Wednesday, March 22, 2017

Falls Are the Leading Cause of Injury Among Older Adults

​One in four upstate New York adults older than age 65 fell at least once in the last year, according to research by Excellus BlueCross BlueShield. Forty percent, or two in five of those who fell, experienced an injury.

Using two years of self-reported survey data from government health agencies, Excellus BlueCross BlueShield found that falls are common among upstate New York adults ages 65 and older. The risk for falling and the severity of an injury increase with age.

Of upstate New Yorkers age 65 to 69:
24 percent fell in the last 12 months
32 percent were injured from a fall

Of upstate New Yorkers age 80+:
31 percent fell in the last 12 months
44 percent were injured from a fall

“One finding of concern − but we frankly have no explanation for it − is the regional variation in the rate of falls per 1,000 population ages 65 and older,” said Bruce Naughton, MD, vice president and chief medical officer for Medicare. The data show that adults ages 65 and older in the Utica-Rome-North Country region reported falls at more than twice the rate of adults 65+ in the Finger Lakes region, where the rate of reported falls was lower than state and upstate New York averages.

“Falling is not an accepted part of the aging process in any region,” said Naughton. “There are simple things that everyone can do right now for themselves and their loved ones to help reduce the incidence of falls and promote independent and active lifestyles.” 

Lower body weakness and difficulty with balance are risk factors for falling. Naughton advises staying active and maintaining a fitness routine. Simple activities, such as exercising in a chair or stretching in bed, can greatly improve strength and balance. Finding a fitness partner can add the motivation to go for walks, take a dip in a local pool or even learn tai chi.

Certain medications can affect balance. People also are more likely to fall if they have vision problems or inadequate nutrition. According to Naughton, proper vision care (including up-to-date eyeglass prescriptions), proper nutrition and a thorough medication review can help cut down on falls.

Nationally, one in five falls causes serious harm, such as a broken bone or a head injury.

Among older New York state residents who are hospitalized because of a fall, 60 percent go to a nursing home or rehab facility, 27 percent experience a hip fracture, and 11 percent suffer a traumatic brain injury.

The estimated annual impact that falls have on health care spending in upstate New York is substantial, according to a report issued by Excellus BlueCross BlueShield in 2012. That report shows $30.6 million in emergency room costs and $321.0 million in hospital costs directly related to falls.

Home hazards contribute to the incidence of falls.

“We all take great care to childproof our homes when there are toddlers running about,” said Naughton. “We need to give the same attention to eliminating tripping hazards for older adults, or anyone who has difficulty with walking or balance.” 

The most common tripping hazards include:

·    Throw rugs that bunch or slide.

·    Clutter.

·    Steps that are uneven, too steep or too long, and that have inadequate railings.

·    Lighting that’s either too dim, or so bright that it causes glare.

·    Pets that follow too closely or lie in prime walking areas.

·    Unstable chairs or tables that can’t support a person’s weight.

·    Extension cords across walkways.

·    Bathrooms that lack grab bars, or that have low toilet seats.

·    Sloping yards and driveways.

·    Cracks in sidewalks, or uneven transitions between bare floors and carpeted rooms.

“We can and should encourage people to stay active as they age, keep their doctors informed about any issues with balance or vision, and eliminate easy tripping hazards around the house and yard to reduce fall-related injuries, emergency room visits and hospital stays,” said Naughton.

Cocoa + caffeine = more attention, motivation to perform cognitive work; less anxiety & fatigu

Deep down, we always knew it, but science is proving that cocoa and caffeine are indeed the best marriage ever. Clarkson University researcher Ali Boolani recently completed a study that explores the powers of these two dark delights.

The assistant professor of physical therapy and physician assistant studies teamed up with colleagues at the University of Georgia to examine the "acute effects of brewed cocoa consumption on attention, motivation to perform cognitive work and feelings of anxiety, energy and fatigue."

In a nearly year-long double-blind study, some lucky test subjects drank brewed cocoa, cocoa with caffeine, caffeine without cocoa, and a placebo with neither caffeine nor cocoa. Then they were asked to do tests to evaluate both cognitive tasks and mood.


Brewed cocoa can acutely reduce errors associated with attention in the absence of changes in either perceived motivation to perform cognitive tasks or feelings of energy and fatigue. Supplemental caffeine in brewed cocoa can enhance aspects of attention while brewed cocoa can attenuate the anxiety-provoking effects found from drinking caffeine alone.

"It was a really fun study," Boolani says. "Cocoa increases cerebral blood flow, which increases cognition and attention. Caffeine alone can increase anxiety. This particular project found that cocoa lessens caffeine's anxiety-producing effects -- a good reason to drink mocha lattes!"

"The results of the tests are definitely promising and show that cocoa and caffeine are good choices for students and anyone else who needs to improve sustained attention," says Boolani.

Boolani and his colleagues - have published a paper about the results of their study in the journal BMC Nutrition.

Tuesday, March 21, 2017

Intensive aquatic resistance training decreases body fat mass and improves physcial function

Aquatic resistance training significantly decreases body fat mass and increases walking speed, i.e., phsyical function in postmenopausal women with mild knee osteoarthritis. The effect of aquatic resistance training on walking speed are long lasting and are maintained one-year after training is ceased. However, higher overall levels of leisure time physical activity are required for long-term management of fat and body mass. This was observed in the study carried out in the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. This study investigated the effect of a 4-month intensive aquatic resistance training program as well as the association between overall leisure time physical activity on body composition and functional capacity in post-menopausal women with mild knee OA. This study was conducted in cooperation with the Central Finland Central Hospital, the Department of Medical Technology, Institute of Biomedicine in University of Oulu, Finland and the Department of Orthopaedics and Traumatology in University of Helsinki, Finland. Eighty-seven 60 to 68 years old eligible postmenopausal women with knee pain and confirmed radiographic osteoarthritis related changes in the knee joint were enrolled into the study and randomly assigned into either a training group or a control group. The participants in the training group completed 1-hour of intensive aquatic lower limb resistance exercises three times a week for 4-months. The control group maintained usual care and were asked to continue their usual leisure time activities. Eighty-four women continued into the 12-month follow-up period. Daily physical leisure time activity was recorded throughout the whole 16-month study period.
People with mild knee OA should consider participating in high intensity aquatic resistance training in order to slow or even stop the progression of their knee OA. Higher levels of daily leisure time physical activity was only associated with reduced body weight therefore the high intensity aquatic exercise was essential for improvements in both functional capacity and body composition reported Dr. Ben Waller.

Aquatic exercise for prevention of knee OA
Treatment of knee osteoarthritis is shifting focus from end stage treatment to preventing the progression from early to the late stage of the disease, with the specific aim of decreasing the need for joint replacement and other costly treatments. Two main risk factors for the progression and worsening of pain and decreased in function capacity are increased body mass, in particular fat mass and slower walking speeds. Exercise on land is known to have a positive effect on body composition and walking speed but often people with knee OA avoid physical activity due to pain, even in the early stage of the disease. Therefore, aquatic resistance training appears be an alternative training modality for this population.
The clinical significance of this study is, that the decrease in body mass and increase in walking speed achieved safely with aquatic resistance training are both large enough to prevention worsening of clinical symptoms and slow or even stop the loss of cartilage which are typical finding in late-stage knee osteoarthritis.
The results of this study will be published in the Peer reviewed journal of Osteoarthritis and Cartilage.

Indigenous South American group has healthiest arteries of all populations due to healthy lifestyle

The Tsimane people -- a forager-horticulturalist population of the Bolivian Amazon -- have the lowest reported levels of vascular aging for any population, with coronary atherosclerosis (hardening of the arteries) being five times less common than in the US, according to a study published in The Lancet and being presented at the American College of Cardiology conference.

The researchers propose that the loss of subsistence diets and lifestyles in contemporary society could be classed as a new risk factor for heart disease. The main risk factors are age, smoking, high cholesterol, high blood pressure, physical inactivity, obesity and diabetes.

"Our study shows that the Tsimane indigenous South Americans have the lowest prevalence of coronary atherosclerosis of any population yet studied," said senior anthropology author, Professor Hillard Kaplan, University of New Mexico, USA. "Their lifestyle suggests that a diet low in saturated fats and high in non-processed fibre-rich carbohydrates, along with wild game and fish, not smoking and being active throughout the day could help prevent hardening in the arteries of the heart. The loss of subsistence diets and lifestyles could be classed as a new risk factor for vascular aging and we believe that components of this way of life could benefit contemporary sedentary populations."

Although the Tsimane lifestyle is very different from that of contemporary society, certain elements of it are transferable and could help to reduce risk of heart disease.

While industrial populations are sedentary for more than half of their waking hours (54%), the Tsimane spend only 10% of their daytime being inactive. They live a subsistence lifestyle that involves hunting, gathering, fishing and farming, where men spend an average of 6-7 hours of their day being physically active and women spend 4-6 hours.

Their diet is largely carbohydrate-based (72%) and includes non-processed carbohydrates which are high in fibre such as rice, plantain, manioc, corn, nuts and fruits. Protein constitutes 14% of their diet and comes from animal meat. The diet is very low in fat with fat compromising only 14% of the diet -- equivalent to an estimated 38 grams of fat each day, including 11g saturated fat and no trans fats. In addition, smoking was rare in the population.

In the observational study, the researchers visited 85 Tsimane villages between 2014 and 2015. They measured the participants' risk of heart disease by taking CT scans of the hearts of 705 adults (aged 40-94 years old) to measure the extent of hardening of the coronary arteries, as well as measuring weight, age, heart rate, blood pressure, cholesterol, blood glucose and inflammation.

Based on their CT scan, almost nine in 10 of the Tsimane people (596 of 705 people, 85%) had no risk of heart disease, 89 (13%) had low risk and only 20 people (3%) had moderate or high risk. 

These findings also continued into old age, where almost two-thirds (65%, 31 of 48) of those aged over 75 years old had almost no risk and 8% (4 of 48) had moderate or high risk. These results are the lowest reported levels of vascular aging of any population recorded to date.

By comparison, a US study of 6814 people (aged 45 to 84) found that only 14% of Americans had a CT scan that suggested no risk of heart disease and half (50%) had a moderate or high risk -- a five-fold higher prevalence than in the Tsimane populatio
In the Tsimane population, heart rate, blood pressure, cholesterol, and blood glucose were also low, potentially as a result of their lifestyle. The researchers also note that the low risk of coronary atherosclerosis was identified despite there being elevated levels of inflammation in half of the Tsimane population (51%, 360 of 705 people).

"Conventional thinking is that inflammation increases the risk of heart disease," said Professor Randall Thompson, cardiologist at Saint Luke's Mid America Heart Institute, USA. "However, the inflammation common to the Tsimane was not associated with increased risk of heart disease, and may instead be the result of high rates of infections."

Because the study is observational it cannot confirm how the Tsimane population is protected from vascular aging, or which part of their lifestyle (diet, physical activity or smoking) is most protective. The researchers suggest it is more likely to be a result of their lifestyle than genetics, because of a gradual increase in cholesterol levels coinciding with a rapidly changing lifestyle.

"Over the last five years, new roads and the introduction of motorised canoes have dramatically increased access to the nearby market town to buy sugar and cooking oil," said Dr Ben Trumble, Arizona State University, USA. "This is ushering in major economic and nutritional changes for the Tsimane people."

The researchers did not study whether coronary artery hardening in the Tsimane population impacted on their health, but note that deaths from heart attacks are very uncommon in the population so it is likely that their low levels of atherosclerosis and heart disease are associated. The researchers are investigating this in further research.

"This study suggests that coronary atherosclerosis could be avoided if people adopted some elements of the Tsimane lifestyle, such as keeping their LDL cholesterol, blood pressure and blood sugar very low, not smoking and being physically active," said senior cardiology author Dr Gregory S. Thomas, Long Beach Memorial Medical Centre, USA. "Most of the Tsimane are able to live their entire life without developing any coronary atherosclerosis. This has never been seen in any prior research. While difficult to achieve in the industrialized world, we can adopt some aspects of their lifestyle to potentially forestall a condition we thought would eventually effect almost all of us."

Improving your sleep quality is as beneficial to health and happiness as winning the lottery

Improving your sleep quality is as beneficial to health and happiness as winning the lottery, according to research by the University of Warwick.

Dr Nicole Tang in the Department of Psychology has discovered that working on getting a better night's sleep can lead to optimal physical and mental wellbeing over time -- and that quality of sleep is more important than how many hours you get.

Analysing the sleep patterns of more than 30,500 people in UK households across four years, Dr Tang finds that improving your sleep quality leads to levels of mental and physical health comparable to those of somebody who's won a jackpot of around £200,000.

The study shows that positive changes in sleep over time -- improved quality and quantity, and using less sleep medication -- are linked with improved scores on the General Health Questionnaire (GHQ), which is used by mental health professionals to monitor psychological wellbeing in patients.

People surveyed who reported positive improved sleep scored a 2-point change in the GHQ -- a result comparable to those recorded from patients completing an eight-week programme of mindfulness-based cognitive therapy designed to improve psychological wellbeing.

Furthermore, the same people showed improved scores on the 12-Item Short Form Survey, which tests levels of physical and emotional health, as well as people's ability to perform everyday activities.
Conversely, it was found that a lack of sleep, bad quality sleep, and using more sleep medication can lead to worsened medical and emotional states.

Dr Tang's research proves that improving the quality and quantity of sleep amongst the population -- as well as discouraging the use of sleep medication -- is an effective, simple and cheap method of raising the health and wellbeing of society as a whole.

Consequently, she argues that working on getting good quality sleep, and the reduction of sleep medication, should be promoted as a public health value -- something that everyone can do easily to stay physically and mentally healthy.

Dr Tang comments:
"We are far from demonstrating a causal relationship, but the current findings suggest that a positive change in sleep is linked to better physical and mental wellbeing further down the line.
"It is refreshing to see the healing potential of sleep outside of clinical trial settings, as this goes to show that the benefits of better sleep are accessible to everyone and not reserved for those with extremely bad sleep requiring intensive treatments.
"An important next step is to look at the differences between those who demonstrate a positive and negative change in sleep over time, and identify what lifestyle factors and day-to-day activities are conducive to promoting sleep. Further research in this area can inform the design of public health initiatives."

How cruciferous vegetables fight cancer

Research has discovered one of the underlying reasons why broccoli is so good for you, in work leading to a new way to approach the genetic basis of cancer.
Credit: Photo courtesy of Oregon State University
Researchers have discovered one of the reasons why broccoli, cauliflower, and cabbage (cruciferous vegetables) may be good for your health.

They found that sulforaphane, a dietary compound from broccoli that's known to help prevent prostate cancer, may work through its influence on long, non-coding RNAs. This is another step forward in a compelling new area of study on the underlying genetics of cancer development and progression.

The findings were published by researchers from Oregon State University in the Journal of Nutritional Biochemistry.

The research provides more evidence for how these lncRNAs, which were once thought to be a type of "junk DNA" of no particular value or function, may instead play a critical role in triggering cells to become malignant and spread.

Growing evidence shows that lncRNAs, which number in the thousands, have a major role in cell biology and development, often by controlling what genes are turned on, or "expressed" to carry out their genetic function. Scientists now believe that when these lncRNAs are dysregulated they can contribute to multiple disease processes, including cancer.

The lncRNAs are also of special interest, researchers say, because they are so highly cell- and tissue-specific.

Unlike many chemotherapeutic drugs that affect healthy cells as well as malignant ones and can cause undesired side effects, the control of lncRNAs may offer a new way to specifically prevent or slow the progression of malignant cells.

"This could be a turning point in our understanding of how cancer may be triggered and spreads," said Emily Ho, the endowed director of the Moore Family Center for Whole Grain Foods, Nutrition and Preventive Health at OSU, a professor in the College of Public Health and Human Sciences and principal investigator with the Linus Pauling Institute.

"It's obviously of interest that this dietary compound, found at some of its highest levels in broccoli, can affect lncRNAs. This could open the door to a whole range of new dietary strategies, foods or drugs that might play a role in cancer suppression or therapeutic control."

In particular, this research showed that one lncRNA, called LINC01116, is upregulated in a human cell line of prostate cancer, but can be decreased by treatment with sulforaphane. The data "reinforce the idea that lncRNAs are an exciting new avenue for chemoprevention research, and chemicals derived from diet can alter their expression," the scientists wrote in their study.

"We showed that treatment with sulforaphane could normalize the levels of this lncRNA," said Laura Beaver, a research associate in the Linus Pauling Institute and College of Public Health and Human Sciences, and lead author on the study. "This may relate to more than just cancer prevention. It would be of significant value if we could develop methods to greatly slow the progress of cancer, help keep it from becoming invasive."

The impact of diet on lncRNA expression has been largely unknown until now, the researchers said. In this study, they identified a four-fold decrease in the ability of prostate cancer cells to form colonies when LINC01116 was disrupted.

Among men, prostate cancer is the second most frequently diagnosed cancer globally, and the second leading cause of cancer-related deaths in the United States. Worth noting, the researchers said, is that an increased consumption of cruciferous vegetables such as broccoli, which are high in sulforaphane, appears to be associated with a lower risk of developing prostate cancer.

That same lncRNA, they noted, is also overexpressed in studies of several other types of cancer, including brain, lung and colon cancer. Some other lncRNAs have been found at higher levels in breast, stomach, lung, prostate cancer and chronic lymphocytic leukemia.

Wednesday, March 15, 2017

Non-aspirin NSAIDs increase heart attack and stroke risk


Regular use of ibuprofen (Advil) was associated with a 31% increased risk of cardiac arrest, according to new research published in the European Heart Journal - Cardiovascular Pharmacotherapy

This provides additional evidence for The U.S. Food and Drug Administration (FDA) iin 2015  strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.

“Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs. As is the case with current prescription NSAID labels, the Drug Facts labels of over-the-counter (OTC) non-aspirin NSAIDs already contain information on heart attack and stroke risk. We will also request updates to the OTC non-aspirin NSAID Drug Facts labels.
Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech.
NSAIDs are widely used to treat pain and fever from many different long- and short-term medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. NSAIDs are available by prescription and OTC. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib.
 The prescription NSAID labels will be revised to reflect the following information:
  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
  • The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.

Women who eat their veggies at lower risk of psychological stress

Published today in the British Medical Journal Open, the longitudinal study of more than 60,000 Australians aged 45 years and above measured participants fruit and vegetable consumption, lifestyle factors and psychological distress at two time points, 2006-08 and 2010.

Psychological distress was measured using the Kessler Psychological Distress Scale, a 10-item questionnaire measuring general anxiety and depression. Usual fruit and vegetable consumption was assessed using short validated questions.

Key findings

  • People who ate 3-4 daily serves of vegetables had a 12 per cent lower risk of stress than those who ate 0-1 serves daily.
  • People who ate 5-7 daily serves of fruit and vegetables had a 14 per cent lower risk of stress than those who ate 0-4 serves daily.
  • Women who ate 3-4 daily serves of vegetables had an 18 per cent lower risk of stress than women who ate 0-1 serves daily.
  • Women who ate 2 daily serves of fruit had a 16 per cent lower risk of stress than women who ate 0-1 serves daily.
  • Women who ate 5-7 daily serves of fruit and vegetables had a 23 per cent lower risk of stress than women who ate 0-1 serves daily.

At the start of the study, characteristics associated with higher stress included: being female, younger, having lower education and income, being overweight/obese, a current smoker and being physically inactive.

Fruit consumption alone had no significant association with a lower incidence of stress.

There was no significant association between higher levels of fruit and vegetable intake (greater than 7 daily serves) and a lower incidence of stress.

"This study shows that moderate daily fruit and vegetable consumption is associated with lower rates of psychological stress," said Dr Melody Ding of the University of Sydney's School of Public Health.

"It also reveals that moderate daily vegetable intake alone is linked to a lower incidence of psychological stress. Moderate fruit intake alone appears to confer no significant benefit on people's psychological stress."

These new findings are consistent with numerous cross sectional and longitudinal studies showing that fruit and vegetables, together and separately, are linked with a lower risk of depression and higher levels of well-being assessed by several measures of mental health.

"We found that fruit and vegetables were more protective for women than men, suggesting that women may benefit more from fruit and vegetables," said first author and University of Sydney PhD student, Binh Nguyen.

The investigators say further studies should investigate the possibility of a 'threshold' between medium and higher levels of fruit and vegetable intake and psychological stress.

This research was based on data from the Sax Institute's 45 and Up Study.

Older women taking statins face higher risk of diabetes

Older Australian women taking cholesterol-lowering statins face a significantly increased risk of developing diabetes, according to a University of Queensland study.

UQ School of Public Health researcher Dr Mark Jones said women over 75 faced a 33 per cent higher chance of developing diabetes if they were taking statins.

The risk increased to over 50 per cent for women taking higher doses of statins.

"We found that almost 50 per cent of women in their late seventies and eighties in the study took statins, and five per cent were diagnosed with new-onset diabetes," Dr Jones said.

"Statins are highly prescribed in this age group but there are very few clinical trials looking at their effects on older women.

"The vast majority of research is on 40- to 70-year-old men."

Statins, a class of drugs that lower cholesterol in the blood, are prescribed to reduce the incidence of cardiovascular events such as heart attacks and strokes.

"What's most concerning was that we found a 'dose effect' where the risk of diabetes increased as the dosage of statins increased.

"Over the 10 years of the study most of the women progressed to higher doses of statins," Dr Jones said.

"GPs and their elderly female patients should be aware of the risks.

"Those elderly women taking statins should be carefully and regularly monitored for increased blood glucose to ensure early detection and management of diabetes."

The research was based on prescription and survey data from 8372 women born between 1921 and 1926 who are regularly surveyed as part of the Women's Health Australia study (also known as the Australian Longitudinal Study on Women's Health).

The research is published in Drugs and Ageing.

Yoga and controlled breathing reduce depressive symptoms

A new study demonstrated that individuals with major depressive disorder had a significant reduction in depressive symptoms during a 12-week integrative health intervention that included Iyengar yoga classes and coherent breathing. Participants who took three yoga classes a week were more likely to achieve lower depression scores after 12 weeks than subjects who took two classes, according to the study published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available open access on The Journal of Alternative and Complementary Medicine website.

In the study, adults 18-64 years of age with major depressive disorder participated in either three (high-dose intervention) or two (low-dose) yoga classes per week and practiced coherent breathing at 5 breaths per minute. The researchers used a Depression Inventory measure to assess depressive symptoms in the 30 participants, at the beginning of the study and throughout the 12-week intervention.

"The practical findings for this integrative health intervention is that it worked for participants who were both on and off antidepressant medications, and for those time-pressed, the two times per week dose also performed well," says The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks.

Brain Health Food Guide for Adults

"There is increasing evidence in scientific literature that healthy eating is associated with retention of cognitive function, but there is also a lot of misinformation out there," says Dr. Carol Greenwood, co-author of the Brain Health Food Guide, senior scientist at Baycrest's Rotman Research Institute (RRI) and professor at the University of Toronto's Department of Nutritional Sciences.

There is not a lot of evidence about individual foods, but rather classes of foods, says Dr. Greenwood, who is also a co-author of Mindfull, the first science-based cookbook for the brain. Older adults are encouraged to eat berries or cruciferous vegetables, such as cauliflower, cabbage and Brussels sprouts, rather than a specific type of berry or vegetable.

Research has found that dietary patterns similar to those outlined in the Brain Health Food Guide are associated with decreasing the risk of developing Alzheimer's disease by 36 per cent and mild cognitive impairment (a condition likely to develop into Alzheimer's) by 27 per cent.

Some tips suggested by the Brain Health Food Guide include:

  • Focus on an overall pattern of healthy eating, not one specific "superfood" for brain health
  • Eat fish, beans and nuts several times a week
  • Include healthy fats from olive oil, nuts and fish in one's diet
  • Add beans or legumes to soups, stews and stir-fried foods
  • Embrace balance, moderation and variety

Monday, March 13, 2017

Depression doubles long-term risk of death after heart disease diagnosis

Depression is the strongest predictor of death in the first decade following a diagnosis of coronary heart disease, according to a new study by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City.

The study, which is scheduled for presentation this week at the American College of Cardiology's 66th Annual Scientific Session in Washington, D.C., found people with coronary heart disease who are diagnosed with depression are about twice as likely to die compared with those who are not diagnosed with depression.

"Our study shows that it doesn't matter if depression emerges in the short term or a few years down the road - it's a risk factor that continually needs to be assessed," said Heidi May, PhD, MSPH, a cardiovascular epidemiologist at the Intermountain Medical Center Heart Institute in Salt Lake City, and the study's lead author. "I think the take-home message is that patients with coronary disease need to be continuously screened for depression, and if found to be depressed, they need to receive adequate treatment and continued follow-up."

The Intermountain Medical Center Heart Institute study focused on patients diagnosed with a heart attack, stable angina or unstable angina, all of which are caused by a reduced flow of oxygen-rich blood to the heart, typically as a result of plaque buildup in the heart's arteries. These conditions fall under the umbrella term coronary heart disease, which is the most common form of heart disease and kills about 370,000 people in the United States annually.

Researchers have long understood heart disease and depression to have a two-way relationship, with depression increasing the likelihood of heart disease and vice versa. Whereas previous studies have investigated depression occurring within a few months of a coronary heart disease diagnosis, this new study is the first to shed light on the effects of depression over the long term.

"The majority of studies evaluating depression following a heart disease event have occurred within 30 days of the event," said May. "We sought to determine if the risk of all-cause mortality associated with depression varies with time between the diagnosis of heart disease and a follow-up depression diagnosis."

The research team analyzed health records from almost 25,000 Intermountain Healthcare patients tracked for an average of nearly 10 years following a diagnosis of coronary heart disease. About 15 percent of patients received a follow-up diagnosis of depression, a substantially larger proportion than the estimated rate of 7.5 to 10 percent in the general population.

Out of 3,646 people with a follow-up diagnosis of depression, half died during the study period, compared to 38 percent of the 20,491 people who did not have a depression diagnosis. This means people with depression were twice as likely to die compared to those without depression.

May says the results were surprising.

"I thought depression would be significant, but not the most significant predictor," she added.

After adjusting for age, gender, risk factors, other diseases, heart attack or chest pain, medications and follow-up complications, the results showed depression was the strongest predictor of death in this patient group. These results were consistent regardless of age, gender, the timing of depression onset, past history of depression or whether or not the patient had a heart attack.

Given the significant impact of depression on long-term survival, the researchers said clinicians should seek ways to better identify depression in patients with coronary heart disease, either by using patient questionnaires designed to screen for depression or by actively watching for signs of depression during follow-up examinations.

"It can be devastating to be diagnosed with coronary artery disease," May said. "Clinicians need to pay attention to the things their patients are expressing, in terms of both physical symptoms as well as emotional and nonverbal factors."

Signs of depression include persistent feelings of sadness, hopelessness or worthlessness; anxiety, irritability or restlessness; losing interest in hobbies and activities; fatigue or moving slowly; difficulty sleeping or concentrating; aches or pains without a clear physical cause; changes in appetite or weight; and thoughts of death or suicide.

Depression is linked with behaviors that can be detrimental to cardiovascular health, such as reduced physical activity, poor diet, increased smoking or alcohol use and reduced compliance with medical treatment.

"There is a lot more research that needs to be done with depression and heart disease, May said. "Moving forward, we would like to further assess treatment affects, severity of symptoms, and other comorbidities that may put a patient at an increased risk of death.

May will present the study on Friday, March 17, 2017, at 9:30 a.m., ET at the American College of Cardiology's 66th Annual Scientific Session in Washington, D.C. The meeting runs March 17-19.

A healthy diet improves sperm quality and fecundability of couples

Nowadays, in order to improve sperm quality and fertility changes, many fertility clinics recommend simple lifestyle changes such as increased physical activity, cognitive behavioural therapy or yoga to reduce stress, give advice on how to reduce alcohol and caffeine intake and provide lists of dietary recommendations. However, there is a lack of a proven scientific evidence regarding the role of diet in determining sperm parameters.

Researchers at the Human Nutrition Unit of the Universitat Rovira i Virgili (URV) and the Pere i Virgili Health Research Institute, (Tarragona-Spain) who are also members of the Ciberobn network of the Carlos III Health Institute, have conducted the first systematic review of all observational studies on sperm quality and male fecundability and their relationship with diet, food and nutrient consumption.

The results indicate that low sperm quality parameters are inversely associated with healthy diets rich in certain nutrients such as omega-3 fatty acids, certain antioxidants (vitamin E, vitamin C, β-carotene, selenium, zinc, cryptoxanthin and lycopene), other vitamins (vitamin D and folate) and low saturated fatty acids and trans-fatty acids. Fish, shellfish, seafood, poultry, cereals, vegetables and fruits, low-fat dairy and skimmed milk were positively associated with several sperm quality parameters. In contrast, diets rich in processed meat, soy foods, potatoes, full-fat dairy and total dairy products, cheese, coffee, alcohol, sugar-sweetened beverages and sweets have been associated with lower-quality sperm in some studies. A high intake of alcohol, caffeine, red meat and processed meat by males has a negative influence on the chance of pregnancy or fertilization rates of their partners.

According to the researchers, their review has provided a comprehensive overview of existing high-quality research into the effect of diet and the consumption of different foods and nutrients on fecundability and male fertility so that safer and more effective dietary recommendations can be made in the future.

These results highlight the fact that adherence to a healthy diet, e.g. the Mediterranean diet, by men could significantly improve their sperm quality and the fecundity of their partners.

Saturday, March 11, 2017

Fish and mercury: Detailed consumption advisories would better serve women across US

Among women of childbearing age in the U.S., fish consumption has increased in recent years while blood mercury concentrations have decreased, suggesting improved health for women and their babies, a new study shows.

The research at Oregon State University also indicates fish consumption advisories tailored to specific regions and ethnic groups would help women of childbearing age to eat in even more healthy ways, including better monitoring of mercury intake.

Food from the ocean has a unique and valuable nutritional profile. Among seafood's many benefits are the omega-3 fatty acids that promote neurodevelopment, and the nutrients in seafood are especially important for pregnant women to pass on to developing fetuses.

But the main way people are exposed to toxic methylmercury -- a mercury atom with a methyl group, CH3, attached to it -- is through eating seafood. Thus the need for precise, nuanced fish consumption advisories, said Leanne Cusack of Oregon State University, the corresponding author on the study.

Comparatively less-toxic elemental mercury enters the ocean from natural sources such as volcanic eruptions and also from human activities like the burning of fossil fuels, which accounts for about two-thirds of the mercury that goes into the water.

Once in the ocean, the mercury is methylated, diffuses into phytoplankton and passes up the food chain, accumulating along the way.

A scallop or a shrimp, for example, can have a mercury concentration of less than 0.003 parts per million. A large predator like a tuna, on the other hand, can contain roughly 10 million times as much methylmercury as the water that surrounds it and have a concentration of many parts per million.

Exactly how the mercury in the ocean becomes methylated, scientists don't know.

Fish advisories are usually aimed at women of childbearing age because a developing fetus has greater sensitivity to the neurotoxic effects of methylmercury. Jointly, the U.S. Environmental Protection Agency and the Food and Drug Administration recommend women in that group eat two meals of low-mercury fish per week.

Using data from the ongoing National Health and Nutrition Examination Survey, Cusack's research group looked at fish consumption patterns with regard to blood mercury levels in U.S. women of childbearing age from 1999 to 2010.

Findings were recently published in the journal Environmental Health.

Women in the coastal regions, particularly the Northeast, were found to have the highest blood mercury concentrations; women living away from the sea, especially in the inland Midwest, had the lowest.

Coastal residents also ate fish the most frequently, with the species consumed varying by region. The type of fish most often consumed was shellfish in every part of the U.S. except for the inland West and inland Midwest.

As women's age and household income increased, so did their fish consumption frequency and blood mercury concentrations. Among ethnic groups, Asian Americans, Pacific Islanders, Alaska Natives and Native Americans ate fish the most often and showed the most mercury, and Mexican Americans consumed fish the least often and showed the smallest concentration of mercury.

"We also found total monthly fish consumption by women of reproductive age was higher than it had been in recent years, with women consuming more marine fish and shellfish but with no appreciable difference in the mean consumption of freshwater fish, tuna, swordfish and shark," said Cusack, a postdoctoral scholar in OSU's College of Public Health and Human Sciences.

"That's encouraging because marine and shellfish are associated with smaller increases in blood mercury. And also encouragingly, an average women who'd eaten fish nine or more times in the previous month had lower blood mercury levels than women who'd had fish at the same rate in 1999-2000."

The differences in consumption and mercury levels by race and region illustrate the need for tailored fish advisories, she said.

"They need to have information about fish types and quantities you can safely eat," Cusack said. "The more detailed they can be, the better.

"The main thing is we do need to increase fish consumption in this demographic," Cusack added. "It has been increasing since 1999, but it's still not at the level where we want to see it. People need to start consuming fish, and advisories need to focus on the benefits of consumption and not just the risks by providing a broad range of fish that are low in methylmercury and high in omega-3's."

Friday, March 10, 2017

Rapid blood pressure drops in middle age linked to dementia in old age

Middle-aged people who experience temporary blood pressure drops that often cause dizziness upon standing up may be at an increased risk of developing cognitive decline and dementia 20 years later, new Johns Hopkins Bloomberg School of Public Health research suggests.

The findings, being presented March 10 at the American Heart Association's EPI|LIFESTYLE 2017 Scientific Sessions in Portland, Ore., suggest that these temporary episodes - known as orthostatic hypotension - may cause lasting damage, possibly because they reduce needed blood flow to the brain. Previous research has suggested a connection between orthostatic hypotension and cognitive decline in older people, but this appears to be the first to look at long-term associations.

"Even though these episodes are fleeting, they may have impacts that are long lasting," says study leader Andreea Rawlings, PhD, MS, a post-doctoral researcher in the Department of Epidemiology at the Bloomberg School. "We found that those people who suffered from orthostatic hypotension in middle age were 40 percent more likely to develop dementia than those who did not. It's a significant finding and we need to better understand just what is happening."

An estimated four million to five million Americans currently have dementia and, as the population ages, that number is only expected to grow. There currently is no treatment and no cure for the condition.

For the study, the researchers analyzed data from the Atherosclerosis Risk in Communities (ARIC) cohort, a study of 15,792 residents in four communities in the United States, who were between the ages of 45 and 64 when the study began in 1987. For this study, they focused on the 11,503 participants at visit one who had no history of coronary heart disease or stroke. After 20 minutes lying down, researchers took the participants' blood pressure upon standing. Orthostatic hypotension was defined as a drop of 20 mmHg or more in systolic blood pressure or 10 mmHg or more in diastolic blood pressure. Roughly six percent of participants, or 703 people, met the definition.

These participants, who were on average 54 years old upon enrolling in the study, continued to be followed over the next 20 or more years. People with orthostatic hypotension at the first visit were 40 percent more likely to develop dementia than those who did not have it. They had 15 percent more cognitive decline.

Rawlings says it is not possible to tease out for certain whether the orthostatic hypotension was an indicator of some other underlying disease or whether the drop in blood pressure itself is the cause, though it is likely that the reduction in blood flow to the brain, however temporary, could have lasting consequences.

It also wasn't clear, she says, whether these participants had repeated problems with orthostatic hypotension over many years or whether they had just a brief episode of orthostatic hypotension at the original enrollment visit, as patients were not retested over time.

"Identifying risk factors for cognitive decline and dementia is important for understanding disease progression, and being able to identify those most at risk gives us possible strategies for prevention and intervention," Rawlings says. "This is one of those factors worth more investigation."

High-intensity aerobic training can reverse aging processes in adults

Everyone knows that exercise is good for you, but what type of training helps most, especially when you're older -- say over 65? A Mayo Clinic study says it's high-intensity aerobic exercise, which can reverse some cellular aspects of aging. The findings appear in Cell Metabolism.

Mayo researchers compared high-intensity interval training, resistance training and combined training. All training types improved lean body mass and insulin sensitivity, but only high-intensity and combined training improved aerobic capacity and mitochondrial function for skeletal muscle. Decline in mitochondrial content and function are common in older adults.

High-intensity intervals also improved muscle protein content that not only enhanced energetic functions, but also caused muscle enlargement, especially in older adults. The researchers emphasized an important finding: Exercise training significantly enhanced the cellular machinery responsible for making new proteins. That contributes to protein synthesis, thus reversing a major adverse effect of aging. However, adding resistance training is important to achieve significant muscle strength.

"We encourage everyone to exercise regularly, but the take-home message for aging adults that supervised high-intensity training is probably best, because, both metabolically and at the molecular level, it confers the most benefits," says K. Sreekumaran Nair, M.D., Ph.D., a Mayo Clinic endocrinologist and senior researcher on the study. He says the high-intensity training reversed some manifestations of aging in the body's protein function. He cautioned that increasing muscle strength requires resistance training a couple of days a week.

The study's goal was to find evidence that will help develop targeted therapies and exercise recommendations for individuals at various ages. Researchers tracked metabolic and molecular changes in a group of young and older adults over 12 weeks, gathering data 72 hours after individuals in randomized groups completed each type of exercise. General findings showed:

  • Cardio respiratory health, muscle mass and insulin sensitivity improved with all training.
  • Mitochondrial cellular function declined with age but improved with training.
  • Increase in muscle strength occurred only modestly with high-intensity interval training but occurred with resistance training alone or when added to the aerobic training.
  • Exercise improves skeletal muscle gene expression independent of age.
  • Exercise substantially enhanced the ribosomal proteins responsible for synthesizing new proteins, which is mainly responsible for enhanced mitochondrial function.
  • Training has little effect on skeletal muscle DNA energy transfer but promotes skeletal muscle protein expression with maximum effect in older adults.

Low gluten diets linked to higher risk of type 2 diabetes

Eating more gluten may be associated with a lower risk of developing Type 2 diabetes, according to research presented at the American Heart Association's Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions.

Gluten, a protein found in wheat, rye and barley, gives bread and other baked goods elasticity during the baking process and a chewy texture in finished products. A small percentage of the population cannot tolerate gluten due to Celiac disease or gluten sensitivity, but gluten-free diets have become popular for people without these conditions, even though there is lack of evidence that reducing gluten consumption provides long-term health benefits.

"We wanted to determine if gluten consumption will affect health in people with no apparent medical reasons to avoid gluten," said Geng Zong, Ph.D., a research fellow in the Department of Nutrition at Harvard University's T.H. Chan School of Public Health in Boston, Massachusetts. "Gluten-free foods often have less dietary fiber and other micronutrients, making them less nutritious and they also tend to cost more. People without Celiac disease may reconsider limiting their gluten intake for chronic disease prevention, especially for diabetes."

Micronutrients are dietary components such as vitamins and minerals.

In this long-term observational study, researchers found that most participants had gluten intake below 12 grams/day, and within this range, those who ate the most gluten had lower Type 2 diabetes risk during thirty years of follow-up. Study participants who ate less gluten also tended to eat less cereal fiber, a known protective factor for Type 2 diabetes development.

After further accounting for the potential effect of cereal fiber, individuals in the highest 20 percent of gluten consumption had a 13 percent lower risk of developing Type 2 diabetes in comparison to those with the lowest daily gluten consumption (approximately fewer than 4 grams).

The researchers estimated daily gluten intake for 199,794 participants in three long-term health studies -- 69,276 from the Nurses' Health Study (NHS), 88,610 from the Nurses' Health Study II (NHSII) and 41,908 from the Health Professionals Follow-up Study (HPFS) -- from food-frequency questionnaires completed by participants every two to four years. The average daily gluten intake in grams was 5.8 g/d for NHS, 6.8 g/d for NHSII, and 7.1 g/d for HPFS, and major dietary sources were pastas, cereals, pizza, muffins, pretzels, and bread.

Over the course of the study, which included 4.24 million person-years of follow-up from 1984-1990 to 2010-2013, 15,947 cases of Type 2 diabetes were confirmed.

Study participants reported their gluten consumption and the study was observational, therefore findings warrant confirmation by other investigations. Also, most of the participants took part in the study before gluten-free diets became popular, so there is no data from gluten abstainers.

Wednesday, March 8, 2017

In the first place: Memorization tool bulks up brain's internal connection

A time-honored mnemonic method used by memory athletes -- people adept at feats such as quickly memorizing the sequence of all the cards in a deck or a vast string of digits -- can be taught to people with no prior hint of prodigious memorization skills, according to researchers at the Stanford University School of Medicine.

This mnemonic training induces patterns of activity within new trainees' brains that closely resemble those of memory athletes, said the Stanford scientists, who helped lead a multi-institution study of memory training.

Many of the memory athletes recruited for the study, which will be published March 8 in Neuron, attribute their prowess to their use of the "method of loci" or related mnemonic systems.

The method of loci involves pairing each item to be memorized with a visual recollection of a specific landmark along a well-traveled route, such as a round-trip walk to a local store. It was used by ancient Greek and Roman orators and is the origin of language sequences such as "in the first place," "in the second place" and so forth.

Outside the competitive arena, though, the memory athletes say they are just like the rest of us.

"If you were to ask one of them if their skill spills over into other aspects of their lives, they would say no," said Stanford medical student William Shirer, one of the study's lead co-authors. "They lose their car keys as frequently as you and I do."

Bulking up the memory networks

The brain's operations are largely carried out by networks of multiple, discrete brain regions. These regions, anatomically connected to one another via white-matter tracts or through intermediary nodes, share "functional connectivity," meaning their activity is tightly coupled. Around two dozen separate networks mediating memory, language, vision, executive planning and other functions have been identified with the use of functional magnetic resonance imaging.

"Training normal humans to be memory athletes bulks up the brain's memory networks," said the study's senior author, Michael Greicius, MD, MPH, associate professor of neurology and neurological sciences at Stanford.

The other lead authors of the study are assistant professor of neuroscience Martin Dresler, PhD; postdoctoral scholar Boris Konrad, PhD; and graduate student Nils Muller, all at the Donders Institute for Brain, Cognition and Behavior in the Netherlands.

In 2013, Dresler, who was then a visiting scholar at Stanford, alerted Greicius, an imaging expert, to data Dresler and Konrad had acquired on 23 of the 50 top-scoring memory athletes in an annual contest called the World Memory Championships. (Konrad is a memory athlete.) In these tournaments, contestants compete in timed events in which they must memorize torrents of unrelated words, blizzards of fictional historic dates, lengthy digital series, sequences of playing cards and so forth.

"Why do people engage in such things? Probably, as in any other sport, because they can, and they have fun," said Dresler. "I admit, that's hard to believe when you see them staring at their digit columns or piles of card decks from morning to evening."

In one experiment, 17 memory athletes who took a word-memorization test could correctly recall, on average, nearly 71 of 72 words 20 minutes after a timed memorization session. In contrast, a group of control participants, devoid of special memorization skills and without any prior training, averaged about 40 correctly recalled words.

Prior to their memorization tasks, all participants received eight-minute fMRI scans under instructions to simply relax and let their minds wander, so that the scientists could monitor goings-on in a brain network that's most active when a person's brain is at rest. This collection of closely cooperating brain structures, called the resting-state network, has been found to be involved in memory.

In a subsequent analysis of these fMRI scans, the Stanford scientists zeroed in on 71 brain regions previously implicated in memory or in visuospatial processing, a brain function one might expect to be activated during use of the method of loci. They calculated, for each participant, the extent to which activity in any two of these 71 regions -- nearly 5,000 pairwise measurements per fMRI scan for each participant -- was correlated.

After the initial round of memorization tests, Dresler and Konrad gave fMRI scans and memorization tests to 51 untrained non-athletes, then divided them into three groups. The first group underwent a six-week course of daily online-training sessions in the method of loci. The second group received six weeks of training to improve a different facet of memory called working memory: the ability to juggle several pieces of data in your head at the same time for a short period. The third group got no training at all.

Putting the training to the test

Afterward, the three groups underwent resting-state fMRI scans and then took the 72-word memorization test. Recall was checked at 20 minutes and 24 hours afterward. Four months later they came back for another test session, with a different set of 72 words.

The memorization skills of control participants trained in the method of loci improved dramatically. They could recall almost as many words as the memory athletes could, and they achieved similar results four months after completing training. Not only that, but their resting-state functional connectivity patterns now resembled to those of the memory athletes than they had been prior to training.

No such memory gains and brain-connectivity changes were seen among participants who received working-memory training or no training at all.

"The degree to which someone's resting-network organization changed to resemble that of the memory athletes' predicted how much that person's memory performance would improve," Shirer said.

"The strength of functional connectivity within this distributed memory network was correlated with performance outside the scanner," said Greicius, who is medical director of the Stanford Center for Memory Disorders and a member of Stanford Bio-X and the Stanford Neurosciences Institute. "This suggests that a six- or eight-minute snapshot of a person's functional connectivity has some value in predicting how they perform in the world."

History of exercise helps prevent heart disease after breast cancer

While regular exercise is recommended as part of a heart-healthy lifestyle for any person, it also appears to help mitigate the increased cardiovascular risk faced by women treated for breast cancer, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.

The study found that women with breast cancer who engaged in the equivalent of five hours of moderate exercise per week before their diagnosis were 40 percent less likely to have a cardiovascular event and 60 percent less likely to die from coronary heart disease compared to those with a low pre-diagnosis level of exercise. Researchers said this study is the first to examine the long-term impact of exercise before a cancer diagnosis and the cardiovascular benefits of exercise across all types of cancer treatments.

About one in eight U.S. women will be diagnosed with breast cancer during her lifetime, and these women are living longer thanks to advances in screening and treatment. Heart disease is the leading cause of death in the United States, and women who have been diagnosed with early-stage breast cancer face a markedly increased risk of heart disease compared to the general population. This increased risk, which reduces long-term survival, is attributed, in part, to cardiovascular damage from cancer therapies.

"Next to a second or recurrent cancer, heart disease is the second leading killer in cancer patients and survivors, so anything we can do to prevent cancer survivors from developing heart disease is very important," said Tochi Okwuosa, DO, a cardiovascular disease specialist at Rush University Medical Center and the study's lead author. "We found that with exercise, even before one is diagnosed with cancer, you can lower the risk of cardiovascular problems that are caused by chemotherapy and radiation therapy."

The research is based on data from the Women's Health Initiative, a large, nationwide observational study and clinical trial conducted by the National Institutes of Health from 1991-2006. Researchers extracted data from 4,015 study participants who were diagnosed with non-metastatic breast cancer. Based on physical activity questionnaires participants completed periodically throughout the study, participants were grouped into quartiles of exercise according to metabolic equivalent task (MET) hours per week, a standardized metric that reflects both the amount and intensity of exercise: low (fewer than 2.5 MET hours per week), intermediate (2.5-8.6 MET hours per week), moderate (8.6-18 MET hours per week) and high (more than 18 MET hours per week, which translates to roughly five hours of moderate exercise per week).

The researchers then analyzed cardiovascular events during an average of 12 years following participants' breast cancer diagnosis. After adjusting for age, they found that women reporting intermediate, moderate and high levels of exercise before their cancer diagnosis were 23 percent, 25 percent and 41 percent less likely to experience a cardiovascular event, respectively, compared to women reporting the lowest level of physical activity. Cardiovascular events included cardiovascular death, heart failure, heart attack, chest pain, stroke or "mini-stroke," buildup of plaque in the carotid or peripheral arteries, and revascularization procedures such as angioplasty or bypass surgery.

The results also showed women reporting intermediate, moderate and high levels of exercise before their cancer diagnosis were 41 percent, 55 percent and 60 percent less likely, respectively, to be diagnosed with coronary heart disease, a buildup of plaque in the heart's arteries, compared to women reporting low physical activity. Similar patterns were observed for all types of cancer treatment and after adjusting for a range of cardiovascular risk factors, demographic factors and medical conditions.

Radiation therapy, which in breast cancer is administered relatively close to the heart (particularly with older techniques), damages heart muscle cells and can lead to persistent inflammation many years later. This inflammation is thought to contribute to problems with the heart valves, buildup of plaque in the arteries, faulty heart rhythms and fluid buildup around the heart. Chemotherapy drugs including doxorubicin paclitaxel and others have been associated with an increased risk for heart failure and heart rhythm disorders, Okwuosa said. Even targeted therapies such as trastuzumab, now standard of care in certain types of breast cancers, can increase the risk of heart failure, while other newer therapies can cause significant hypertension, she said.

"Some of the chemotherapies can cause heart problems because the heart has very limited ability to regenerate, unlike hair can regenerate, for example, so the risk of cardiovascular issues can persist for many years," Okwuosa said. "Exercise provides a level of conditioning within our bodies which, even when we're under cardiovascular stress (such as with cancer treatments) at some later point, helps us tolerate that stress better. Exercise performed throughout one's life or even close to the time of cancer diagnosis seems to help the patient down the line with respect to the cardiovascular problems and side effects of the cancer therapy."

The study is limited by its reliance on self-reported exercise behavior rather than more objective measures. In addition, although the results suggested that women who exercised more had a lower risk of having a heart attack or being diagnosed with heart failure, those results were not statistically significant, most likely because those outcomes did not occur in large enough numbers, Okwuosa said.

Younger heart attack patients more likely to have low 'good' vs. high 'bad' cholesterol

Men under 45 years old and women under 50 years old who suffer a heart attack are far more likely to have abnormally low good cholesterol than elevated bad cholesterol, according to research scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.

Elevated LDL-C, known as "bad" cholesterol, is considered a risk factor for a heart attack or stroke because it suggests that arteries are clogged with deposits known as plaque. HDL-C, known as "good" cholesterol, acts like a scavenger, scouring the blood to get rid of excess fat and bad cholesterol. Healthy levels of HDL-C (above 40 in men, above 50 in women) may protect against heart attacks and strokes, partly due to HDL-C's role in clearing bad cholesterol from the arteries, reducing inflammation and preventing blood clots, whereas low levels of HDL-C have been shown to increase risk.

"In this study of younger heart attack patients, low HDL-C was the most common abnormality, seen in approximately 90 percent of the men and 75 percent of the women," said Bradley Collins, a fourth-year student at Harvard Medical School and lead author of the study. "This finding suggests that low HDL-C should be considered a marker of increased heart attack risk in younger patients particularly."

Through a review of billing data and medical records at two large medical centers, Collins and his co-authors identified 813 men under 45 years old and women under 50 years old who had been treated for a heart attack over the past 16 years. The patients' average age was 48; 38 percent were women.

The finding that these younger heart attack patients were more likely to have low HDL-C than to have elevated LDL-C suggests that different measures may need to be used to accurately identify heart attack risk in this age group, Collins said.

Furthermore, traditional tools for calculating heart attack risk may underestimate risk in younger patients by putting too much emphasis on patient age, he said.

The average age for a heart attack in the United States is 65 for men and 70 for women.

In 2013, an estimated 750,000 Americans had a heart attack. Of these, about 116,000 died. Although both the annual number of heart attacks and the annual number of deaths from heart attacks have been declining in recent years, some data suggest these reductions may not be happening in younger people. Recent studies have shown that while hospitalization rates for heart attacks declined more than 20 percent over a 10-year period among patients with an average age of 75, there was no such decline among patients under 55.

Researchers said current data suggest that while treatments primarily aimed at increasing HDL-C have not been shown to decrease cardiovascular events, low HDL-C should be viewed as a risk marker for heart attacks, regardless of LDL-C levels. Thus, low HDL-C should prompt the initiation of preventive measures, such as lifestyle changes, better glucose and blood pressure control, and medications to lower LDL-C. Combining all these measures together can lead to significant improvement in overall cardiovascular health, Collins said.

HDL-C is often a "modifiable" risk factor for heart disease--that means people can take action to increase HDL-C by giving up smoking, maintaining a healthy weight, finding ways to be more physically active, and eating more fruit and vegetables while avoiding unhealthy fats, such as trans fats.

"For many people, heart attacks can be prevented by following a healthy lifestyle. When we identify individuals who have a higher risk, however, we can achieve the greatest risk reduction by combining a healthy lifestyle with medications," Collins said.

A limitation of the current study is that it is based on data from a fairly small number of patients who were treated at just two medical centers.

The researchers are exploring several possible studies to follow up on these findings, Collins said.

"We are examining whether low HDL-C also predicts risk for repeat heart attacks in younger patients and whether there are genetic risk factors in this population," he said. "We also want to look at prescribing patterns for statins in younger patients who are at increased risk for heart disease. Ultimately, we would like to develop new tools for calculating heart attack risk that are more applicable to younger people."

Collins will also present other data from the same study showing that, compared with men, women who have a heart attack before age 50 have a significantly higher rate of death from any cause. These younger women are also more likely to have what is known as a Type 2 heart attack, which occurs when a problem other than a blocked artery causes the heart to need more oxygen than it can get.

"A Type 2 heart attack may occur in patients who have other very complicated medical conditions, including terminal cancer, internal bleeding or a severe bacterial infection," Collins said. "These heart attacks are often overlooked, given the severity of the patient's main diagnosis."

The next phase of this research will examine how many patients died of heart disease as opposed to other conditions.

Sound waves boost older adult' memory, deep sleep and triples memory scores

Gentle sound stimulation -- such as the rush of a waterfall -- synchronized to the rhythm of brain waves significantly enhanced deep sleep in older adults and improved their ability to recall words, reports a new Northwestern Medicine study.

Deep sleep is critical for memory consolidation. But beginning in middle age, deep sleep decreases substantially, which scientists believe contributes to memory loss in aging.

The sound stimulation significantly enhanced deep sleep in participants and their scores on a memory test.

"This is an innovative, simple and safe non-medication approach that may help improve brain health," said senior author Dr. Phyllis Zee, professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine sleep specialist. "This is a potential tool for enhancing memory in older populations and attenuating normal age-related memory decline."

The study will be published March 8 in Frontiers in Human Neuroscience.

In the study, 13 participants 60 and older received one night of acoustic stimulation and one night of sham stimulation. The sham stimulation procedure was identical to the acoustic one, but participants did not hear any noise during sleep. For both the sham and acoustic stimulation sessions, the individuals took a memory test at night and again the next morning. Recall ability after the sham stimulation generally improved on the morning test by a few percent. However, the average improvement was three times larger after pink-noise stimulation.

The older adults were recruited from the Cognitive Neurology and Alzheimer's Disease Center at Northwestern.

The degree of slow wave sleep enhancement was related to the degree of memory improvement, suggesting slow wave sleep remains important for memory, even in old age.

Although the Northwestern scientists have not yet studied the effect of repeated nights of stimulation, this method could be a viable intervention for longer-term use in the home, Zee said.

Previous research showed acoustic simulation played during deep sleep could improve memory consolidation in young people. But it has not been tested in older adults.

The new study targeted older individuals -- who have much more to gain memory-wise from enhanced deep sleep -- and used a novel sound system that increased the effectiveness of the sound stimulation in older populations.

The study used a new approach, which reads an individual's brain waves in real time and locks in the gentle sound stimulation during a precise moment of neuron communication during deep sleep, which varies for each person.

During deep sleep, each brain wave or oscillation slows to about one per second compared to 10 oscillations per second during wakefulness.

Giovanni Santostasi, a study coauthor, developed an algorithm that delivers the sound during the rising portion of slow wave oscillations. This stimulation enhances synchronization of the neurons' activity.

After the sound stimulation, the older participants' slow waves increased during sleep.

Larger studies are needed to confirm the efficacy of this method and then "the idea is to be able to offer this for people to use at home," said first author Nelly Papalambros, a Ph.D. student in neuroscience working in Zee's lab. "We want to move this to long-term, at-home studies."

Northwestern scientists, under the direction of Dr. Roneil Malkani, assistant professor of neurology at Feinberg and a Northwestern Medicine sleep specialist, are currently testing the acoustic stimulation in overnight sleep studies in patients with memory complaints. The goal is to determine whether acoustic stimulation can enhance memory in adults with mild cognitive impairment.

Previous studies conducted in individuals with mild cognitive impairment in collaboration with Ken Paller, professor of psychology at the Weinberg College of Arts and Sciences at Northwestern, have demonstrated a possible link between their sleep and their memory impairments.

Wrist-worn heart rate monitors less accurate than standard chest strap

Researchers at Cleveland Clinic put five popular wrist-worn fitness trackers to the test to find out how accurately they gauge heart rate across several types of exercise and intensity levels. Based on their findings, the old-fashioned chest strap monitor is best, particularly for people who need to keep tabs on how quickly or slowly their heart is beating during activity, according to the study team. The standard chest strap was the most accurate regardless of the intensity of the workout or whether someone was using the treadmill, elliptical or stationery bike. The results are scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.

This study builds on earlier research by the same team that assessed a different set of heart rate monitors and was limited only to walking or jogging on a treadmill. Heart rate is often used as part of a formula to calculate how many calories are being burned during exercise. However, for people with heart problems, an accurate heart rate reading is important.

"If you need to know your heart rate with accuracy when exercising--either because you are training for a marathon or have safe heart rate limits set by your doctor, perhaps due to coronary artery disease, heart failure or other heart conditions--wrist-worn monitors are less accurate than the standard chest strap," said Marc Gillinov, MD, The Judith Dion Pyle Chair in Heart Valve Research, Thoracic and Cardiovascular Surgery at the Cleveland Clinic, Ohio and the study's lead author. "We found these devices can equally over- and underestimate heart rate. The error ranged from +/-34 beats per minute to +/-15 beats per minute, depending on the type of activity."

This single-center study included 50 volunteers, mostly Cleveland Clinic employees, who responded to internet notices and flyers. They were 38 years old on average (±12 years), 43 percent female and generally healthy. Each participant was fitted with a continuous 4-lead electrocardiogram (EKG), a chest monitor and an armband (Scosche Rhythm+). They were then randomly fitted with two of four different wearable heart rate monitors (one on each wrist). The devices chosen for testing (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, and TomTom Spark Cardio) were based on their popularity and sales figures. Researchers then recorded volunteers' heart rates at rest and after light, moderate and vigorous exercise across three types of activities, including the treadmill, stationary bike and elliptical (with and without hand levers). Measurements on the wearable devices were compared to readings from the chest strap and EKG. Participants exercised for a total of 18 minutes; one dropped off at the final stage due to fatigue.

The chest strap monitor closely matched readings from the electrocardiogram (EKG), which is the gold standard for measuring the heart's activity (level of agreement with EKG, rc=.996; 1 being perfect agreement); however, the wrist-worn devices were less accurate on average (level of agreement with EKG, rc=.67-.92). While the watch-style heart rate monitors may accurately report heart rate at rest, and most were acceptable on the treadmill, they were fairly inaccurate while bicycling or using the elliptical. Of the wrist-worn heart rate monitors, only the Apple Watch provided accurate heart rate readings when participants switched to the elliptical trainer without arm levers; none gave correct measurements when they used arm levers. The wrist and forearm monitors also became less accurate the more intense the activity levels, with the exception of the Apple Watch.

"Even though all these wrist-worn monitors work by the same general principles, there is considerable variation among them," Gillinov said. "Overall, they were most accurate when someone was using the treadmill at low intensity and worst when exercising on the elliptical at high intensity."

What's behind the discrepancies? Unlike the chest strap, which like the EKG measures electrical activity of the heart, wrist-worn monitors use optical sensing or light to measure blood flow.

"It's not measuring what the heart does, but rather [downstream] blood flow--basically the volume of blood in the tissue," Gillinov said, adding that these devices also introduce many more variables that can result in incorrect readings (e.g., insufficient contact with the skin because of sweating or poor fit, skin pigmentation).

The bottom line, Gillinov said, is that the wrist-worn devices don't provide the full picture; nor are they intended to be medical devices.

"We are just at the beginning of a revolution in personal management of health by virtue of wearable physiological monitoring," Gillinov said. "As people take more control of their health and record their own physiological data, they need to know how accurate it is; this is especially concerning for people with heart conditions that can be exacerbated [with activity]. Cardiologists can use this data and decide which monitor they would recommend and help educate patients about their limitations."

This study is limited due to its small size. Researchers say larger studies are needed and should also evaluate how these devices perform in measuring heart rate in people who have heart failure, diabetes, are recovering from heart attack or are obese.

Sodium intake high, rising among people with high blood pressure

Despite recommendations to limit sodium intake to support a heart-healthy lifestyle, daily sodium intake significantly increased in Americans with high blood pressure from 1999-2012, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.

The study found people with high blood pressure consumed an average of 2,900 milligrams of sodium per day in 1999 and 3,350 milligrams per day in 2012, for an overall average daily sodium intake of 3,100 milligrams during the 14-year study period. That's more than twice the 1,500 milligram daily maximum recommended for people with high blood pressure in dietary guidelines issued by the U.S. Department of Health and Human Services and U.S. Department of Agriculture since 2005.

The increase appears to be driven by rising sodium intake among Hispanics and African-Americans, groups that historically showed lower sodium intake levels compared to whites but whose sodium consumption matched that of whites by the end of the study period. Groups with the lowest sodium intake included those with more advanced forms of heart disease such as a history of heart attack or stroke.

"We all tell our patients to limit sodium in their diet, and we try to educate them about sodium content in food products, but it is clear that we are not having enough of an effect on people's diets," said Elena Dolmatova, MD, a resident at Rutgers New Jersey Medical School and the study's lead author. "We need to find a way to address this so that the message actually gets to people. People shouldn't wait until they have a heart attack before taking action to limit sodium."

Excess sodium consumption increases the risk of heart disease because it draws additional water into the bloodstream, raising the volume--and consequently, the pressure--of the blood as it flows through blood vessels. This increased blood pressure creates strain on the heart and cardiovascular system.

The researchers analyzed data from the National Health and Nutrition Examination Survey, a nationally representative study that started in the 1960s and involves about 5,000 U.S. residents annually. Dolmatova and her colleagues extracted the records of 13,000 people participating in the survey between 1999-2012 who indicated they had been diagnosed with high blood pressure. People in the sample were an average age of 60 and slightly more than half were men.

The team then analyzed the sodium intake of these 13,000 study participants based on questionnaires that provided a snapshot of their daily food intake. The analysis revealed that daily sodium intake increased among people with high blood pressure by more than 14 percent overall from 1999-2012. Intake increased by 26 percent and 20 percent among Hispanic and African-American participants, respectively, compared to 2 percent in white Americans. White participants had the highest overall sodium intake across the study period and a markedly higher intake than other racial groups at the start of the study, but showed little change in sodium intake over time. All racial groups reported roughly the same daily sodium intake by 2012.

In general, men reported higher sodium intake than women, although both men and women increased their sodium intake over the course of the study at roughly the same rate.

Relative to all people with high blood pressure, those with the lowest sodium intake were people who had experienced a heart attack or stroke, were taking blood pressure medications, or who had diabetes, obesity or heart failure. Although these findings suggest people with worse health conditions are likely more motivated to take dietary recommendations seriously, the researchers emphasized that reducing sodium intake is important for anyone with high blood pressure.

"For many diseases, lifestyle modification is the first and most effective step in treatment," Dolmatova said. "There are [many] medications for hypertension, but they all come at a cost and have side effects; we [the medical community] have to focus more effort on educating people to successfully implement these lifestyle modifications and thus decrease the use of medications."

U.S. dietary guidelines recommend a daily maximum of 1,500 milligrams of sodium for people with high blood pressure or a high risk of developing it, and a daily maximum of 2,300 milligrams (the amount in one teaspoon of table salt) for most other people. Since the majority of the typical American's daily sodium intake comes from prepared or processed foods, experts recommend cutting down on processed foods or switching to low-sodium or sodium-free products to reduce sodium intake. Other recommendations include selecting less salty items at restaurants, using less salt when cooking at home and tasting food before adding salt at the table.

One limitation of this retrospective study is that it relied on self-reporting by participants to measure both high blood pressure and dietary intake. In addition, because authors analyzed the data during the 12-year period from 1999 to 2012, the study does not reflect any dietary changes that might have occurred since the latest U.S. dietary guidelines were released in 2016.

How much sun is good for our health?

Spanish researchers have estimated the duration of solar radiation exposure required in order to obtain the recommended doses of vitamin D. While in spring and summer 10 to 20 minutes in the sun are enough, in the winter months almost two hours would be needed, therefore for the vast majority of the population it is difficult to achieve the optimal values.

Every year, studies on the benefits of sunbathing in moderate doses are interspersed with those that confirm the risks of doing it excessively.

Although ultraviolet (UV) solar radiation contributes to the development of sun erythema, cancer and aging of the skin, it also reduces blood pressure, synthesises vitamin D and improves the treatment of several diseases.

Now, the Solar Radiation Research Group at the Polytechnic University of Valencia (UPV) has analysed the exposure time needed to obtain the recommended doses of vitamin D without damaging our health. The results have been published in the journal Science of the Total Environment.

As María Antonia Serrano, a scientist at the UPV and main author of the study, explains to SINC: "In Spain, despite being a country with many hours of sunlight, several articles have reported a high percentage of vitamin D deficiency among various strata of the Spanish population."

Vitamin D deficiency is linked in adults to a higher risk of suffering from various diseases. Since very few foods contain this vitamin, its synthesis in the skin as a result of sun exposure is the main natural source that exists.

Serrano and her colleagues estimated the time needed to obtain the recommended doses - which is equivalent to a daily intake of 1,000 IUs (international units) of vitamin D - in an area such as the city of Valencia, which receives a large dose of UV radiation throughout the year.

Burning in 30 minutes

The study analysed ultraviolet solar irradiance (UVER) around midday (between 12:30 and 13:30) for four months of the year (one in each season) from 2003 to 2010. With these figures the time taken to cause erythema - reddening of the skin caused by burns - was calculated.

As such, the facts show that in July, an individual with skin type III (the most common one among the population of Spain) must not spend more than 29 minutes in the sun if they wish to avoid erythema. However, in January, the same individual can remain in the sun for 150 minutes.

The minimum exposure time to obtain the recommended daily dose of vitamin D was obtained in the same way. "The problem can appear in winter due to low levels of UV radiation and because people cover most of their bodies," the expert adds.

It was found that around midday in January, with 10% of the body exposed, around 130 minutes are needed to obtain the recommended daily dose of vitamin D.

As this time is shorter than the time taken to get erythema, there is no risk of sunburn. By contrast, in April and July, with 25% of the body exposed, around 10 minutes is sufficient to acquire the vitamin. And in October, for example, 30 minutes would be enough.

"These calculations were made for skin type III, but the figures would change for those who are lighter or darker in complexion," Serrano points out. "It is also essential to bear in mind that we have considered the usual percentage of the body exposed for the season. If more skin is exposed, exposure time can be reduced."

Similarly, the time obtained for erythema to occur was calculated for average days. "It should be taken with caution. On extreme days, permissible exposure times would be much shorter," she stresses.

Maintaining vitamin D in winter

The results show that, although there is sufficient radiation in countries like Spain, it is difficult to attain recommended doses of vitamin D in winter (from November to February) at a northern mid-latitude, since the exposure time required is excessive (130 minutes).

In these months, with 10% of the body exposed, at solar noon two hours of sun exposure would be needed to obtain an optimal dose of vitamin D; but at 10:00 approximately 9.7 hours would be required and at 16:00 around 5.7 hours.

On the other hand, in the middle hours of the day in spring and summer, with 25% of the body exposed, around 10 minutes of sun exposure at about 13:00 and 20 minutes from 15:00 to 17:00 would be sufficient to meet daily vitamin D requirements.

"Radiation received also depends on posture, body shape and clothing. It should also be remembered that not all areas of the body synthesise vitamin D with the same efficiency," Serrano reveals.

An individual's age also plays an important role in synthesising vitamin D from UV radiation, because the older one gets the less able one becomes to produce vitamin D: middle-aged adults have 66% of the potential children have to do this.

"These results can help to adopt the right measures to make up for any deficiency, such as informing the medical profession about the utility of increasing vitamin D intake in the diet or through supplements," the Spanish researcher concludes.