-metastatic prostate cancer and osteoporosis patients have fewer vertebral, other fracture

13 aug 2009-- Denosumab is linked to a reduction in fractures in women with osteoporosis and in men undergoing androgen-deprivation therapy for non-metastatic prostate cancer, according to two studies published online Aug. 11 in the New England Journal of Medicine.

In one study, Steven R. Cummings, M.D., of the University of California in San Francisco, and colleagues assigned 60- to 90-year-old women, who had a bone mineral density T score less than −2.5 but not less than −4 to receive 60 mg of denosumab or placebo subcutaneously every six months for 36 months. They found that denosumab, when compared with placebo, reduced the risk of radiographic vertebral fracture (cumulative incidence, 2.3 versus 7.2 percent), hip fracture (0.7 versus 1.2 percent) and non-vertebral fracture (6.5 versus 8 percent).

In the other study, Matthew R. Smith, M.D., of Massachusetts General Hospital in Boston, and colleagues randomly assigned 734 non-metastatic prostate cancer patients on androgen-deprivation therapy to receive 60 mg of denosumab subcutaneously every six months and another 734 to receive placebo. Those in the denosumab group had a decreased incidence of new vertebral fractures at 36 months (1.5 versus 3.9 percent with placebo). At 24 months, lumbar spine bone mineral density had increased by 5.6 percent in the denosumab group but decreased by 1 percent in the placebo group.

"A significant increase in bone mineral density was seen with denosumab at all measured skeletal sites, including the lumbar spine, hip, and radius. Denosumab was associated with significant decreases, as compared with placebo, in the cumulative incidence of new vertebral fractures at 12, 24, and 36 months," the authors of the second study write.

Both studies were supported by Amgen; several authors reported financial relationships with Amgen and other pharmaceutical companies.

Abstract - Cummings
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Abstract - Smith
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Editorial

Aspirin After Cancer Diagnosis Linked to Lower Mortality

Drug linked to survival after colorectal cancer, especially in tumors overexpressing COX-2

13 aug 2009-- The use of aspirin after the diagnosis of colorectal cancer -- especially tumors overexpressing cycooxygenase-2 (COX-2) -- may be associated with better survival, according to research published in the Aug. 12 issue of the Journal of the American Medical Association.

Andrew T. Chan, M.D., of the Massachusetts General Hospital in Boston, and colleagues analyzed data from 1,279 participants in the Nurses' Health Study and the Health Professionals Follow-up Study diagnosed with stages I, II, or III colorectal cancer, who were followed for a median 11.8 years after diagnosis. Subjects provided information on their aspirin use, and investigators assessed COX-2 expression in many of the subjects' primary tumors.

The researchers found that subjects who regularly took aspirin after their diagnosis had a lower risk of colorectal cancer-specific mortality (multivariate hazard ratio, 0.71) and overall mortality (multivariate hazard ratio, 0.79), compared to nonusers. Aspirin use after diagnosis was associated with lower risk of colorectal cancer-specific mortality in those whose primary tumors overexpressed COX-2 (multivariate hazard ratio, 0.39), but not in those with COX-2-negative tumors.

"The survival benefits of aspirin were similar in patients who received standard adjuvant chemotherapy and those who did not, and in patients with stage I and stage II disease as well as those who had stage III disease at diagnosis. Thus, aspirin may have the potential to be useful as adjuvant therapy not just for locally advanced disease but for early stage patients as well," writes the author of an accompanying editorial.

Abstract
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Cause of Cognitive Decline After Heart Bypass Examined

Coronary artery disease itself is more likely the cause of decline than use of pump

12 aug 2009 -- Use of a pump during coronary artery bypass surgery does not appear to be responsible for long-term loss of cognitive function and memory in patients with coronary artery disease; it instead may be due to the disease itself, according to a study in the August issue of the Annals of Thoracic Surgery.

Ola A. Selnes, Ph.D., and colleagues from Johns Hopkins University in Baltimore compared cognitive outcomes in 152 patients after on-pump coronary artery bypass surgery, 75 patients with off-pump bypass surgery, 99 non-surgical cardiac patients who received drugs and arterial stents, and 69 heart-healthy subjects.

After 72 months, the researchers found that there were no consistent differences in cognitive function among the patients with coronary artery disease. Although these patients had lower cognitive function at baseline and a greater degree of decline compared with heart-healthy subjects, the decline was small, and none were substantially worse off at 72 months.

"Long-term postoperative cognitive decline probably exists, but evidence is accumulating that advanced age and atherosclerosis may be more important determinants of long-term cognitive decline than a history of cardiac operations," Diederik van Dijk, M.D., from University Medical Center Utrecht in the Netherlands writes in an accompanying editorial.

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