Thursday, March 22, 2018

Mono-unsaturated fats from plants, not animals may reduce risk of death from heart disease and other causes

Diets rich in mono-unsaturated fatty acids from plants were associated with a lower risk of dying from heart disease or other causes compared to diets rich in mono-unsaturated fats from animals, which were linked to a higher risk of death from heart disease or other causes, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

"Our results emphasize the importance of the source and quantity of mono-unsaturated fatty acids in the diet - we should eat more mono-unsaturated fatty acids from plant sources and less mono-unsaturated fatty acids from animal sources," said Marta Guasch-Ferré, Ph.D., a research associate and one of the lead authors of this study along with Geng Zong, Ph.D., a research fellow. Both are at the Harvard School T.H. Chan of Public Health in Boston.

Mono-unsaturated fats are usually liquid at room temperature and solidify when refrigerated. Sources of plant-based mono-unsaturated fats include olive and other vegetable oils, avocados and many nuts and seeds. Sources of animal-based mono-unsaturated fats include full-fat dairy products, eggs, poultry, red meats and fish.

To assess the impact of mono-unsaturated fatty acids consumption on death from cardiovascular disease and other causes, researchers used data from 63,412 women from the Nurses' Health Study and 29,966 men from the Health Professionals Follow-Up Study. Both studies used detailed food-frequency questionnaires administered every four years to evaluate the composition of the participants' diets. This type of observational study can identify a trend among the participants but cannot prove cause and effect.

During an average 22 years of follow-up, there were 20,672 deaths among participants, 4,588 of them from heart disease. Analyzing the diet information, the researchers found:
  • Participants with a higher intake of mono-unsaturated fatty acids from plants had a 16 percent lower risk of death from any cause compared to those with lower intakes.
  • Participants with a higher intake of mono-unsaturated fatty acids from animals had a 21 percent higher risk of death from any cause.
  • Replacing saturated fats, refined carbohydrates (like simple sugars) or trans fats with an equal number of calories (2 percent - 5 percent of the total) from mono-unsaturated fatty acids from plants might lower the risk of heart disease deaths and death from any cause between 10 percent and15 percent.
  • Replacing mono-unsaturated fatty acids from animals with an equal amount of calories (5 percent of the total) of mono-unsaturated fatty acids from animals might lower the risk of heart disease deaths and deaths from any cause between 24 percent to 26 percent.
In the study, the risks were adjusted to account for several known factors that could influence the risk of death, including ethnicity; smoking status; intake of alcohol, fruits and vegetables and total calories; family history of chronic diseases; physical activity; body mass index; and heart disease risk factors when participants enrolled. The results should be interpreted with caution because the study relied on the participants' self-reporting what they ate and because participants consuming higher amounts of plant-based foods may be more health conscious in general.

Drinking sugary drinks may be associated with greater risk of death American H

Adults over the age of 45 who consume large amounts of sugary beverages including soft drinks, fruit drinks and fruit juices may have a higher risk of dying from heart disease or other causes, compared to those who drink fewer sugary drinks, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

The researchers found a graded association between consuming more sugary beverages and an increased risk of death from heart disease or any cause. Study participants in the top 25 percent of consumers, those who tended to drink 24 ounces or more of sugary beverages each day, had twice the risk of death from coronary heart disease compared to those in the lowest 25 percent of people who drank less than 1 ounce. In addition, there was an increased risk of death from all causes, including other cardiovascular conditions. The study, however, found no link between the consumption of sugary foods and increased risk of death, a distinction the researchers said may be related to how sugary drinks and foods are processed by the body.

Several studies have shown an association between added sugar and obesity and various chronic diseases. However, few have been able to look at the association between increased sugar consumption and death. It is important to note that this study does not prove cause and effect, rather it identifies a trend.

"There were two parts of this question we wanted to understand," said Jean Welsh, Ph.D., M.P.H., study author, assistant professor at Emory University and a research director with Children's Healthcare of Atlanta. "Do added sugars increase risk of death from heart disease or other causes, and, if so, is there a difference in risk between sugar-sweetened beverages and sugary foods? We believe this study adds strong data to what already exists highlighting the importance of minimizing sugary beverages in our diet."

This study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a U.S.-based longitudinal study of 30,183 black and white adults over age 45. The final study population was 17,930 after excluding those with a self-reported history of heart disease, as well as stroke and Type 2 diabetes. This type of study is designed to find an association or trend, not to prove cause and effect.

The researchers estimated sugary food and beverage consumption using a food frequency questionnaire. Sugar-sweetened beverages included those pre-sweetened, such as sodas and fruit drinks. Sugar-sweetened foods included desserts, candy and sweetened breakfast foods as well as foods to which calorie-containing sweeteners such as sugars or syrups had been added.

The participants were followed for an average of about 6 years, and researchers used death records to look at the cause of death, focusing on deaths from heart disease, such as heart attack, heart failure and deaths from all other causes.

The researchers observed this effect when they statistically made the participants equal with respect to income, race, education, smoking history and physical activity. When they controlled for known heart disease risk factors such as total calorie consumption, high blood pressure, abnormalities in blood lipids or body weight, the effect remained. Researchers did not see any increased risk with consumption of sugary foods.

The quantity and frequency of consumption of sugary beverages, coupled with the fact that they contain few, if any other nutrients, results in a flood of sugars that need to be metabolized, Welsh said. When people consume sugars in foods there are often other nutrients such as fats or proteins which slow down metabolism and may explain the different effect seen between the two.

The study's finding should encourage healthcare providers to ask patients about sugary beverage consumption during well visits to open the door to a conversation about a dietary change that could be made to reduce risk, Welsh said.

"We know that if healthcare providers don't ask patients about lifestyle practices linked to obesity and chronic disease, patients tend to think they're not important," Welsh said. "Simply asking patients about their sugary beverage consumption is valuable."

Menopausal hormone therapy helps maintain the brain

Taking menopausal hormone therapy soon after menopause to relieve symptoms may also benefit the brain, according to a study published in the March 21, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"We found that one form of menopausal hormone therapy taken soon after menopause may preserve brain structure in the portion of the brain responsible for memory and thinking skills," said study author Kejal Kantarci, MD, MS, of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology. "It may also reduce the development of amyloid plaques that can build up and lead to memory loss."

For the study, researchers identified 75 healthy women with an average age of 53 who were between five months to three years past menopause. Of those, 20 women took conjugated equine estrogen in pill form, 22 received estradiol via skin patches and 33 received a placebo of either the pills or patches. In addition, the women taking active hormone were also given progesterone pills for the first 12 days each month. Placebo pills were given to those in the placebo group.

Study participants were given memory and thinking tests as well as MRI scans at the start of the study, at 18 months, at three years and at the end of four years of hormone treatment, and then again three years after therapy ended. Researchers measured overall brain volume and the accumulation of brain lesions and compared scores on thinking and memory tests. A total of 68 women also had positron emission tomography (PET) scans to detect plaques in the brain that are related to memory loss and Alzheimer's disease.

Researchers found that participants who took estradiol via skin patches maintained brain volume in the dorsolateral prefrontal cortex, an area of the brain that assists with memory, thinking, planning and reasoning, over the seven years of the study. Women who maintained volume in this area of the brain were also more likely to have a lower amount of the amyloid plaque deposits that are related to memory loss and Alzheimer's disease. This suggests that estradiol therapy may have long-term effects on the brain.

Researchers also found that for those taking estrogen pills, there were greater structural changes in the brain during therapy, but those changes stopped when participants stopped taking the pills.
Scores on thinking and memory tests were similar for women in the hormone therapy groups and those taking placebo.

"More research is needed to determine the biological reasons behind brain changes during menopausal hormone therapy," said Kantarci. "Future research is also need to better define just how the different hormonal products, pills versus skin patches, affect the brain."

A limitation of the study is that the women were all in good cardiovascular health, so the results may not be similar for those with heart problems, diabetes or other health issues. However, Kantarci noted that not including those with heart issues may have made it easier to observe the effects of hormone therapy on the brain, since there was no interference from contributing heart problems.

Sitting and physical inactivity may increase risk of urinary tract symptoms

Prolonged sitting time and low physical activity levels were linked with the development of lower urinary tract symptoms (LUTS) in a BJU International study of 69,795 middle-aged Korean men.
A team led by researchers at the Kangbuk Samsung Hospital, in South Korea, found that the incidence rate of LUTS--which relate to urine storage and/or voiding disturbances--was 39 per 1000 person-years. (A person-year is the number of years of follow-up multiplied by the number of people in the study.)

"The results support the importance of both reducing sitting time and promoting physical activity for preventing LUTS," said lead author Dr. Heung Jae Park. "Further studies are still needed to examine the influence of sedentary behaviors on LUTS and its determinants," added senior author Dr. Seungho Ryu.

Tai chi as good as or better than aerobic exercise for managing chronic pain

The ancient martial art of tai chi has similar or greater benefits than aerobic exercise for people with the chronic pain condition fibromyalgia, finds a trial published by The BMJ today.

The findings suggest it may be time to rethink what type of exercise is most effective for patients with chronic pain conditions.

Fibromyalgia is a long-term condition that causes widespread body pain. It may also lead to extreme tiredness, muscle stiffness, difficulty sleeping and depression. It affects around 2-4% of the adult population worldwide.

Aerobic exercise is currently recommended as a standard treatment, but many patients find it difficult to exercise due to fluctuations in symptoms.

Some trials have suggested that tai chi alleviates pain and improves physical and mental health in patients with fibromyalgia but concluded that larger and more rigorous trials are needed to confirm the results.

So to investigate further, a team of US researchers set out to compare the effectiveness of tai chi with aerobic exercise and to test whether this depends on its frequency or duration.

They identified 226 adults with fibromyalgia who had not participated in tai chi or other similar types of complementary and alternative medicine within the past six months. The average age of participants was 52 years, 92% were women, 61% were white, and average duration of body pain was nine years.

At the start of the trial, participants completed the fibromyalgia impact questionnaire (FIQR), which scores physical and psychological symptoms such as pain intensity, physical function, fatigue, depression, anxiety, and overall wellbeing.

Participants were then randomly assigned to either supervised aerobic exercise twice weekly for 24 weeks or to one of four tai chi interventions: 12 or 24 weeks of supervised tai chi completed once or twice weekly.

Changes in symptom scores were assessed at 12, 24 and 52 weeks and participants were able to continue routine drugs and usual visits to their physicians throughout the trial.

FIQR scores improved in all five treatment groups at each assessment, but the combined tai chi groups improved significantly more than the aerobic exercise group at 24 weeks. Tai chi also showed greater benefit when compared with aerobic exercise of the same intensity and duration (twice weekly for 24 weeks).

Those who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks, but there was no significant increase in benefit for those who received tai chi twice weekly compared with once weekly.

The effects of tai chi were consistent across all instructors and no serious adverse events related to the interventions were reported. The findings also remained largely unchanged after further analyses to test the strength of the results.

The researchers point to several study limitations. For example, participants were aware of their treatment group assignment, and attendance differed between the two treatment groups, both of which could have influenced the results. However, key strengths include the large and diverse sample and longer follow-up than previous studies.

"Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia," write the authors. "This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia," they conclude.

In a linked opinion article, lead researcher Dr Chenchen Wang, says the public health problem of chronic pain calls for an "all hands on deck" approach to give patients feasible therapeutic options for the management of fibromyalgia. "It is time, therefore, for physicians to explore new approaches and rethink their strategies in order to provide the best care for patients with chronic pain conditions."

In a second opinion article, Amy Price, a trauma survivor with chronic pain, describes how tai chi has helped improve her balance, reduce anxiety, and manage pain.

She acknowledges that tai chi does not work for everyone with fibromyalgia, but says the advantage is that "it is low risk and minimally invasive, unlike surgery, and it will not harm your organs, like long term drug use." And there is also the chance that it might complement other interventions to help your body work better, she concludes.

Flu and pneumonia infections increase risk of having a heart attack and stroke

People who have had flu or pneumonia may be six times more likely to suffer from a heart attack or stroke in the days after infection, according to new research published in the European Respiratory Journal [1].

The research, funded by the Academy of Medical Sciences, is the largest study to look at the risk of heart attacks and strokes due to specific respiratory infections. It found that several different organisms that cause respiratory infections also increase heart attack and stroke risk, including S. pneumoniae bacteria and influenza.

The researchers say that the findings suggest that getting vaccinated against these two infections could also have a role in preventing heart attack and stroke, along with preventing infection in the first place.

In general, respiratory infections are thought to increase the risk of heart attack and stroke by causing inflammation, which can lead to the development of blood clots. The influenza virus and S.pneumoniae, the most common pneumonia causing bacteria, can also have harmful effects on the heart muscle.

The new research found that having flu or pneumonia increases the risk of having a heart attack for up to a week after infection, and the risk of having a stroke is increased for one month.

Lead researcher Dr Charlotte Warren-Gash, Associate Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, UK, explained the importance of the study: "Heart disease, strokes and lower respiratory infections have been the three leading causes of death globally for over 15 years, and are important public health problems that affect large numbers of people worldwide.
"As people age, having more than one medical condition becomes more common, so it is even more important to understand the links between different diseases. If we can understand who is at risk of these cardiovascular complications after respiratory infections, we can potentially intervene to prevent them, with methods such as vaccines."

Using national infection surveillance data from the Scottish Morbidity Record, the researchers identified 1,227 adults with a first heart attack and 762 with a first stroke who also had a respiratory virus or bacteria infection at any time between 2004 and 2014.

The research team then investigated the rate of heart attacks and strokes in the periods of time immediately after a respiratory infection, and then compared this to the rate of cardiovascular events in other periods of time in the same people.

The data showed that having a confirmed respiratory infection made people six times more likely to have a heart attack or stroke for three days after infection. Dr Warren-Gash explains: "In Scotland, among those aged 75 years and above, around two in 10,000 people have a heart attack each week. Our analysis found this figure rose to 10 in 10,000 in the week after having a respiratory infection."

The S.pneumoniae bacteria and the influenza virus were found to have the biggest impact on increasing the risk of having heart attacks and strokes.

The effect of infections on heart attack and stroke risk was greater in people aged less than 65 years compared to those aged 65 and above. The researchers note that vaccine uptake is higher among those aged 65 and over, and say that being vaccinated could help to protect against heart attacks and strokes after respiratory infection.

However, Dr Warren-Gash said: "For most young, healthy people, the risk of heart attacks and strokes occurring after a respiratory infection is low. This research is particularly relevant for those over the age of 65, as well as people with pre-existing heart diseases, as these groups are at higher risk of heart attacks and strokes.

"These groups are already recommended to have vaccinations against influenza and S.pneumoniae - the two bugs we found to be linked to the highest cardiovascular risk - but we know that vaccine uptake is not high among younger people with heart problems. Understanding that there is a link between these bugs and heart attacks and strokes is an added incentive to get those vaccinations."

The researchers acknowledge that the study was not able to look at individual effects of less common respiratory viruses, or to examine how respiratory infections affect cardiovascular risk in different age groups in detail.

Dr Warren-Gash added: "Our research highlights the importance of ongoing work into which doses of vaccine are best to protect people from heart attacks and strokes. Although flu and pneumonia seem to have the biggest impact, this research also shows that a group of other respiratory viruses had some triggering effects. We don't currently have vaccines for these viruses so further research is needed."

Professor Mina Gaga, President of the European Respiratory Society, and Medical Director and Head of the Respiratory Department of Athens Chest Hospital, said: "We already know that having a respiratory infection is associated with a temporary increase in the risk of heart attacks in the weeks that follow infection, and there is some evidence that pneumococcal and influenza vaccinations have a protective effect.

"This large study reinforces the importance of making sure patients who are at-risk of heart attacks and strokes, such as people with chronic diseases and those aged over 65, are vaccinated against influenza and pneumonia to help better protect against adverse cardiovascular complications as well as respiratory infection."

Surpassing critical blood pressure threshold could signal hypertension regardless of age

Hypertension, abnormally high blood pressure, is associated with an increased risk of heart attack and stroke. Many healthcare professionals still believe that incremental changes in blood pressure are normal, and expected, with aging. A new study by investigators at Brigham and Women's Hospital, published in the journal of JAMA Cardiology, found that a systolic (top) blood pressure that regularly exceeds 120-125 mmHg could signal impending hypertension, regardless of age. These results are in line with the recently updated American College of Cardiology and American Heart Association high blood pressure guidelines, which categorize high blood pressure as greater than 130/80 mmHg.

"There used to be a widespread belief that a gradual increase in blood pressure over time is part of normal aging," says Susan Cheng, MD, a cardiologist at BWH and senior author on the paper. "But, if you look at native communities, where people live without the lifestyle exposures usually seen in industrialized societies, this trend is hard to find. And so, we wondered if blood pressure is supposed to very gradually increase over time or instead remain stable. We also wanted to find out, for people in whom blood pressure does rise, is there a tipping point at which hypertension starts to develop. In other words, if hypertension does develop, when does the change start to happen, what does it look like, and how might we prevent it?"

In the study, researchers examined data from 1,252 participants from the Framingham Heart Study, which contains one of the few existing cohorts with standardized blood pressure (BP) measurements performed at frequent intervals (every two years) over an extended period of time (1948 to 2005). The team defined hypertension onset as a blood pressure over or equal to 140/90 mmHg. Participants were categorized based on the age at which their hypertension was diagnosed (age 40-49, 50-59, 60-69, 70-79 years, or no onset).

The research team found that, among the patients who developed hypertension, blood pressure trajectories leading up to the onset of hypertension appeared similar in pattern. In fact, their blood pressure levels were generally stable until they approached the range of ~120-125 mmHg, above which their blood pressure rose rapidly and into the range of hypertension. This finding was consistent whether the hypertension developed in middle or older age, suggesting that blood pressures above this level could represent a critical threshold of vascular remodeling occurring in the body. Interestingly, this blood pressure range is in line with recently published guidelines that lowered the definition of high systolic blood pressure to 130 mmHg.

"Although our findings suggest the potential importance of working to keep your top blood pressure number below 120 mmHg, they also offer a hope for healthy aging - our results demonstrated that some individuals are able to maintain a very normal range of blood pressure throughout life," says Niiranen Teemu, MD, first author and a research associate at Brigham and Women's Hospital.

The researchers found that many people in the study were able maintain a systolic blood pressure below 120-125 mmHg and, in effect, delay the uptick of blood pressure elevation until much later in life and, in some cases, avoid it altogether. This new way of understanding life course trends in blood pressure could affect clinical practice by motivating physicians to be more vigilant when encountering blood pressure at or approaching uptick levels.

 Further investigations are needed to unravel the sequence of changes in the body that occur before hypertension sets in and to determine the potential benefits of interventions in preventing progressive rises in blood pressure, at any age.