Reconceptualizing the study of population aging

Age is not just the number of years one has lived, argue IIASA population researchers. A new study from the group provides a set of tools for measuring age in all its dimensions.

13 dec 2013--A groundbreaking study published today in the journal Population and Development Review by IIASA population researchers Warren Sanderson and Sergei Scherbov reorients the way demographers study population aging, providing a new toolbox of methodologies for demographers to better understand the impacts of an aging population on society.

Previously, studies of aging used only one characteristic of people, their chronological age. The new study provides a framework for measuring aging based instead on characteristics of people that change with age, including life expectancy, health, cognitive function, and other measures. These measures can be used by demographers to better understanding aging societies.

"Your true age is not just the number of years you have lived," says IIASA researcher Sergei Scherbov. "It also includes characteristics such as health, cognitive function, and disability rates."

Demographers have not traditionally used such measures in studies of population and society, instead using age as a proxy for those characteristics. But as lifespans get longer, the same age no longer correlates with the same level of health and other such characteristics.

"We use to consider people old at age 65," says Scherbov. "Today, someone who is 65 may be more like someone who was 55 forty-fifty years ago in terms of many important aspects of their lives."

The authors show that policy recommendations with respect to aging differ depending on exactly which characteristics of people are measured. "For different purposes we need different measures. Aging is multidimensional," says Scherbov. By reconceptualizing population aging to incorporate how people actually function, the study provides the foundation of a much richer and more realistic view of population aging.

More information: Sanderson, W. C. and Scherbov, S. (2013), The Characteristics Approach to the Measurement of Population Aging. Population and Development Review, 39: 673. DOI: 10.1111/j.1728-4457.2013.00633.x

Provided by International Institute for Applied Systems Analysis

35 year study finds exercise reduces risk of dementia

The study identifies five healthy behaviours as being integral to having the best chance of leading a disease-free lifestyle: taking regular exercise, non-smoking, a low bodyweight, a healthy diet and a low alcohol intake.

11 dec 2013--The people who consistently followed four or five of these behaviours experienced a 60 per cent decline in dementia and cognitive decline - with exercise being the strongest mitigating factor – as well as 70 per cent fewer instances of diabetes, heart disease and stroke, compared with people who followed none.

"The size of reduction in the instance of disease owing to these simple healthy steps has really amazed us and is of enormous importance in an aging population," said Principle Investigator Professor Peter Elwood from Cardiff University's School of Medicine. "What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health – healthy behaviours have a far more beneficial effect than any medical treatment or preventative procedure.

"Taking up and following a healthy lifestyle is however the responsibility of the individual him or herself. Sadly, the evidence from this study shows that very few people follow a fully healthy lifestyle. Furthermore, our findings reveal that while the number of people who smoke has gone down since the study started, the number of people leading a fully healthy lifestyle has not changed," he added.

Recent surveys indicate that less than one per cent of people in Wales follow a completely healthy lifestyle, based on the five recommended behaviours, and that five per cent of the population follow none of the healthy behaviours; roughly equating to a city with a population the size of Swansea (240,000).

Professor Elwood continued: "If the men had been urged to adopt just one additional healthy behaviour at the start of the study 35 years ago, and if only half of them complied, then during the ensuing 35 years there would have been a 13 per cent reduction in dementia, a 12 per cent drop in diabetes, six per cent less vascular disease and a five per cent reduction in deaths."

The Caerphilly Cohort Study recorded the healthy behaviours of 2,235 men aged 45-59 in Caerphilly, South Wales. The study had multiple aims and has been the basis for over 400 research papers in the medical press. One of the most important aims was to examine the relationship between healthy lifestyles, chronic disease and cognitive decline over a 35-year period; and to monitor changes in the take-up of healthy behaviours.

Dr Doug Brown, Director of Research and Development at the Alzheimer's Society, said: "We have known for some time that what is good for your heart is also good for your head, and this study provides more evidence to show that healthy living could significantly reduce the chances of developing dementia. These large, longitudinal studies are expensive and complicated to run, but are essential to understand how dementia can be prevented. We are calling on the G8 Summit next week to commit to greater funding of important studies such as this one which give us hope for reducing the impact of dementia in the future."

Christopher Allen, Senior Cardiac Nurse at the British Heart Foundation, which part-funded the study, said: "The results of this study overwhelmingly support the notion that adopting a healthy lifestyle reduces your risk of cardiovascular disease and dementia. These findings will hopefully go a long way in encouraging people to carefully consider their lifestyle and how it will impact on their health in later years."

Unhealthy living has accounted for around 10 per cent of the costs of the NHS in Wales since the study first started, while the annual expenditure on prevention and public health services in Wales is estimated to have been £280M.

Provided by Cardiff University

Angioplasty possibly no better than drug therapy

For patients with stable coronary artery disease (CAD) who are not experiencing a heart attack and an abnormal stress test, treatment of their narrowed arteries by the common procedure of angioplasty may not provide additional benefits compared to drug therapy alone. This finding results from a survey of more than 4,000 patients with myocardial ischemia, or inadequate circulation, led by cardiologists at Stony Brook University School of Medicine. The survey results are published in the online first edition of JAMA Internal Medicine .

10 dec 2013--In the research paper titled "Percutaneous Coronary Intervention Outcomes in Patients With Stable Obstructive Coronary Artery Disease and Myocardial Ischemia: A Collaborative Meta-analysis of Contemporary Randomized Clinical Trials," David L. Brown, MD, and Kathleen Stergiopoulos, MD, PhD, Professors in the Department of Medicine, Division of Cardiovascular Medicine at Stony Brook University School of Medicine, worked with colleagues internationally to design a data study that combined data from clinical trials performed between 1970 and 2012 of patients who had either percutaneous coronary intervention (PCI), or angioplasty, plus drug therapy, or drug therapy alone to treat their CAD.

Each of the clinical studies within the analysis reported outcomes of death and nonfatal myocardial infarction reported. Additionally, to reflect contemporary medical and interventional practice, inclusion criteria required stent implantation in at least 50 percent of the PCI procedures and statin medications to lower cholesterol in at least 50 percent of patients in both the PCI and drug therapy alone groups. This led to a total of five clinical trials yielding 4,064 patients with myocardial ischemia diagnosed by exercise stress testing, nuclear or echocardiocraphic stress imaging, or fractional flow reserve.

The researchers reviewed outcomes data up to five years post PCI or drug treatment alone. They analyzed all-cause death, non-fatal myocardial infarction, unplanned revascularization, and angina in the patients.

The analysis showed all-cause death rates between the two groups was not significantly different – 6.5 percent for patients receiving PCI and drug therapy versus 7.3 percent for patients receiving drug therapy alone. There was little difference in the rates of non-fatal myocardial infarction (9.2 percent with PCI vs. 7.6 percent drug therapy) and recurrent or persistent angina (20.3 percent vs. 23.3). The rate of unplanned revascularization was slightly different but not statistically significant (18.3 percent vs. 28.4 percent).

"If our findings are confirmed in ongoing trials, many of the more than 10 million stress tests performed annually and subsequent revascularizations may be unnecessary," said Dr. Brown.

He cautioned that additional studies beyond data analyses of clinical trials are necessary to fully determine if practices with PCI in stable CAD patients needs to be re-evaluated, and if so, under what circumstances and in which patient populations.

More information: Stergiopoulos K, Boden WE, Hartigan P, et al. Percutaneous Coronary Intervention Outcomes in Patients With Stable Obstructive Coronary Artery Disease and Myocardial Ischemia: A Collaborative Meta-analysis of Contemporary Randomized Clinical Trials. JAMA Intern Med. 2013. DOI: 10.1001/jamainternmed.2013.12855

Provided by Stony Brook University

Experts urge US to measure, pursue our happiness

A smiley face balloon floats over Revere Beach in Revere, Mass. as beachgoers head for the water on Sunday, July 16, 2006. According to a report released in December 2013 from the National Academy of Sciences, which advises the U.S. government, by gauging happiness, there'd be more to consider than cold hard cash when deciding matters that affect daily lives. The panel of economists, psychologists and other experts assembled by the academy recommended that federal statistics and surveys, which normally deal with income, spending, health and housing, should include a few extra questions on happiness. (AP Photo/Michael Dwyer)

A panel of experts thinks the U.S. government should be more in touch with Americans' feelings.

09 dec 2013--By gauging happiness, there'd be more to consider than cold hard cash when deciding matters that affect daily lives, according to a report this week from the National Academy of Sciences, which advises the government.

The panel of economists, psychologists and other experts assembled by the academy recommended that federal statistics and surveys, which normally deal with income, spending, health and housing, include a few extra questions on happiness.

"You want to know how people are doing?" said panel chairman Arthur Stone, a professor of psychology at New York's Stony Brook University. "One of things you may want to do is ask them."

Asking how people feel can be as important as how much they are spending, Stone said.

For example, economists have something they call the "misery index" which adds the unemployment and inflation rates, but doesn't include how people feel. If you want to know misery, the question to ask is "how much suffering is going on," he said.

The panel suggests a series of questions to measure daily happiness and general well-being, asking how often you smiled, were stressed, laughed or were in pain. Example questions ranged from a simple yes-no "Yesterday, did you spend time with friends or family?" to a more complex 1-10 rating for "Overall, how satisfied are you with your life nowadays?"

Over the past decade, these types of questions have shown to be valid scientifically, said Carol Graham, a Brookings Institution economist who was on the panel.

The report said the answers can help governments shape policy on basic benefits, such as retirement age and pensions, care for the chronic and terminally ill, unemployment and working conditions. It cited a study by one of the Nobel Prize-winning panelists that showed people's feelings about commuting problems helped officials decided whether or not to create commuter toll lanes on highways.

People laugh as they take part in performing a group exercise during a laughter yoga class in St. Albans, England on Sunday, June 9, 2013. Laughter Yoga was started in India in 1995 by medical doctor Madan Kataria, in response to a body of scientific research which shows that laughter is extremely good for physical, emotional and mental well being. According to a report released in December 2013 from the U.S. National Academy of Sciences, which advises the U.S. government, by gauging happiness, there'd be more to consider than cold hard cash when deciding matters that affect daily lives. The panel of economists, psychologists and other experts assembled by the academy recommended that federal statistics and surveys, which normally deal with income, spending, health and housing, should include a few extra questions on happiness. (AP Photo/Matt Dunham)

In terms of collecting happiness data, the United States government "is a bit of a laggard" behind other industrial nations, said John Helliwell, an economist who co-directs an institute that studies well-being at the University of British Columbia in Vancouver.

In one of the few surveys where the government does ask, the U.S. is a pretty happy nation. Last year, about 87 percent of Americans considered themselves very happy or pretty happy.

But it's far behind No. 1 Denmark, a host of northern European countries, Canada, Israel and Mexico. The United States ranked 17th in a world happiness ranking report directed by Helliwell, which was based on international surveys and came out in September.

When governments and academics study happiness they find that money isn't everything. Many of the richest countries, including the United States, weren't in the Top 10 in self-reported happiness in the report.

"Having no money is terrible for everything," said Graham, author of several books on the economics and measuring of happiness. But after people make "a comfortable amount of money," it doesn't add too much to happiness, she said.

That's what a study last week in the journal PLoS One found. It used worldwide surveys and found that as people made more money worldwide they got happier—but only to a point. That point is just shy of $36,000 a year per person, or $144,000 for a family of four.

Once people reached that point, happiness measurements level off and even go down ever so slightly, said study lead author, Eugenio Proto, an economist at the University of Warwick. According to the study, in general, people in the U.S. passed that "bliss point" a few years ago, however federal income figures don't show nearly that high a household wealth level.

Happiness studies, Helliwell said, "keep reminding you that there is much more to life than income and housing."

More information: National Academy report: bit.ly/18JeagO
World Happiness report: bit.ly/18oZb8X
PLoS One study: bit.ly/1blYY38

© 2013 The Associated Press. All rights reserved.

Further doubt cast on benefit of vitamin D supplementation for disease prevention

A comprehensive review of the evidence suggests that low vitamin D levels are not a cause but a consequence of ill health, casting strong doubt on the value of vitamin D supplements to protect against acute and chronic disorders such as cancer, cardiovascular disease, diabetes, Parkinson's disease, and even death.

08dec 2013--The findings of the large systematic review, published in The Lancet Diabetes & Endocrinology, challenge the prevailing wisdom among many scientists that vitamin D has a potential role in disease prevention, and will have important implications for nearly half of US adults who take vitamin D supplements at an overall cost of $600 million every year.

It is well known that vitamin D promotes the uptake of calcium and bone formation, but observational evidence also suggests a link between inadequate levels of vitamin D and greater risks of many acute and chronic diseases. But whether this is a cause-and-effect relationship is unknown, which has prompted large randomised trials to test whether vitamin D supplementation can reduce the risk of disease development.

"If the health benefits of high vitamin D concentrations shown by data from observational studies are not reproduced in randomised trials (the gold standard method for assessing a causal relation between an exposure and an outcome) then the relation between vitamin D status and disorders are probably the result of confounding or physiological events involved in these disorders", explains lead author Professor Philippe Autier from the International Prevention Research Institute in Lyon, France.

Autier and colleagues analysed data from 290 prospective observational studies and 172 randomised trials examining the effects of vitamin D levels on non-bone health outcomes up to December 2012.

They found that the benefits of high vitamin D concentrations from observational studies— including reduced risk of cardiovascular events (up to 58%), diabetes (up to 38%), and colorectal cancer (up to 34%)—were not confirmed in randomised trials. Indeed, meta-analyses of recent randomised trials failed to identify any effect of raising vitamin D concentrations with supplementation on disease occurrence, severity, or clinical course.

According to Autier, "What this discrepancy suggests is that decreases in vitamin D levels are a marker of deteriorating health. Ageing and inflammatory processes involved in disease occurrence and clinical course reduce vitamin D concentrations, which would explain why vitamin D deficiency is reported in a wide range of disorders."

A linked Lancet Diabetes & Endocrinology Editorial says that the odds are stacked against vitamin D being of use in preventing non-skeletal disorders, but adds that, "Large [ongoing] clinical trials to assess the effects of vitamin D on non-skeletal health outcomes are therefore justified. It would be a real boon to patients if the results are positive, but unless effect sizes for clinically important outcomes are large, the results will only confirm the neutral effect reported by most clinicaltrials thus far."

More information: www.thelancet.com/journals/landia/article/PIIS2213-8587(13)70165-7/abstract

Provided by Lancet

Coffee or beer? The choice could affect your genome

Coffee and beer are polar opposites in the beverage world. Coffee picks you up, and beer winds you down.

07 dec 2013--Now Prof. Martin Kupiec and his team at Tel Aviv University's Department of Molecular Microbiology and Biotechnology have discovered that the beverages may also have opposite effects on your genome. Working with a kind of yeast that shares many important genetic similarities with humans, the researchers found that caffeine shortens and alcohol lengthens telomeres—the end points of chromosomal DNA, implicated in aging and cancer.

"For the first time we've identified a few environmental factors that alter telomere length, and we've shown how they do it," said Prof. Kupiec. "What we learned may one day contribute to the prevention and treatment of human diseases."

Researchers from TAU's Blavatnik School of Computer Science and Columbia University's Department of Biological Sciences collaborated on the research, published in PLOS Genetics.

Between death and immortality

Telomeres, made of DNA and proteins, mark the ends of the strands of DNA in our chromosomes. They are essential to ensuring that the DNA strands are repaired and copied correctly. Every time a cell duplicates, the chromosomes are copied into the new cell with slightly shorter telomeres. Eventually, the telomeres become too short, and the cell dies. Only fetal and cancer cells have mechanisms to avoid this fate; they go on reproducing forever.

The researchers set out to expand on a 2004 study by Nobel Prize-winning molecular biologist Prof. Elizabeth Blackburn, which suggested that emotional stress causes the shortening of the telomeres characteristic of aging, presumably by generating free radicals in the cells. The researchers grew yeast cells in conditions that generate free radicals to test the effect on telomere length. They were surprised to find that the length did not change.

They went on to expose the yeast cells to 12 other environmental stressors. Most of the stressors—from temperature and pH changes to various drugs and chemicals—had no effect on telomere length. But a low concentration of caffeine, similar to the amount found in a shot of espresso, shortened telomeres, and exposure to a 5-to-7 percent ethanol solution lengthened telomeres.

From yeasts to you

To understand these changes, the TAU researchers scanned 6,000 strains of the yeast, each with a different gene deactivated. They then conducted genetic tests on the strains with the longest and shortest telomeres, revealing that two genes, Rap1 and Rif1, are the main players mediating environmental stressors and telomere length. In total, some 400 genes interact to maintain telomere length, the TAU researchers note, underscoring the importance of this gene network in maintaining the stability of the genome. Strikingly, most of these yeast genes are also present in the human genome.

"This is the first time anyone has analyzed a complex system in which all of the genes affecting it are known," said Prof. Kupiec. "It turns out that telomere length is something that's very exact, which suggests that precision is critical and should be protected from environmental effects."

More laboratory work is needed to prove a causal relationship, not a mere correlation, between telomere length and aging or cancer, the researchers say. Only then will they know whether human telomeres respond to the same signals as yeast, potentially leading to medical treatments and dietary guidelines. For now, Prof. Kupiec suggests, "Try to relax and drink a little coffee and a little beer."

Provided by Tel Aviv University

Dietary supplement use among older persons

Many older people are ingesting too much magnesium and vitamin E in the form of dietary supplements. This was discovered by scientists of the Helmholtz Zentrum München in a population-based study; their results have been published in 'The Journal of Nutrition, Health and Aging'.

06 dec 2014--The scientists working with Sigrid Schwab, Priv.-Doz. Dr. Barbara Thorand and Professor Dr. Annette Peters from the Institute of Epidemiology II (EPI II) at the Helmholtz Zentrum München (HMGU) investigated the prevalence of dietary supplement use in the general population and determined daily intake amounts of ingested vitamins and minerals in supplement users.

The data are derived from the KORA-Age Study, which examines the association between lifestyle factors and health status in people aged 65 years or older in the area of Augsburg, Germany. Roughly 54 percent of the women and 34 percent of the men over 64 years of age take dietary supplements or medications containing vitamins, minerals or other substances such as omega-3 fatty acids or coenzyme Q10. In addition to the sex, the frequency of ingestion is associated with the level of education, physical activity, smoking habits and presence of a neurological disease. In women, the most frequently supplemented substances are magnesium and vitamin D, while in men they are magnesium and vitamin E. In both sexes, it was observed that the ingested doses of magnesium and vitamin E frequently exceed the Tolerable Upper Intake Levels established by the European Food Safety Authority. The administered supplement quantities were too high in 20 percent of the female and 33 percent of the male participants regularly taking magnesium and in 8 and 14 percent, respectively, of the participants regularly taking vitamin E. In contrast, vitamin D, whose supplementation is frequently medically recommended in this age group because of its positive effect on bone metabolism, was taken by relatively few older people, the scientists reported.

"Current and population-based data on the intake of supplements in older people are largely missing for Europe. Nevertheless, this population group is of special interest due to the age-related nutrient deficits", says Prof. Peters, Director of EPI II. "Industry and advertising appear to have a large influence on the selection of the preparations. Results such as these are therefore important in order to make it possible to give meaningful recommendations on dietary supplements for older people."

The aim of the KORA-Age Study is to identify factors associated with healthy and contented aging and to support the active participation of older people in social life.

More information: Schwab, S. et al. (2013), The Use of Dietary Supplements among Older Persons in Southern Germany – Results from the KORA-Age Study, The Journal of Nutrition, Health and Aging,DOI: 10.1007/s12603-013-0418-8

Provided by Helmholtz Association of German Research Centres

44 million now suffer from dementia worldwide, study finds

The number of people suffering from dementia has risen 22 percent in the past three years, with 44 million people living with the disease worldwide, according to a study released Thursday.

The report from Alzheimer Disease International predicts that the number of people suffering from the disease will triple worldwide to 135 million by 2050.

According to the new figures, 16 million people in western Europe will be living with the condition by 2050.

Marc Wortmann, executive director at Alzheimer Disease International, said: "It's a global epidemic and it is only getting worse—if we look into the future the numbers of elderly people will rise dramatically.

"It's vital that the World Health Organisation makes dementia a priority, so the world is ready to face this condition."

The study was released ahead of a G8 summit on dementia being held in London next week.

Britain's Department of Health called dementia "a growing worldwide challenge".

"We are leading a global fightback by bringing the G8 countries together to tackle dementia as a global issue for the first time," said a spokesman.

"The G8 summit next week will provide a unique opportunity to make real progress much faster, and re-double international efforts to find effective treatments and cures."

British actress Carey Mulligan urged G8 health ministers increase funding for dementia research.

"Since my own grandmother, Nans, was diagnosed with Alzheimer's, I have experienced at first hand just how terribly painful and frightening dementia can be for both the person diagnosed and their family," she wrote in a letter published in Thursday's Times.

"On behalf of all those who have dementia today, and the future generations who might still be spared, I would urge the G8 to deliver."

© 2013 AFP

Exercise beneficial for dementia

Exercise may benefit older people with dementia by improving their cognitive functioning and ability to carry out everyday activities, according to a new systematic review published in The Cochrane Library. However, the authors of the review did not see any clear effect of exercise on depression in older people with dementia and say that more evidence is needed to understand how exercise could reduce the burden on family caregivers and health systems.

04 dec 2013--Due to people living longer, rates of dementia are expected to rise sharply in the coming decades. Dementia affects the brain in different ways and is associated with effects on memory and personality. It is thought that exercise might be useful in treating dementia or slowing its progression, through improvements in the ability to carry out everyday tasks and positive effects on mental processes such as memory and attention, collectively described as cognitive functioning. Exercise may therefore indirectly benefit family caregivers and the healthcare system by reducing some of the burden of dementia.

The study updates a Cochrane review carried out in 2008, when only four trials on the effects of exercise in older people with dementia were available. In the updated review, data from eight trials involving 329 people showed that exercise could improve cognitive functioning. Data from six studies involving 289 people showed that exercise could improve the ability of older people with dementia to carry out daily activities, such as walking short distances or getting up from a chair.

"In our previous review, we were unable to draw any conclusions about the effectiveness of exercise in older people with dementia, due to a shortage of appropriate trials," said researcher, Dorothy Forbes, an Associate Professor of Nursing who works at the University of Alberta in Edmonton, Alberta. "Following this new review, we are now able to conclude that there is promising evidence for exercise programs improving cognition and the ability to carry out daily activities. However, we do still need to be cautious about how we interpret these findings."

The researchers remain cautious because there were substantial differences among the results of individual trials. In addition, they did not find enough evidence to determine whether exercise improved challenging behaviours or depression in older people with dementia. They were unable to come to any conclusions regarding quality of life, or benefits for family caregivers and health systems, because there was not enough evidence.

However, the researchers suggest that if more evidence becomes available in future, it may help to address the question of whether exercise can help people with dementia remain at home for longer. "Clearly, further research is needed to be able to develop best practice guidelines to enable healthcare providers to advise people with dementia living at home or in institutions," said Forbes. "We also need to understand what level and intensity of exercise is beneficial for someone with dementia."

More information: Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD006489. 

Provided by Wiley

Cancer risk for aging Baby Boomers

As 10,000 baby boomers reach 65 each day, the incidence of cancer is increasing, estimated to increase by 67% between 2010 and 2030, bringing attention to the nation's response to cancer care. Cancer is diagnosed at a higher rate, accounts for more survivors, and results in more deaths than in younger patients.

03 dec 2013--"The increase in the number of older adults, the association of cancer with aging, the workforce shortage, and the financial stressors across the health care system and family networks all contribute to a crisis in cancer care that is most pronounced in the older population," wrote three members of the Institute of Medication Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population in an editorial published In JAMA, The Journal of the American Medical Association.

"Often caregiving falls to a family member who is also aging," noted Mary D. Naylor, PhD, FAAN, RN, the Marian S. Ware Professor in Gerontology and the Director of the NewCourtland Center for Transitions and Health and a member of the committee. As the originator of the Transitional Care Model, Dr. Naylor has addressed the unique needs of older adults and their caregivers, offering evidence-based solutions. "We need to address the physical, psychological, financial and emotional tolls on caregivers by developing more effective ways to prepare and support them."

The authors noted potential improvements to cancer care among older persons, including:

• Passing new laws extending the time period for clinical trials (similar to laws passed for pediatric patients) in order to include more older adults, noting that "although the majority of patients with cancer and cancer survivors are older adults, historically they have been and continue to be underrepresented in all types of cancer trials. The result may be that drugs are tested on a younger and fitter population that belies potential health risks to older people who may also have more than one condition;
• Letting the patients decide what works. The authors recommended "publicly reported, robust measures of patient reported outcomes meaningful for this population;" and
• Establishing a national workforce commission "to plan for the challenges of an aging population and the complexity of care required by older adults with cancer, including a workforce that values multidisciplinary teams and geriatrics principles.

More information: "Improving the Quality of Cancer Care in an Aging Population: Recommendations From an IOM Report." Arti Hurria, MD; Mary Naylor, PhD, RN; Harvey Jay Cohen, MD. JAMA. 2013;310(17):1795-1796. DOI: 10.1001/jama.2013.280416.

Provided by University of Pennsylvania School of Nursing

Global study reveals pandemic of untreated cancer pain due to over-regulation of pain medicines

A ground-breaking international collaborative survey, published today in Annals of Oncology, shows that more than half of the world's population live in countries where regulations that aim to stem drug misuse leave cancer patients without access to opioid medicines for managing cancer pain.

02 dec 2013--The results from the Global Opioid Policy Initiative (GOPI) [1] project show that more than 4 billion people live in countries where regulations leave cancer patients suffering excruciating pain.

National governments must take urgent action to improve access to these medicines, says the European Society for Medical Oncology, leader of a group of 22 partners that have launched the first global survey to evaluate the availability and accessibility of opioids for cancer pain.

"The GOPI study has uncovered a pandemic of over-regulation in much of the developing world that is making it catastrophically difficult to provide basic medication to relieve strong cancer pain," says Nathan Cherny, Chair of the ESMO Palliative Care Working Group and lead author of the report, from Shaare Zedek Medical Center, Jerusalem, Israel. "Most of the world's population lacks the necessary access to opioids for cancer pain management and palliative care, as well as acute, post-operative, obstetric and chronic pain."

"When one considers that effective treatments are cheap and available, untreated cancer pain and its horrendous consequences for patients and their families is a scandal of global proportions," Cherny says.

The study conducted in Africa, Asia, Latin America & the Caribbean and the Middle East assessed the availability of the seven opioid medications considered to be essential for the relief of cancer pain by the WHO Model List of Essential Medicines [2] and the International Association for Hospice and Palliative Care [3]. Those essential medications include codeine, oral oxycodone, transdermal fentanyl, immediate and slow release oral morphine, as well as injectable morphine, and oral methadone.

While there are problems with the supply of these medicines in many countries, the main problem is over-regulation that makes it difficult for healthcare professionals to prescribe and administer them for legitimate medical use, the authors say.

"This is a tragedy born out of good intentions," says Cherny. "When opioids are over-regulated, the precautionary measures to prevent abuse and diversion are excessive and impair the ability of healthcare systems to relieve real suffering. The GOPI study has uncovered over-regulation in much of the developing world."

"The next step is for international and local organisations working alongside governments and regulators to thoughtfully address the problems," adds study co-author James Cleary, Director of the Pain and Policy Studies Group and Founding Director of the Palliative Medicine at the UW Carbone Cancer Center, Madison, Wisconsin, USA.

"Regulatory reform must be partnered with education of healthcare providers in the safe and responsible use of opioid medication, education of the public to destigmatize opioid analgesics and improved infrastructure for supply and distribution," he says.

There are already concrete examples of countries reforming their policies to improve access to opioid medicines, the study authors say, among them the Ukraine, which previously had a limited opioid formulary. "Concerted efforts supported by the Open Society Institute, reports from Human Rights Watch, together with the investment in local clinical champions through programmes such as the Pain and Policy Studies Group's (PPSG) International Pain Policy Fellowship (IPPF) Program, have led to the government approving the manufacture and distribution of immediaterelease oral morphine in the Ukraine with concurrent changes in policy," Cleary says.

"The ongoing initiatives to reform regulations, improve accessibility and promote the education of clinicians and consumers in the effective use of opioid medications for the relief of cancer pain will require vision, determination and the same spirit of cooperation between organisations that made this study successful. The challenges are great, but no greater than our resolution to the task of making pain relief for cancer patients a reality irrespective of geography. Governments should look at the GOPI survey data for their country and take concrete actions to reduce the barriers," Cherny concludes.

More information: [1] The "Global Opioid Policy Initiative project to evaluate the availability and accessibility of opioids for cancer pain management" is published as a Supplement of Annals of Oncology, free access available here:annonc.oxfordjournals.org/content/24/suppl_11.toc. This survey is a follow-up of the Europe-wide survey conducted in 2010 by ESMO and EAPC. "Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative" (annonc.oxfordjournals.org/content/21/3/615.full.pdf+html?sid=1f8cb457-23ba-4bc4-a525-450ec88e932d)

[2] www.who.int/medicines/publications/essentialmedicines/18th_EML_Final_web_8Jul13.pdf

[3] www.hospicecare.com

Provided by European Society for Medical Oncology

Mobility explains the association between social activity and mortality risk in older people

Social activity and health correlate in old age, but less is known about what explains this association. The results of a study carried out in the Gerontology Research Center showed that part of the association between social activity and mortality was mediated by mobility among older men and women. Of other potential mediators, having less depressive symptoms and better cognitive functioning are merely prerequisites for social activity.

01dec 2013--"The health-enhancing influences of social activity may be partly explained by better mobility among persons who are socially active. Moreover, social activity may maintain mobility and thus decrease mortality risk, as many social activities also include physical activity," says Katja Pynnönen, a PhD student from the University of Jyväskylä, Department of Health Sciences.

Collective social activity researched in this study included, for example cultural activities, acting in organizations, travelling, physical activity in groups, and dancing. When participating in these kinds of activities, a person acts together with other people and may experience a sense of belonging to a group and a feeling of being liked and accepted.

Helping others in various daily tasks is an example of productive social activity which may give feelings of doing good and being useful.

"Good cognitive functioning and having less depressive symptoms seemed to be prerequisites for social activity. Thus, it is important to recognize and take into account those older people who have memory problems and are melancholy, and may need extra support to participate in social activities," says Pynnönen.

The study is part of the Evergreen project carried out in the University of Jyväskylä. In 1988, 406 men and 775 women aged 65–84 years took part in face-to-face interviews. Data on mortality were drawn from the population register.

More information: Do mobility, cognitive functioning, and depressive symptoms mediate the association between social activity and mortality risk among older men and women? Pynnönen Katja, Törmäkangas Timo, Rantanen Taina, Lyyra Tiina-Mari , European Journal of Ageing, October 2013 DOI: 10.1007/s10433-013-0295-3

Provided by Academy of Finland

Mediterranean diet without breakfast the best choice for diabetics, new study says

For patients with diabetes, it is better to eat a single large meal than several smaller meals throughout the day. This is the result of a current dietary study at Linköping University in Sweden.

30 nov 2013--In the study the effect on blood glucose, blood lipids and different hormones after meals were compared using three different macronutrient compositions in patients with type 2 diabetes. The three diets were a low-fat diet, a low-carbohydratediet and a Mediterranean diet. The scientists included 21 patients that tested all three diets in a randomized order. During each test day blood samples were collected at six time points.

The low-fat diet had a nutrient composition that has traditionally been recommended in the Nordic countries, with about 55% of the total energy from carbohydrates. The low-carbohydrate diet had a relatively low content of carbohydrate; approximately 20% of the energy was from carbohydrates and about 50% of the total energy came from fat. The Mediterranean diet was composed of only a cup of black coffee for breakfast, and with all the caloric content corresponding to breakfast and lunch during the other two test days accumulated to one large lunch.

Furthermore, the total caloric content included energy from 150 ml (women) to 200 ml (men) of French red wine to ingest with the lunch. The food in the Mediterranean diet had an energy content from carbohydrates that was intermediate between the low-fat and the low-carbohydrate meals, and sources of fat were mainly olives and fatty fish.

"We found that the low-carbohydrate diet increased blood glucose levels much less than the low-fat diet but that levels of triglycerides tended to be high compared to the low-fat diet," says Doctor Hans Guldbrand, who together with Professor Fredrik Nystrom was the principal investigator of the study.

"It is very interesting that the Mediterranean diet, without breakfast and with a massive lunch with wine, did not induce higher blood glucose levels than the low-fat diet lunch, despite such a large single meal," says Professor Nyström.

"This suggests that it is favorable to have a large meal instead of several smaller meals when you have diabetes, and it is surprising how often one today refers to the usefulness of the so-called Mediterranean diet but forgets that it also traditionally meant the absence of a breakfast. Our results give reason to reconsider both nutritional composition and meal arrangements for patients with diabetes," says Professor Nystrom.

More information: A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes by Hanna Fernemark, Christine Jaredsson, Bekim Bunjaku, Ulf Rosenqvist, Fredrik H Nyström and Hans Guldbrand. PLOS ONE Nov 27 2013. DOI: 10.1371/journal.pone.0079324

Provided by Linköping University

Vitamins can damage the body's own defences

Each year, we spend billion of dollars on dietary supplements. New research indicates that vitamin pills may upset the fragile balance in our cells and thus cause more harm than good.

29 nov 2013--Vitamin supplements are a billion-dollar industry. We want to stay healthy and fit and help our bodies with this. But perhaps we are achieving precisely the opposite?

"We believe that antioxidants are good for us, since they protect the cells from oxidative stress that may harm our genes. However, our bodies have an enormous inherent ability to handle stress. Recent research results show that the body's responses to stress in fact are important in preventing our DNA from eroding. I fear that the fragile balance in our cells can be upset when we supplement our diet with vitamin pills," says Hilde Nilsen to the research magazine Apollon. Nilsen is heading a research group at the Biotechnology Centre, University of Oslo.

Maintenance of genes

Our DNA – the genetic code that makes us who we are – is constantly exposed to damage.

In each of the hundred trillion cells in our body, up to two hundred thousand instances of damage to the DNA take place every day. These may stem from environmental causes such as smoking, stress, environmental pathogens or UV radiation, but the natural and life-sustaining processes in the organism are the primary sources of damage to our DNA.

How can the repair of damage to our DNA help us stay healthy and live long lives?

A small worm provides the answer

To answer this question, Hilde Nilsen and her group of researchers have allied themselves with a small organism – a one millimetre-long nematode called Caenorhabditis elegans (C. elegans). This roundworm, which lives for only 25 days, is surprisingly sophisticated with its 20 000 genes; we humans only have a couple of thousand more.

"C. elegans is a fantastically powerful tool, because we can change its hereditary properties. We can increase its ability to repair DNA damage, or we can remove it altogether. We can also monitor what happens when damage to DNA is not repaired – in several hundred specimens and through their entire lifespan."

Different "repair proteins" take care of various types of damage to the DNA. The most common ones are repaired by "cutting out" and replacing a single damaged base – by itself or as part of a larger fragment.

Affecting lifespan with the aid of genes

In some specimens that do not have the ability to repair the damage, the researchers observe that the ageing process proceeds far faster than normal. Is it because the damage accumulates in the DNA and prevents the cells from producing the proteins they need for their normal operation? Most researchers have thought so, but Hilde Nilsen doubts it.

One of the genes studied by the researchers has a somewhat shortened lifespan: on average, this mutant lives three days less than normal. Translated into human terms, this means dying at the age of 60 rather than at 70.
– We were surprised when we saw that these mutants do not in fact accumulate the DNA damage that would cause ageing. On the contrary: they have less DNA damage. This happens because the little nematode changes its metabolism into low gear and releases its own antioxidant defences. Nature uses this strategy to minimize the negative consequences of its inability to repair the DNA. So why is this not the normal state? Most likely because it comes at a cost: these organisms have less ability to respond to further stress ‒ they are quite fragile.

Hilde Nilsen and her colleagues have now –for the very first time – shown that this response is under active genetic control and is not caused by passive accumulation of damage to the DNA, as has been widely believed.

This provides an opportunity to manipulate these processes. And that's exactly what we have done: we have re-established the normal lifespan of a short-lived mutant by removing other proteins that repair damage. Hence, the cause could not be accumulation of damage, since there is no reason to assume that a mutant with no other alternative ways to repair its DNA will be less exposed to damage. There must be something else.

The researchers have gone on to discover that this "something else" in fact is the other repair proteins. They believe that the proteins inhibit damage that they fail to repair completely.

"The consequence is that they establish a barrier – a road block. This triggers a cascade of signals that reprogram the cell.

"Wouldn't this imply that the repair proteins defy their own purpose – after all, the result is a shorter lifespan?

"We need to remember that most likely, the purpose of the DNA repairs is to ensure that we produce healthy offspring – not necessarily that we live as long as possible after our reproductive age interval. Initiating a survival response that reinforces the antioxidant defences means that a lack of ability to repair the DNA has less impact than it would otherwise have on our reproduction. To the species as a whole, it's a small cost that some individuals will be less good at handling stress and have a shorter life."

Because this is an active process within the cells, the researchers refer to it as reprogramming.

"We have found several proteins that trigger this reprogramming. The process has the same effect as a reduction in caloric intake, which we know helps increase the lifespan in many species. In other words, there are two routes to a long life. When we stimulate both of these two routes in our nematode at the same time, we can quadruple its normal lifespan," Nilsen says.

Can do great harm

The balance between oxidants and antioxidants is crucial to our physiology, but exactly where this equilibrium is situated varies from one person to the next.

"This is where I start worrying about the synthetic antioxidants. The cells in our body use this fragile balance to establish the best possible conditions for themselves, and it is specially adapted for each of us. When we take supplements of antioxidants, such as C and E vitamins, we may upset this balance," the researcher warns.

"It sounds intuitively correct that intake of a substance that may prevent accumulation of damage would benefit us, and that's why so many of us supplement our diet with vitamins. Our research results indicate that at the same time, we may also cause a lot of harm. The health authorities recommend that instead, we should seek to have an appropriate diet. I'm all in favour of that. It's far safer for us to take our vitamins through the food that we eat, rather than through pills," Hilde Nilsen states emphatically.

Huge consumption of dietary supplements

The National Research Centre in Complementary and Alternative Medicine (NAFKAM) has investigated the volume of dietary supplements consumed in Norway in 2012:

• Last year, 70 per cent of the population purchased dietary supplements.
• In total, Norwegians spent nearly NOK 3 billion on pills or beverages intended to supplement our diet.
• Many of us use dietary supplements as elements of an alternative diet or in dosages that exceed the recommendations given in the instruction leaflet.

Provided by University of Oslo

The good news about the global epidemic of dementia

It's rare to hear good news about dementia. But that's what a New England Journal of Medicine Perspective article reports. The article discusses several recent studies that show how age-adjusted rates in aging populations have declined for people born later in the last century, particularly in those older people most likely to develop dementia and Alzheimer's disease. The Perspective also describes what researchers have reported to be associated with this encouraging trend.

28 nov 2013--The authors are Eric B. Larson, MD, MPH, executive director of Group Health Research Institute and Group Health's vice president for research; Kristine Yaffe, MD, a professor of psychiatry, neurology, and epidemiology and biostatistics, the Roy and Marie Scola endowed chair in psychiatry, and vice chair for clinical and translational research in psychiatry at the University of California, San Francisco and the San Francisco Veterans Affairs (VA) Medical Center; and Kenneth M. Langa, MD, PhD, a professor of medicine at the University of Michigan and VA Healthcare System. Dr. Larson is also an adjunct professor at the University of Washington Schools of Medicine and Public Health.

"Of course, people are tending to live longer, with worldwide populations aging, so there are many new cases of dementia," Dr. Larson said. "But some seem to be developing it at later ages—and we're optimistic about this lengthening of the time that people can live without dementia." Dementia in those affected may be starting later in the course of life, closer to the time of death.

In 2008, Drs. Langa and Larson reported one of the first studies suggesting a decline in U.S. dementia rates, using information from the U.S. Health and Retirement Study. They found that the decline tracked with education, income, and improvements in health care and lifestyle. Since then, several studies in Europe have confirmed this trend—and the reasons behind it.

"We're very encouraged to see a growing number of studies from around the world that suggest that the risk of dementia may be falling due to rising levels of education and better prevention and treatment of key cardiovascular risk factors such as high blood pressure and cholesterol," Dr. Langa said. He added that it will be very important to continue to follow these trends in the population given the wide-ranging impact of dementia on patients, families, and the health care system.

"This is a fascinating example of personal health changes earlier in life having an impact on personal and public health in late life," Dr. Yaffe said. She and Dr. Larson have reported that regular exercise may help delay dementia. In an earlier publication this year in the New England Journal, Dr. Larson's team reported that people with lower blood sugar levels tend to have less risk of dementia. And Dr. Yaffe and her team have focused on a host of other lifestyle factors that have the potential to reduce risk.

"Still, we need to be aware that recent increases in obesity and diabetes threaten to reverse these gains, because of the impact these conditions can have on the aging brain," Dr. Yaffe said. "The obesity and diabetes epidemics are not affecting age groups most at risk for dementia—yet." But it's just a matter of time.

"To help more people avoid dementia, we'll need to find better ways of preventing obesity—and avoiding obesity-linked health risks, including diabetes and dementia," Dr. Larson said. Narrowing health disparities will also be crucial, because obesity and diabetes are more common among certain racial and ethnic minorities and others who lack access to education and health care.

"As luck would have it, preventing obesity and diabetes jibes with preventing dementia," Dr. Larson said. "In other words, we must focus on exercise, diet, education, treating hypertension, and quitting smoking."

On December 11, the New England Journal of Medicine will post a podcast of Dr. Larson discussing this perspective piece, and that day he and Dr. Yaffe will also address the U.K. Department of Health's G8 Dementia Summit in London. The Summit aims to develop coordinated global action on dementia.

Provided by Group Health Research Institute

A gene mutation for excessive alcohol drinking found

UK researchers have discovered a gene that regulates alcohol consumption and when faulty can cause excessive drinking. They have also identified the mechanism underlying this phenomenon.

27 nov 2013--The study showed that normal mice show no interest in alcohol and drink little or no alcohol when offered a free choice between a bottle of water and a bottle of diluted alcohol.

However, mice with a genetic mutation to the gene Gabrb1 overwhelmingly preferred drinking alcohol over water, choosing to consume almost 85% of their daily fluid as drinks containing alcohol.

The consortium of researchers from five UK universities – Imperial College London, Newcastle University, Sussex University, University College London and University of Dundee – and the MRC Mammalian Genetics Unit (MGU) at Harwell, funded by the Medical Research Council (MRC), Wellcome Trust and ERAB, publish their findings today in Nature Communications.

Dr Quentin Anstee, Consultant Hepatologist at Newcastle University, joint lead author said: "It's amazing to think that a small change in the code for just one gene can have such profound effects on complex behaviours like alcohol consumption.

"We are continuing our work to establish whether the gene has a similar influence in humans, though we know that in people alcoholism is much more complicated as environmental factors come into play. But there is the real potential for this to guide development of better treatments for alcoholism in the future."

Working at the MRC Mammalian Genetics Unit, a team led by Professor Howard Thomas from Imperial College London introduced subtle mutations into the genetic code at random throughout the genome and tested mice for alcohol preference. This led the researchers to identify the gene Gabrb1 which changes alcohol preference so strongly that mice carrying either of two single base-pair point mutations in this gene preferred drinking alcohol (10% ethanol v/v - about the strength of wine), over water.

The group showed that mice carrying this mutation were willing to work to obtain the alcohol-containing drink by pushing a lever and, unlike normal mice, continued to do so even over long periods. They would voluntarily consume sufficient alcohol in an hour to become intoxicated and even have difficulty in coordinating their movements.

The cause of the excessive drinking was tracked down to single base-pair point mutations in the gene Gabrb1, which codes for the beta 1 subunit, an important component of the GABAA receptor in the brain. This receptor responds to the brain's most important inhibitory chemical messenger (GABA) to regulate brain activity.

The researchers found that the gene mutation caused the receptor to activate spontaneously even when the usual GABA trigger was not present.

These changes were particularly strong in the region of the brain that controls pleasurable emotions and reward, the nucleus accumbens, as Dr Anstee explains: "The mutation of the beta1 containing receptor is altering its structure and creating spontaneous electrical activity in the brain in this pleasure zone, the nucleus accumbens. As the electrical signal from these receptors increases, so does the desire to drink to such an extent that mice will actually work to get the alcohol, for much longer than we would have expected."

Professor Howard Thomas said: "We know from previous human studies that the GABA system is involved in controlling alcohol intake. Our studies in mice show that a particular subunit of GABAA receptor has a significant effect and most importantly the existence of these mice has allowed our collaborative group to investigate the mechanism involved. This is important when we come to try to modify this process first in mice and then in man."

Initially funded by the MRC, the 10-year project to find genes affecting alcohol consumption was led by Professor Howard Thomas from Imperial College London and initiated at the MRC Mammalian Genetics Unit. The consortium now involves researchers at five UK universities - Imperial College London, Newcastle University, Sussex University, University College London and the University of Dundee. Senior investigators are Dr Quentin Anstee at Newcastle University and Dr Susanne Knapp at Imperial College London (joint lead authors); Professor Dai Stephens at Sussex University; Professor Trevor Smart at University College London; Professor Jeremy Lambert and Dr Delia Belelli at the University of Dundee; and Professor Steve Brown at the MRC Mammalian Genetics Unit.

Professor Hugh Perry, Chair of the MRC's Neurosciences and Mental Health Board, said: "Alcohol addiction places a huge burden on the individual, their family and wider society. There's still a great deal we don't understand about how and why consumption progresses into addiction, but the results of this long-running project suggest that, in some individuals, there may be a genetic component. If further research confirms that a similar mechanism is present in humans, it could help us to identify those most at risk of developing an addiction and ensure they receive the most effective treatment."

More information: Anstee, Q. M. et al. Mutations in the Gabrb1 gene promote alcohol consumption through increased tonic inhibition. Nat. Commun. 4:2816 DOI: 10.1038/ncomms3816 (2013).

Provided by Newcastle University

Regular physical activity in later life boosts likelihood of 'healthy aging' up to sevenfold

It's never too late to get physically active, with even those starting relatively late in life reaping significant health benefits, finds research published online in the British Journal of Sports Medicine.

26nov 2013--Four years of sustained regular physical activity boosted the likelihood of healthy ageing sevenfold compared with consistent inactivity, the findings show.

The researchers tracked the health of almost 3500 people, whose average age was 64, for more than eight years. All were participants in the English Longitudinal Study of Ageing, which involves a nationally representative sample of the household population of England, born on or before 29 February 1952.

The researchers wanted to quantify the impact of physical activity on the risk of developing long term conditions, depression, and dementia, and on the likelihood of "healthy ageing."

This is usually taken to mean not only an absence of major disease and disability, but also good mental health, the preservation of cognitive abilities, and the ability to maintain social connections/activities.

There's a growing body of evidence to suggest that regular physical activity is essential for the maintenance of good health, while across the developed world, inactivity is ranked alongside smoking, excess drinking, and obesity as a leading cause of reduced life expectancy.

Participants described the frequency and intensity of regular physical activity they did in 2002-3, and then every subsequent two years until 2010-11.

Their responses were categorised as: inactive (no moderate or vigorous activity on a weekly basis); moderately active (at least once a week); and vigorously active (at least once a week).

Any changes in frequency and intensity were noted at the two yearly monitoring sessions: always inactive; became inactive; became active; always active.

Serious ill health, such as heart disease/stroke, diabetes, emphysema, or Alzheimer's disease, was confirmed by medical records.

Cognitive abilities and mental health were assessed using a battery of validated tests, while disability was measured according to participants' responses to questions about the ease with which they were able to carry out routine activities of daily living, and an objective test of walking speed.

Nearly one in 10 of the sample became active and 70% remained active. The rest remained inactive or became inactive.

At the end of the monitoring period almost four out of 10 had developed a long term condition; almost one in five was depressed; a third had some level of disability; and one in five was cognitively impaired.

But one in five was defined as a healthy ager. And there was a direct link to the likelihood of healthy ageing and the amount of exercise taken.

Those who had regularly indulged in moderate or vigorous physical activity at least once a week were three to four times more likely to be healthy agers than those who had remained inactive, after taking account of other influential factors.

Those who became physically active also reaped benefits, compared with those who did nothing. They were more than three times as likely to be healthy agers.

And those who sustained regular physical activity over the entire period were seven times as likely to be healthy agers as those who had consistently remained inactive.

"This study supports public health initiatives designed to engage older adults in physical activity, even those who are of advanced age," conclude the authors.

More information: Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing, Online First, doi 10.1136/bjsports-2013-092993

Provided by British Medical Journal

Prognostic value of lipoprotein (a) with low cholesterol unclear

25 nov 2013—Lipoprotein (a) (Lp[a]) has utility in assessing cardiovascular risk in patients with coronary artery disease (CAD); however, the prognostic value of Lp(a) in patients with low cholesterol levels remains unclear, according to a study published online Oct. 23 in the Journal of the American College of Cardiology.

Michelle O'Donoghue, M.D., from Brigham and Women's Hospital in Boston, and colleagues combined data from three studies of patients with CAD (6,762 participants) and eight previously published studies in which plasma Lp(a) was measured (for a total of 18,979 patients).

The researchers found that increasing levels of Lp(a) were not associated with cardiovascular event risk when modeled as a continuous variable (OR, 1.03) or by quintile (OR Q5:Q1, 1.05), based on data from the three studies. Utilizing the total combined data, subjects with Lp(a) levels in the highest quintile were at increased risk of cardiovascular events (OR, 1.40); however, there was significant between-study heterogeneity (P = 0.001). The association between Lp(a) and cardiovascular events, when stratified on the basis of low-density lipoprotein (LDL) cholesterol, was significant in studies in which average LDL cholesterol was ≥130 mg/dL (OR, 1.46; P < 0.001), whereas this relationship was not significant for studies with an average LDL cholesterol <130 .="" br="">

"Lp(a) is significantly associated with the risk of cardiovascular events in patients with established CAD; however, there exists marked heterogeneity across trials," O'Donoghue and colleagues conclude. "In particular, the prognostic value of Lp(a) in patients with low cholesterol levels remains unclear."

Several authors disclosed financial ties to the pharmaceutical industry, including companies that funded some studies included in the meta-analysis.

More information: Full Text (subscription or payment may be required)