Wednesday, February 22, 2017

Tai Chi may reduce stroke risk



Weekly Tai Chi exercise sessions may reduce stroke risk by lowering high blood pressure and increasing the good cholesterol, or high-density lipoprotein (HDL), according to research presented at the American Stroke Association's International Stroke Conference 2017.

Researchers studied how Tai Chi compared to brisk walking for reducing stroke risk in 246 adults with known stroke risk factors, including high blood pressure. Participants were randomly assigned to a group that participated in two 60-minute Tai Chi sessions each week; a walking group that walked briskly for 30 minutes every day; or a control group, which was told to maintain the activities they were doing before the study.

At three months into the assigned activities, researchers found:

The Tai Chi group had notably greater reductions of 10.25 mm Hg in systolic (upper number) and 6.5 mm Hg in diastolic (lower number) blood pressure measurements than those in the control group.

The Tai Chi group also had an average 0.16 millimole (mmol/L) increase in HDL, compared to the control group.

There were no notable differences in blood pressure or HDL in the walking group.

None of the groups experienced notable changes in total cholesterol, blood sugar levels, body mass index, waist circumference or body fat percentage.

A study longer than three months is needed to monitor the effects of continuing Tai Chi and brisk walking for stroke prevention, researchers suggested.

Middle age diabetes, high blood pressure or smoking = higher risk for dementia later


People who have heart disease risks in middle age - such as diabetes, high blood pressure or smoking - are at higher risk for dementia later in life, according to research presented at the American Stroke Association's International Stroke Conference 2017.

"The health of your vascular system in midlife is really important to the health of your brain when you are older," said Rebecca F. Gottesman, M.D., Ph.D., lead researcher and associate professor of neurology and epidemiology at the Johns Hopkins University in Baltimore.

In an ongoing study that began in 1987 and enrolled 15,744 people in four U.S. communities, the risk of dementia increased as people got older. That was no surprise, but heart disease risks detected at the start of the study, when participants were between 45-64 years of age, also had a significant impact on later dementia, researchers noted. Dementia developed in 1,516 people during the study, and the researchers found that the risk of dementia later in life was:

  • 41 percent higher in midlife smokers than in non-smokers or former smokers;
  • 39 percent higher in people with high blood pressure (?140/90 mmHg) in middle age, and 31 percent higher in those with pre-hypertension (between 120/80 mmHg and 139/89 mmHg) compared to those with normal blood pressure; and
  • 77 percent higher in people with diabetes in middle age than in non-diabetics.
"
Diabetes raises the risk almost as much as the most important known genetic risk factor for Alzheimer's disease," Gottesman said.

Overall, the risk of dementia was 11 percent lower in women. The risk was highest in individuals who were black, had less than a high school education, were older, carried the gene known to increase Alzheimer's risk, or had high blood pressure, diabetes or were current smokers at the time of initial evaluation.

Smoking and carrying the gene known to increase the chance of Alzheimer's were stronger risk factors in whites than in blacks, the researchers noted.

"If you knew you carried the gene increasing Alzheimer's risk, you would know you were predisposed to dementia, but people don't necessarily think of heart disease risks in the same way. If you want to protect your brain as you get older, stop smoking, watch your weight, and go to the doctor so diabetes and high blood pressure can be detected and treated," said Gottesman.

Because Atherosclerosis Risk in Communities is an observational study, the current study could not test whether treating heart risk factors will result in a lessened dementia risk later in life.

"The benefit is that this is a long-term study and we know a lot about these people. Data like these may supplement data from clinical trials that look at the impact of treatment for heart disease risks," Gottesman said.


Prolonged sleep may predict dementia risk


 Data from the Framingham Heart Study has shown that people who consistently sleep more than nine hours each night had double the risk of developing dementia in 10 years as compared to participants who slept for 9 hours or less. The findings, which appear in the journal Neurology, also found those who slept longer had smaller brain volumes.

It is believed that the number of Americans with Alzheimer's disease and other dementias will grow each year as the size and proportion of the U.S. population age 65 and older continues to increase. By 2025 the number of people age 65 and older with Alzheimer's disease is estimated to reach 7.1 million.

A large group of adults enrolled in the Framingham Heart Study (FHS), were asked to indicate how long they typically slept each night. Participants were then observed for 10 years to determine who developed dementia, including dementia due to Alzheimer's disease. Researchers from Boston University School of Medicine (BUSM) then analyzed the sleep duration data and examined the risk of developing dementia.

"Participants without a high school degree who sleep for more than 9 hours each night had six times the risk of developing dementia in 10 years as compared to participants who slept for less. These results suggest that being highly educated may protect against dementia in the presence of long sleep duration," explained co-corresponding author Sudha Seshadri, MD, professor of neurology at BUSM and FHS senior investigator.

According to the researchers the results suggest that excessive sleep may be a symptom rather than a cause of the brain changes that occur with dementia. Therefore, interventions to restrict sleep duration are unlikely to reduce the risk of dementia.

"Self-reported sleep duration may be a useful clinical tool to help predict persons at risk of progressing to clinical dementia within 10 years. Persons reporting long sleep time may warrant assessment and monitoring for problems with thinking and memory," added co-corresponding author Matthew Pase, PhD, fellow in the department of neurology at BUSM and investigator at the FHS.

The researchers believe screening for sleeping problems may aid in the early detection of cognitive impairment and dementia. The early diagnosis of dementia has many important benefits, such as providing a patient the opportunity to more activity direct their future plans and health care decisions.

Popular heartburn drugs linked to gradual yet 'silent' kidney damage


Taking popular heartburn drugs for prolonged periods has been linked to serious kidney problems, including kidney failure. The sudden onset of kidney problems often serves as a red flag for doctors to discontinue their patients' use of so-called proton pump inhibitors (PPIs), which are sold under the brand names Prevacid, Prilosec, Nexium and Protonix, among others.

But a new study evaluating the use of PPIs in 125,000 patients indicates that more than half of patients who develop chronic kidney damage while taking the drugs don't experience acute kidney problems beforehand, meaning patients may not be aware of a decline in kidney function, according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care System. Therefore, people who take PPIs, and their doctors, should be more vigilant in monitoring use of these medications.

The study is published Feb. 22 in Kidney International.

The onset of acute kidney problems is not a reliable warning sign for clinicians to detect a decline in kidney function among patients taking proton pump inhibitors, said Ziyad Al-Aly, MD, the study's senior author and an assistant professor of medicine at Washington University School of Medicine. "Our results indicate kidney problems can develop silently and gradually over time, eroding kidney function and leading to long-term kidney damage or even renal failure. Patients should be cautioned to tell their doctors if they're taking PPIs and only use the drugs when necessary."

More than 15 million Americans suffering from heartburn, ulcers and acid reflux have prescriptions for PPIs, which bring relief by reducing gastric acid. Many millions more purchase the drugs over-the-counter and take them without being under a doctor's care.

The researchers -- including first author Yan Xie, a biostatistician at the St. Louis VA -- analyzed data from the Department of Veterans Affairs databases on 125,596 new users of PPIs and 18,436 new users of other heartburn drugs referred to as H2 blockers. The latter are much less likely to cause kidney problems but often aren't as effective.

Over five years of follow up, the researchers found that more than 80 percent of PPI users did not develop acute kidney problems, which often are reversible and are characterized by too little urine leaving the body, fatigue and swelling in the legs and ankles.

However, more than half of the cases of chronic kidney damage and end-stage renal disease associated with PPI use occurred in people without acute kidney problems.

In contrast, among new users of H2 blockers, 7.67 percent developed chronic kidney disease in the absence of acute kidney problems, and 1.27 percent developed end-stage renal disease.

End-stage renal disease occurs when the kidneys can no longer effectively remove waste from the body. In such cases, dialysis or a kidney transplant is needed to keep patients alive.

"Doctors must pay careful attention to kidney function in their patients who use PPIs, even when there are no signs of problems," cautioned Al-Aly, who also is the VA's associate chief of staff for research and education and co-director of the VA's Clinical Epidemiology Center. "In general, we always advise clinicians to evaluate whether PPI use is medically necessary in the first place because the drugs carry significant risks, including a deterioration of kidney function."


Innovative treatment for depression in older people


An innovative psychological treatment can help older people who are suffering from lower-severity depression, say researchers at the University of York. It can also prevent more severe depression from developing.

Depression is common amongst older people, with one in seven meeting the criteria for full-blown depression. Older people at the greatest risk of depression are those who suffer from loneliness and long-term illnesses, both of which affect this age group disproportionately.

Being depressed can also make health problems worse and older people with depression are at an increased risk of dying. The CASPER clinical trial focussed on older people with lower-severity symptoms who are at the highest risk of becoming clinically depressed.

CASPER is the largest-ever study of its kind and is reported in the Journal of the American Medical Association (JAMA). York based researchers showed that a simple and low-cost intervention reduced the symptoms of depression in older people (aged 65 and over).

Those who received the intervention were also less likely to be more severely depressed after a year. Older people were also less anxious and had improved quality of life compared to people who just received care from their GP.

"We developed our Collaborative Care intervention after consulting with older people and considering evidence about effective treatments for depression." said study manager, Kate Bosanquet, from the University of York's Department of Health Sciences.

"We used a simple psychological approach known as behavioural activation. Older people were encouraged to re-engage with social activity and to find alternative ways of being mentally or physically active. This is important since people with depression commonly withdraw from these types of activities and this makes things worse."

"Older people found Collaborative Care to be an acceptable way of accessing help,' said Della Bailey, one of the therapists working on the study.

"We mostly worked with people over the telephone and found that participants appreciated this approach. This also meant that older people did not have to travel to hospital to receive psychological care."

The study team, which also included researchers from the NHS, other universities and the Hull York Medical School are now planning to train NHS therapists in Collaborative Care to ensure that older people all over the UK can benefit from this intervention.

"'This is the largest rigorous study of its kind and we are very grateful to the National Institute for Health Research, which funded our work, and to the hundreds of older people who participated in the study," said Chief Investigator, Professor Simon Gilbody.


Tuesday, February 21, 2017

Unlocking the heart-protective benefits of soy



A product of digesting a micronutrient found in soy may hold the key to why some people seem to derive a heart-protective benefit from eating soy foods, while others do not, a University of Pittsburgh Graduate School of Public Health-led study discovered.

Japanese men who are able to produce equol -- a substance made by some types of "good" gut bacteria when they metabolize isoflavones (micronutrients found in dietary soy)--have lower levels of a risk factor for heart disease than their counterparts who cannot produce it, according to the research published in the British Journal of Nutrition.

"Scientists have known for some time that isoflavones protect against the buildup of plaque in arteries, known as atherosclerosis, in monkeys, and are associated with lower rates of heart disease in people in Asian countries," said senior author Akira Sekikawa, M.D., Ph.D., an associate professor of epidemiology at Pitt Public Health. "We were surprised when a large trial of isoflavones in the U.S. didn't show the beneficial effects among people with atherosclerosis in Western countries. Now, we think we know why."

All monkeys can produce equol, as can 50 to 60 percent of people in Asian countries. However, only 20 to 30 percent of people in Western countries can.

Sekikawa and his colleagues, who include scientists in Japan, recruited 272 Japanese men aged 40 to 49 and performed blood tests to find out if they were producing equol. After adjusting for other heart disease risk factors such as high blood pressure, cholesterol, smoking and obesity, the team found that the equol-producers had 90-percent lower odds of coronary artery calcification, a predictor of heart disease, than the equol non-producers.

The daily intake of dietary isoflavones -- found in traditional soy foods such as tofu, miso and soymilk--is 25 to 50 milligrams in China and Japan, while it is less than 2 milligrams in Western countries. Equol is available as a supplement--bypassing the need for gut bacteria to produce it--though no clinical trials have been performed to determine a safe dosage for heart protective effects, or if it even does provide such protection.

"I do not recommend that people start taking equol to improve their heart health or for any other reason unless advised by their doctor," said Sekikawa. "Much more study is needed."

Sekikawa and his team are pursuing funding for a much larger observational study to expand on their findings and eventually a randomized clinical trial to examine the effect of taking equol on various medical conditions and diseases.

"Our discovery about equol may have applications far beyond heart disease," said Sekikawa. "We know that isoflavones may be associated with protecting against many other medical conditions, including osteoporosis, dementia, menopausal hot flashes, and prostate and breast cancers. Equol may have an even stronger effect on these diseases."


Exercise most important lifestyle change to help reduce risk of breast cancer recurrence


For patients with breast cancer, physical activity and avoiding weight gain are the most important lifestyle choices that can reduce the risk of cancer recurrence and death, according to an evidence-based review published in CMAJ (Canadian Medical Association Journal).

"Of all lifestyle factors, physical activity has the most robust effect on breast cancer outcomes," writes Dr. Ellen Warner, Sunnybrook Health Sciences Centre, Toronto, Ontario, with coauthor Julia Hamer. "Weight gain of more than 10% body weight after a breast cancer diagnosis increases breast cancer mortality and all-cause mortality. However, there are good reasons to discourage even moderate weight gain because of its negative effects on mood and body image," the authors state.

The review of 67 published articles looks at a variety of lifestyle factors, such as exercise, weight, diet, smoking and more, and examines the changes women can make to improve their chances of survival and reduce the risk of cancer recurring. About one-quarter of women diagnosed with early stage disease will eventually die of later metastases.

As the review contains practical recommendations of interest to patients, their families, physicians and other health care professionals, it is open-access and freely available to a global audience.

While evidence is inconclusive on the impact of some lifestyle behaviours, such as specific diets, alcohol consumption and vitamin supplements, the authors have summarized easy-to-follow key findings and unanswered questions in charts.

Key findings:

  • Avoid weight gain -- weight gain during or after breast cancer treatment is linked to breast cancer-related death. Women who are overweight or obese at diagnosis also have poorer prognoses.
  • Exercise -- patients should engage in at least 30 minutes of moderate exercise a day, five days a week, or 75 minutes of vigorous exercise per week. Two to three sessions of strength training for large muscle groups are also recommended.
  • Diet -- no specific type of diet has been shown to reduce the risk of breast cancer recurrence. Evidence indicates that patients do not need to avoid soy, and it may help with weight management if used to replace higher-calorie meat protein.
  • Vitamin supplementation -- moderate consumption of vitamin C may be helpful although more evidence is needed. Vitamin D supplements may be taken to maintain adequate levels for bone strength, since chemotherapy and hormonal treatments can reduce bone density.
  • Smoking -- stop smoking. While it is unclear if stopping smoking after a breast cancer diagnosis affects recurrence, the risk of death from smoking-related health issues is a strong reason to quit.
  • Alcohol intake -- limiting consumption to one or fewer alcoholic drinks per day may help reduce the risk of a second breast cancer.
"Making positive lifestyle changes can also be psychologically beneficial to patients by empowering them, since the feeling of loss of control is one of the biggest challenges of a cancer diagnosis," write the authors.

Physicians can play an important role in helping patients make positive changes.

"Because it is common for patients to reduce their level of physical activity after a breast cancer diagnosis, it is important for health care professionals to promote and encourage exercise in this patient population," the authors write. "Simply receiving advice from an oncologist to exercise more has been shown to increase patients' level of activity."

An important point to emphasize is that the breast cancer patients in the studies showing the benefits of lifestyle changes were also receiving conventional anticancer therapy; lifestyle changes should never be used as a substitute for standard therapy.

The authors caution that these recommendations are not a silver bullet for all women with breast cancer. Some breast cancers have aggressive biology and will recur despite the most meticulous lifestyle behaviours.

"Patients should not be made to feel that inadequate lifestyle changes have led to recurrence of their cancer," they conclude.