Severe asymptomatic heart disease may accompany narrowing in leg arteries

CHICAGO,06 dec 2009 – Results of a randomized, controlled clinical trial presented today at the annual meeting of the Radiological Society of North America (RSNA) reveal that one in five patients with narrowing or blockage in arteries that supply blood to the legs and other parts of the body also have significant but silent coronary artery disease.

Peripheral arterial disease (PAD) occurs when plaque, a combination of fat, cholesterol and other substances, builds up in the arteries, limiting the flow of oxygen-rich blood throughout the body. PAD usually affects arteries that carry blood to the legs, causing poor circulation, discomfort and pain. More than eight million Americans have PAD, according to the American Heart Association.

According to the National Heart, Lung and Blood Institute, coronary artery disease is the most common type of heart disease and the leading cause of death in the U.S.

"PAD patients, including those experiencing no symptoms of heart disease, are known to be at high risk for cardiovascular events such as a heart attack or stroke," said Rozemarijn Vliegenthart Proenca, M.D., Ph.D., radiology resident at the University Medical Center Groningen in the Netherlands. "The purpose of our clinical trial was to investigate whether noninvasive imaging of the heart and subsequent treatment of PAD patients result in a decrease in cardiac events compared to standard care."

In the clinical trial, a total of 231 PAD patients from four participating hospitals in the Netherlands were divided into one of two groups: one in which 108 patients received standard care—consisting of lifestyle changes and medication—for their condition, and a second group in which 115 patients underwent cardiac imaging of the heart in addition to standard care.

"With new, noninvasive cardiac imaging techniques, asymptomatic coronary atherosclerosis can be readily detected and treated," Dr. Vliegenthart Proenca said.

Among the 115 patients who received cardiac imaging, computed tomography (CT) revealed that 53, or 46 percent, had at least one significant narrowing of a coronary artery. Of those 53 patients, 22 had significant narrowing in the left main coronary artery or its equivalent, and were referred for treatment. Eight of those patients subsequently had bypass surgery, and three underwent coronary angiography with stent placement. The remaining patients were treated with medication.

Cardiac stress MRI was then performed on 76 patients. Cardiac stress MRI, in which a drug is infused into the patient's bloodstream to make the heart work harder, helps determine if the heart muscle is receiving adequate blood flow. Results of the cardiac stress MRI exams identified two additional patients with signs of coronary artery disease, one of whom underwent angiography and stent placement.

In total, 24 (21 percent) of the 115 patients who underwent imaging had evidence of asymptomatic but severe coronary artery disease that required additional treatment.

"In PAD patients experiencing no cardiac symptoms, we found a strikingly high rate of severe coronary artery disease," Dr. Vliegenthart Proenca said. "The results of our trial stress that PAD patients without a history of cardiac symptoms should undergo extensive cardiovascular risk factor management."

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Coauthors are Alexander de Vos, M.D., Ph.D., Matthijs Oudkerk, M.D., Ph.D., Mathias Prokop, M.D., Ph.D., Michiel Bots, M.D., Ph.D., Willem Mali, M.D., Ph.D., Annemarieke Rutten, M.D., Ph.D., Gonda de Jonge, M.D., Daniel Lubbers, M.D., Jan van den Dungen, M.D., Ph.D., Maarten Cramer, M.D., Ph.D., Pieter Doevendans, M.D., Ph.D., Benno Rensing, M.D., Ph.D., Hester van der Zaag-Loonen, M.D., Ph.D., and Felix Zijlstra, M.D., Ph.D.

Note: Copies of RSNA 2009 news releases and electronic images will be available online at RSNA.org/press09 beginning Monday, Nov. 30.

Key To Healthy Long Life Could Lie In Balancing Protein Intake Rather Than Calorie Restriction

05 dec 2009--UK researchers studying flies suggest that balancing protein intake rather than reducing calories may be the key to healthy ageing; their findings may explain why calorie restriction, cutting down food intake while making sure the diet contains enough vitamins, minerals and other essential nutrients, appears to benefit health, and also in some organisms, to increase longevity.

The study is the work of Dr Matthew D W Piper from the Institute of Healthy Ageing in the Department of Genetics Evolution and Environment at University College London, and colleagues, and a paper on it appeared online on 2 December in the journal Nature.

Previous research suggests that calorie or dietary restriction, reducing food intake while making sure the diet contains enough vitamins, minerals and other essential nutrients, causes many organisms, including mice, rats, Rhesus monkeys, and fruit flies (drosophila) to live longer and with better health.

There is also evidence that calorie restriction results in greater health in humans too, but whether it increases our lifespan is not so clear.

But there is a downside: dietary restriction diminishes fertility: a female fruit fly on a calorie restricted diet reproduces less frequently and when she does, she produces fewer offspring, although her reproductive span is longer.

The researchers suggest this is an evolved survival trait; when in short supply, essential nutrients are diverted from supporting reproductive systems to keeping the organism alive.

The UCL Institute of Healthy Ageing researchers wanted to investigate this in more detail: was it calorie restriction per se that led to increased health benefits, or was it the effect of reducing specific nutrients?

For the study, which was funded by the Wellcome Trust and Research into Ageing, Piper and colleagues observed what happened when they fed female fruit various diets comprising yeast, sugar and water, but with different amounts of essential nutrients such as vitamins, lipids and amino acids.

They found that varying the amounts and proportions of amino acids in the diet affected the lifespan and fertility of the female fruit flies, but there was little or no effect when they varied the other nutrients.

On closer investigation they found that the amino acid methionine was crucial to extending lifespan and reducing fertility: when they added it to a low calorie diet it boosted fertility without reducing lifespan, and curiously, when they reduced it in a high calorie diet it extended lifespan.

Piper told the press that:

"By carefully manipulating the balance of amino acids in the diet, we have been able to maximise both lifespan and fertility."

"This indicates that it is possible to extend lifespan without wholesale dietary restriction and without the unfortunate consequence of lowering reproductive capacity," he added.

Piper explained that in the past we thought it was the amount of protein in the diet that was important, but this study shows that in flies, and he suggests this is likely to be the same for other organisms too, the balance of amino acids can affect health later in life.

"If this is the case for humans, then the type of protein will be more important," said Piper, explaining that it is not simply a case of telling people to eat more or fewer nuts to live longer, "it's about getting the protein balance right, a factor that might be particularly important for high protein diets, such as the Atkins diet or body builders' protein supplements".

Although the fruit fly does not look like a human, and we have about four times the number of genes that they have, many of the discoveries about how fly genes behave can often be matched against human couterparts.

Dietary restriction appears to be an evolutionary trait, occuring in organisms from yeast to monkeys, suggesting these mechanisms are preserved in genes that we all have in common, or that have largely similar properties. This opens the possibility of using organisms like the fruit fly to study how dietary restriction works and to translate that into the human equivalent.

Amino acids are the building blocks of life: they make up proteins, complex organic compounds that take part in nearly every process necessary for keeping an organism alive. Methionine is an important amino acid because it is essential to the formation of all proteins.

Proteins are made naturally in the body, and we also source them from a variety of foods, including meat, dairy, nuts, pulses and soya derivatives like tofu.

Methionine occurs in naturally high levels in foods such as sesame seeds, Brazil nuts, wheat germ, fish and meats.

"Amino-acid imbalance explains extension of lifespan by dietary restriction in Drosophila."
Richard C. Grandison, Matthew D. W. Piper & Linda Partridge.
Nature, Published online 2 December 2009
doi:10.1038/nature08619

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

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

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

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

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

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

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

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

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

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

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

Source: Diana Yates
University of Illinois at Urbana-Champaign

Apathy common in dementia patients with brain changes

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

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

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

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

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

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

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

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

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DEMENTIA

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

Loneliness can be contagious

People who feel lonely spread that feeling to others

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Additional media contacts:

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

Life expectancy in Brazil over 72, survey indicates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source
Johns Hopkins Medicine

Microembolic Events Linked to Sudden Cardiac Death

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

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

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

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

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

Abstract
Full Text (subscription or payment may be required)

Microembolic Events Linked to Sudden Cardiac Death


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

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

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

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

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

Abstract
Full Text (subscription or payment may be required)

Chronic pain found to increase risk of falls in older adults

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gingko Biloba May Not Prevent Cardiovascular Disease

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

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

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

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

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

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Effect of Dietary Restriction on Lifespan Explained


Factors mediating enhancement of lifespan and reduction of disease pathology identified

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

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

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

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

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Guidelines for cancer screening differ by group

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

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

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

Breast cancer:

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

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

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

Cervical cancer:

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

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

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

Prostate cancer:

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

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

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

Colon cancer:

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

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

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On the Net:

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

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

Diet, Cognitive Ability May Play Role in Heart Disease

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

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

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

The analysis revealed that:

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

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

More information

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

Alcohol Associated With Lower Heart Disease Risk


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

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

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

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

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

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Slow Eating Raises Response to Appetite Control Hormones

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

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

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

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

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

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New guidelines push back age for Pap smears

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

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

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

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

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

AVOIDING UNNECESSARY PROCEDURES

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

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

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

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

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

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

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

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

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

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

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

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

Surgery not linked to memory problems in older patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AHA: Proton Pump Inhibitors May Up Post-PCI Mortality


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

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

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

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

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

Two co-authors reported financial relationships with pharmaceutical companies.

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