Low physical function after age 65 associated with future cardiovascular disease

 

Among people older than age 65 who were assessed using a short physical function test, having lower physical function was independently associated with a greater risk of developing heart attack, heart failure and stroke, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

The Short Physical Performance Battery (SPPB) used in this study is considered a measure of physical function, which includes walking speed, leg strength and balance. This study examined physical function, which is different from physical fitness.

“While traditional cardiovascular disease risk factors such as high blood pressure, high cholesterol, smoking or diabetes are closely linked to cardiovascular disease, particularly in middle-aged people, we also know these factors may not be as predictive in older adults, so we need to identify nontraditional predictors for older adults,” said study senior author Kunihiro Matsushita, M.D., Ph.D., an associate professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health and the Division of Cardiology at the Johns Hopkins School of Medicine in Baltimore. “We found that physical function in older adults predicts future cardiovascular disease beyond traditional heart disease risk factors, regardless of whether an individual has a history of cardiovascular disease.”

The Atherosclerosis Risk in Communities (ARIC) study, an ongoing community-based cohort enrolled 15,792 participants, ages 45-64 years from 1987-1989, to investigate the causes for atherosclerotic disease (plaque or fatty buildup in the arteries). Yearly and semi-yearly (beginning in 2012) check-ins included phone calls and in-person clinic exams.

The present study evaluated health data from ARIC visit 5 (2011-2013; all participants were older than age 65) as a baseline, when the SPPB physical function test was first collected. The SPPB measured physical function to produce a score according to walking speed, speed of rising from a chair without using your hands and standing balance.

Researchers analyzed health data for 5,570 adults (58% women; 78% white adults; 22% Black adults), average age of 75 from 2011 to 2019. Using SPPB scores, the physical function of the participants was categorized into three groups: low, intermediate and high, based on their test performance.

Researchers examined the association of SPPB scores with future heart attack, stroke and heart failure, as well as the composite of the three, adjusting for major cardiovascular disease risk factors, such as high blood pressure, smoking, high cholesterol, diabetes and history of cardiovascular disease.

The study found:

• Among all participants, 13% had low, 30% had intermediate and 57% had high physical function scores.
• During the 8 years of the study, there were 930 participants with one or more confirmed cardiovascular events: 386 diagnosed with heart attack, 251 who had a stroke and 529 heart failure cases.
• Compared to adults with high physical function scores, those with low physical function scores were 47% more likely to experience at least one cardiovascular disease event, and those with intermediate physical function scores had a 25% higher risk of having at least one cardiovascular disease event.
• The association between physical function and cardiovascular disease remained after controlling for traditional cardiovascular disease risk factors such as age, high blood pressure, high cholesterol and diabetes.
• The physical function score improved the risk prediction of cardiovascular disease outcomes beyond traditional cardiovascular risk factors regardless of whether individuals had a history of cardiovascular disease or were healthy.

“Our findings highlight the value of assessing the physical function level of older adults in clinical practice,” said study lead author Xiao Hu, M.H.S., a research data coordinator in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health. ”In addition to heart health, older adults are at higher risk for falls and disability. The assessment of physical function may also inform the risk of these concerning conditions in older adults.”

Falls and fear of falling in older adults are major health issues, and they are associated with high injury rates, high medical care costs and significant impact on quality of life. A 2022 American Heart Association scientific statement, Preventing and managing falls in adults with cardiovascular disease, advises medication adjustments, reassessing treatment plans, considering non-drug treatment options and properly managing heart rhythm disorders to reduce fall risks among elderly adults.

“Our study adds additional evidence to past research, which has demonstrated the importance of maintaining physical function at an older age,” Matsushita said. “The next questions are: what is the best way for older adults to maintain physical function, and whether interventions that improve physical function can reduce cardiovascular disease risk?”

The study had several limitations. The study population included only white and Black adults but did not include people from other racial or ethnic groups (ARIC began enrollment in 1985, when participation among people from diverse racial and ethnic backgrounds was more limited). The study also didn’t account for individuals whose lack of mobility might prevent them from getting assessed at a research clinic. Additional research will be required to confirm the findings in people from more diverse racial and ethnic groups and people who have even less physical function.

Additional Resources:

• Multimedia is available on the right column of release link: https://newsroom.heart.org/news/low-physical-function-after-age-65-associated-with-future-cardiovascular-disease?preview=b6fa868d1f4857e8cb064f4fb3b09763
• After August 31, view the manuscript online.
• AHA Scientific Statement: Screen time for older adults: Mobile health tech can support seniors with heart disease (April 2021)
• AHA news release: More steps-per-day linked to significant reductions in diabetes and high blood pressure (March 2020)
• AHA health information: Getting physically active
• Follow AHA/ASA news on Twitter @HeartNews
• Follow news from the Journal of the American Heart Association @JAHA_AHA

Blood type A linked to your risk of stroke before age 60

 Gene variants associated with a person’s blood type may be linked to their risk of early stroke, according to a new meta-analysis published in the August 31, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology. The meta-analysis included all available data from genetic studies that included young adult ischemic stroke, which is caused by a blockage of blood flow to the brain.

“Non-O blood types have previously been linked to a risk of early stroke, but the findings of our meta-analysis showed a stronger link between these blood types with early stroke compared to late stroke, and in linking risk mostly to blood type A,” said study author Braxton D. Mitchell, PhD, MPH, of University of Maryland School of Medicine in Baltimore. “Specifically, our meta-analysis suggests that gene variants tied to blood types A and O represent nearly all of those genetically linked with early stroke. People with these gene variants may be more likely to develop blood clots, which can lead to stroke.”

The meta-analysis involved a review of 48 studies on genetics and ischemic stroke from North America, Europe and Asia. The studies included 16,927 people with stroke and 576,353 people who did not have a stroke. Of those with stroke, 5,825 people had early onset stroke and 9,269 people had late onset stroke. Early onset stroke was defined as an ischemic stroke occurring before age 60 and late onset stroke was older than 60.

Researchers looked across all the chromosomes to identify genetic variants associated with stroke. They found a link between early stroke and the area of the chromosome that includes the gene that determines A, AB, B or O blood type.

They then divided participants into A, AB, B and O blood types. They compared the prevalence of those blood types in people with early stroke, late stroke and people who did not have a stroke.

Researchers found that people with early stroke were more likely to have blood type A and less likely to have blood type O compared to people with late stroke and people without stroke. Both early and late stroke were also more likely to have blood type B compared to controls.

When looking at people of European ancestry and comparing 5,825 people with early stroke to 29,320 people who did not have a stroke, the meta-analysis found that 48% of people with early stroke had blood type A compared to 45% of people with late stroke and 44% of people without stroke. They also found 35% of people with early stroke had blood type O compared to 39% of those with late stroke and 41% of people without stroke.

After adjusting for sex and other factors, researchers found those who had blood type A had an 18% higher risk of having an early stroke than people with other blood types. Those who had blood type O had a 12% lower risk of having a stroke than people with other blood types.

“This work deepens our understanding of early onset stroke development and changes,” said Jennifer Juhl Majersik, MD, MS, of the University of Utah and Fellow of the American Academy of Neurology, who wrote an editorial accompanying the study. “Future research is needed to help develop a more precise understanding of how stroke develops. This could lead to targeted preventative treatments for early onset stroke, which could result in less disability during people’s most productive years.”

A limitation of the study was the limited amount of diversity among participants, although 35% of the participants were of non-European ancestry.

Drinking black tea may be associated with lower mortality risk

 

A prospective cohort study found that drinking black tea may be associated with a moderately lower mortality risk. The risk was lowest among persons drinking two or more cups of tea per day. The findings are published in Annals of Internal Medicine.

Tea is one of the most consumed beverages worldwide. Previous research has suggested an association between tea consumptions and lower mortality risk in populations where green tea is the most common type of tea. In contrast, published studies in populations where black tea drinking is more common are limited with inconsistent findings.

Researchers from the National Institutes of Health conducted a study to evaluate the associations of tea consumption with all-cause and cause-specific mortality using data from the U.K. Biobank, where black tea drinking is common. They also assessed whether the associations differ by use of common tea additives (milk and sugar), tea temperature, and genetic variants affecting the rate at which people metabolize caffeine. The U.K. Biobank includes data on a half a million men and women, aged 40 to 69 years, who completed a baseline questionnaire between 2006 and 2010. Of those, 85 percent reported regularly drinking tea and of them, 89 percent reported drinking black tea. Relative to tea nondrinkers, participants who reported drinking 2 or more cups each day had 9 to 13 percent lower risk for mortality. The associations were observed regardless of whether participants also drank coffee, added milk or sugar to their tea, their preferred tea temperature, or genetic variants related to caffeine metabolism. According to the authors, their findings suggest that tea, even at higher levels of intake, can be part of a healthy diet.

Boosting duration, intensity & frequency of physical activity may lower heart failure risk

 

The study, in Circulation, is one of the first to examine the association between objectively measured physical activity levels and heart failure risk independently of sociodemographic, lifestyle and clinical factors A six-year analysis of more than 94,000 adults in the U.K. Biobank with no history of heart failure at enrollment has found that engaging in moderate or vigorous physical activity may lower the risk of developing heart failure, according to new research published today in the American Heart Association’s flagship journal Circulation.

The study is one of the first to use objectively measured activity levels to estimate heart failure risk. The results are consistent with previous studies finding that performing 150-300 minutes of moderate exercise or 75-150 minutes of vigorous exercise each week may reduce the incidence of heart attack and stroke.

Heart failure is a chronic, progressive condition that develops when the heart is not capable of pumping sufficient blood to keep up with the body’s needs for blood and oxygen, and it can result in fatigue and difficulty breathing. Heart failure affects more than 6 million adults in the United States, according to the American Heart Association, and more than 86,000 Americans died of heart failure in 2019. The Association recommends adults should engage in at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity.

“There are many potential ways that regular physical activity may reduce the risk of developing heart failure,” said Frederick K. Ho, Ph.D., co-lead author of the study and a lecturer in public health at the University of Glasgow in Glasgow, Scotland. “For example, physical activity helps prevent weight gain and related cardiometabolic conditions, such as high blood pressure and Type 2 diabetes, all of which are risk factors for heart failure. Regular physical exercise may also strengthen the heart muscle, which, in turn, may prevent heart failure from developing.”

The investigators analyzed the health records of 94,739  adults aged 37-73 in the U.K. Biobank – a large research database in the United Kingdom that enrolled and collected health information on 500,000 adults who received care through the National Health Service. The participants in the U.K. Biobank were enrolled in the database between 2006 and 2010 across Scotland, England and Wales.

Data for this study was gathered between 2013-2015. During that time period, the subset of 94,739 participants were randomly invited to enroll in the study via the email address they had provided to the U.K. Biobank. Participants were an average age of 56 years at enrollment; 57% were female, and 96.6% were white adults. At the time each participant was invited, enrolled and analyzed, they had not been diagnosed with heart failure or had a heart attack. Each participant wore a wrist accelerometer for seven consecutive days, 24 hours per day, to measure the intensity and duration of physical activity. After enrollment, data was collected through linked hospital and death records.

During a median follow-up of 6.1 years after the physical activity measurement was conducted, the analysis found:

• The adults who logged 150-300 minutes of moderate physical activity in one week had a 63% lower risk of heart failure; and
• those who performed 75-150 minutes of vigorous physical activity in one week were estimated to have a 66% lower risk of heart failure compared to participants who engaged in minimal to no moderate or vigorous physical activity.

The estimated risk reductions were adjusted for age, sex, ethnicity, education, socioeconomic conditions, smoking, alcohol intake and dietary factors.

“These findings indicate that every physical movement counts. A leisurely, 10-minute walk is better than sitting and no physical activity. And, if possible, try to walk a little faster, which increases the intensity and potential benefits of exercise,” Ho said.

According to Ho, the study results suggest that going above and beyond the current AHA recommendations for moderate activity may provide greater protection against heart failure. “We found that moderate physical activity has the potential increased cardiovascular risk benefits up until 500 minutes/week, as appropriate for each individual,” he said.

People whose risk factors for heart failure include having a BMI that meets the criteria for overweight or obese, high blood pressure and elevated glucose or cholesterol, may be particularly likely to benefit from increasing their physical activity, according to Ho and colleagues.

“Health care professionals may suggest more physical activity based on a patient’s current lifestyle and health status,” Ho said. “Generally, moderate physical activity is easier to incorporate into daily routines, and it’s generally safer. Vigorous physical activity is sometimes the most time-efficient and may be more suitable for busy people. However, caution is advised for all when beginning a new physical activity regimen to prevent injuries or acute adverse events (such as a heart attack in a formerly sedentary person initiating a vigorous exercise program).”

This observational study cannot prove a cause-and-effect link between the amount and intensity of physical activity and the risk of developing heart failure. Because participants in the U.K. Biobank are overwhelmingly white, further studies would be needed to confirm that these results apply to people from diverse backgrounds who may experience negative social determinants of health.

“Our findings add to the overwhelming body of other evidence, suggesting that maintaining even a modest amount of regular physical activity can help prevent a range of chronic conditions from developing, including heart failure,” said Naveed Sattar, the senior author of the study. Sattar is a professor of metabolic medicine at the Institute of Cardiovascular & Medical Sciences at the University of Glasgow.

Good sleepers have lower risk of heart disease and stroke

Nine in ten people do not get a good night’s sleep, according to research presented at ESC Congress 2022.1 The study found that suboptimal sleep was associated with a higher likelihood of heart disease and stroke. The authors estimated that seven in ten of these cardiovascular conditions could be prevented if everyone was a good sleeper.

“The low prevalence of good sleepers was expected given our busy, 24/7 lives,” said study author Dr. Aboubakari Nambiema of INSERM (the French National Institute of Health and Medical Research), Paris, France. “The importance of sleep quality and quantity for heart health should be taught early in life when healthy behaviours become established. Minimising night-time noise and stress at work can both help improve sleep.”

Previous studies on sleep and heart disease have generally focused on one sleep habit, such as sleep duration or sleep apnoea, where breathing stops and starts while sleeping. In addition, prior studies have often assessed sleep at baseline only. The current study used a healthy sleep score combining five sleep habits. The researchers investigated the association between the baseline sleep score, and changes over time in the sleep score, and incident cardiovascular disease.

This study included 7,200 participants of the Paris Prospective Study III (PPP3), an observational community‐based prospective cohort. Men and women aged 50 to 75 years and free of cardiovascular disease were recruited in a preventive medical centre between 2008 and 2011. The average age was 59.7 years and 62% were men. Participants underwent a physical examination and completed questionnaires on lifestyle, personal and family medical history, and medical conditions.

Questionnaires were used to collect information on five sleep habits at baseline and two follow up visits. Each factor was given 1 point if optimal and 0 if not. A healthy sleep score ranging from 0 to 5 was calculated, with 0 or 1 considered poor and 5 considered optimal. Those with an optimal score reported sleeping 7 to 8 hours per night, never or rarely having insomnia, no frequent excessive daytime sleepiness, no sleep apnoea, and an early chronotype (being a morning person). The researchers checked for incident coronary heart disease and stroke every two years for a total of 10 years.

At baseline, 10% of participants had an optimal sleep score and 8% had a poor score. During a median follow up of eight years, 274 participants developed coronary heart disease or stroke. The researchers analysed the association between sleep scores and cardiovascular events after adjusting for age, sex, alcohol consumption, occupation, smoking, body mass index, physical activity, cholesterol level, diabetes, and family history of heart attack, stroke or sudden cardiac death. They found that the risk of coronary heart disease and stroke decreased by 22% for every 1 point rise in the sleep score at baseline. More specifically, compared to those with a score of 0 or 1, participants with a score of 5 had a 75% lower risk of heart disease or stroke.

The researchers estimated the proportion of cardiovascular events that could be prevented with healthier sleep. They found that if all participants had an optimal sleep score, 72% of new cases of coronary heart disease and stroke might be avoided each year.

Over two follow ups, almost half of participants (48%) changed their sleep score: in 25% it decreased whereas in 23% it improved. When the researchers examined the association between the change in score and cardiovascular events, they found that a 1 point increment over time was associated with a 7% reduction in the risk of coronary heart disease or stroke.

Dr. Nambiema said: “Our study illustrates the potential for sleeping well to preserve heart health and suggests that improving sleep is linked with lower risks of coronary heart disease and stroke. We also found that the vast majority of people have sleep difficulties. Given that cardiovascular disease is the top cause of death worldwide, greater awareness is needed on the importance of good sleep for maintaining a healthy heart."

Study highlights lifelong benefits of statin therapy

 Stopping statin treatment early could substantially reduce lifetime protection against heart disease since a large share of the benefit occurs later in life. That’s the finding of a modelling study presented at ESC Congress 2022.1

Lead author Dr. Runguo Wu of Queen Mary University of London, UK said: “The study indicates that people in their 40s with a high likelihood of developing cardiovascular disease, and people of all ages with existing heart disease, should be considered for immediate initiation of cholesterol lowering treatment. Stopping treatment, unless advised by a doctor, does not appear to be a wise choice.”   

Cardiovascular disease is the most common cause of ill-health and death worldwide, and high cholesterol is a key modifiable risk factor.2 Strong evidence shows that reducing low-density lipoprotein cholesterol by 1 mmol/L with statins reduces the risks of ischaemic heart disease and stroke by 24%-25%.3 Statins are the most commonly used lipid-modifying drug – it is estimated that in 2018, they were taken by more than 145 million people.4 However, delayed treatment initiation and poor adherence are common.5,6 Exaggerated claims about side-effects of statins may also be responsible for under-use among individuals at increased risk of cardiovascular events.7

There is some uncertainty about when to start and how long to persist with statin therapy to optimise the effects. This study estimated the accumulation of benefit with statins according to age at therapy initiation using a microsimulation model that was developed using data on 118,000 participants of large international statin trials from the Cholesterol Treatment Trialists’ (CTT) Collaboration and 500,000 individuals in the UK Biobank population cohort.

The model used individual characteristics (e.g. age, sex) and disease histories to simulate the annual risk of heart attack, stroke, coronary revascularisation, diabetes, cancer, vascular death and nonvascular death for each participant. Treatment with a standard dose of statin (40 mg daily) was used to estimate the effect of therapy versus no therapy in these scenarios: (1) lifelong therapy (used until death or 110 years of age if earlier), (2) therapy stopped at 80 years of age, and (3) delayed initiation of therapy by five years in participants under 45 years of age.

The benefit of statins was measured in quality-adjusted life years (QALYs), which is the length of life adjusted by health to reflect quality of life. One QALY is equal to one year of life in perfect health. Benefits were also reported separately according to baseline cardiovascular risk, which refers to the likelihood of having a heart attack or stroke in the next 10 years, and is based on age, blood pressure, cholesterol levels, smoking status, and medical conditions.8

The researchers found that a large part of QALYs gained with statin therapy accrued later in life. The higher the participants’ 10-year cardiovascular risk, the larger and earlier the statin benefit accrued. Compared with lifelong statins, stopping therapy at 80 years of age erased a large share of the potential benefit, especially for people with relatively low cardiovascular risk.

Dr. Wu said: “Our study suggests that people who start taking statins in their 50s but stop at 80 years of age instead of continuing lifelong will lose 73% of the QALY benefit if they are at relatively low cardiovascular risk and 36% if they are at high cardiovascular risk – since those at elevated risk start to benefit earlier. Women’s cardiovascular risk is generally lower than men’s. This means that for women, most of the lifelong benefit from statins occurs later in life and stopping therapy prematurely is likely more detrimental than for men.”

In people under 45 years of age at low cardiovascular risk, meaning a less than 5% likelihood of heart attack or stroke in the next 10 years, a five-year delay in taking statins had little impact – they lost just 2% of the potential QALY benefit from lifelong therapy. However, the impact was larger in people under 45 years of age at high cardiovascular risk, meaning a more than 20% likelihood of heart attack or stroke in the next 10 years – they lost 7% of the potential QALY benefit from lifelong therapy. Dr. Wu said: “Again, this is because people at higher cardiovascular risk start to accrue benefit early on and have more to lose by delaying statin therapy than those at low risk.”

 

Smoking is even more damaging to the heart than previously thought

Smokers have weaker hearts than non-smokers, according to research presented at ESC Congress 2022.1 The study found that the more people smoked, the worse their heart function became. Some function was restored when people kicked the habit.

“It is well known that smoking causes blocked arteries, leading to coronary heart disease and stroke,” said study author Dr. Eva Holt of Herlev and Gentofte Hospital, Copenhagen, Denmark. “Our study shows that smoking also leads to thicker, weaker hearts. It means that smokers have a smaller volume of blood in the left heart chamber and less power to pump it out to the rest of the body. The more you smoke, the worse your heart function becomes. The heart can recuperate to some degree with smoking cessation, so it is never too late to quit.”

According to the World Health Organization, tobacco kills more than eight million people each year.2 Cigarette smoking is responsible for 50% of all avoidable deaths in smokers, with half of these due to atherosclerotic cardiovascular diseases such as heart attack and stroke.3 The detrimental effects of smoking on the arteries and arterial diseases such as heart attack and stroke are well established.4

Studies have also shown that smoking is associated with a higher risk of heart failure, where the heart muscle does not pump blood around the body as well as it should, usually because it is too weak or stiff. This means that the body does not receive the oxygen and nutrients it needs to work normally. The link between smoking and heart structure and function has not been fully examined. This study therefore explored whether smoking was related to changes in the structure and function of the heart in people without cardiovascular disease, and the effect of changing smoking habits.

The study used data from the 5th Copenhagen City Heart Study which investigated cardiovascular risk factors and diseases in the general population. A total of 3,874 participants aged 20 to 99 years without heart disease were enrolled. A self-administered questionnaire was used to obtain information on smoking history and to estimate pack-years, which is the number of cigarettes smoked through life. One pack-year is defined as 20 cigarettes smoked every day for one year.

Participants had an ultrasound of the heart, called echocardiography, which provides information about its structure and how well it is working. The researchers compared the echocardiography measures of current smokers versus never smokers after adjusting for age, sex, body mass index, hypertension, high cholesterol, diabetes and lung function.

The average age of participants was 56 years and 43% were women. Nearly one in five participants were current smokers (18.6%), while 40.9% were former smokers and 40.5% had never smoked. Compared to never smokers, current smokers had thicker, weaker and heavier hearts. Increasing pack-years were associated with pumping less blood. Dr. Holt explained: “We found that current smoking and accumulated pack-years were associated with worsening of the structure and function of the left heart chamber – the most important part of the heart. Furthermore, we found that over a 10-year period, those who continued smoking developed thicker, heavier and weaker hearts that were less able to pump blood compared to never smokers and those who quit during that time.”

She concluded: “Our study indicates that smoking not only damages the blood vessels but also directly harms the heart. The good news is that some of the damage is reversible by giving up.”

 

Feeling anxious or blue? Ultra-processed foods may be to blame

Do you love those sugary-sweet beverages, reconstituted meat products and packaged snacks? You may want to reconsider based on a new study that explored whether individuals who consume higher amounts of ultra-processed food have more adverse mental health symptoms. 

Although ultra-processed foods are convenient, low cost, quick to prepare or ready-to-eat, these industrial formulations of processed food substances (oils, fats, sugars, starch, protein isolates) contain little or no whole food. They result from extensive ‘physical, biological, and chemical processes’ that create food products that are deficient in original and natural food. Ultra-processed foods typically include flavorings, colorings, emulsifiers and other cosmetic additives.

While there is some evidence regarding ultra-processed food consumption and depression, data are sparse regarding other adverse mental health symptoms including anxiety and mentally unhealthy days.

Researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators explored a nationally representative sample of the United States population to determine if individuals who consume high amounts of ultra-processed foods report significantly more adverse mental health symptoms including depression, anxiety and mentally unhealthy days.   

They measured mild depression, number of mental unhealthy days and number of anxious days in 10,359 adults 18 and older from the U.S. National Health and Nutrition Examination Survey.

Results of the study, published in the journal Public Health Nutrition, showed that individuals who consumed the most ultra-processed foods as compared with those who consumed the least amount had statistically significant increases in the adverse mental health symptoms of mild depression, “mentally unhealthy days” and “anxious days.” They also had significantly lower rates of reporting zero “mentally unhealthy days” and zero “anxious days.” Findings from this study are generalizable to the entire U.S. as well as other Western countries with similar ultra-processed food intakes.

“The ultra-processing of food depletes its nutritional value and also increases the number of calories, as ultra-processed foods tend to be high in added sugar, saturated fat and salt, while low in protein, fiber, vitamins, minerals and phytochemicals,” said Eric Hecht, M.D., Ph.D., corresponding author and an affiliate associate professor in FAU’s Schmidt College of Medicine. “More than 70 percent of packaged foods in the U.S. are classified as ultra-processed food and represent about 60 percent of all calories consumed by Americans. Given the magnitude of exposure to and effects of ultra-processed food consumption, our study has significant clinical and public health implications.”

Researchers used the NOVA food classification for the study, which is a widely used system recently adopted by the Food and Agricultural Organization of the United Nations. NOVA considers the nature, extent and purpose of food processing in order to categorize foods and beverages into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods.

“Data from this study add important and relevant information to a growing body of evidence concerning the adverse effects of ultra-processed consumption on mental health symptoms,” said Charles H. Hennekens, M.D., Dr.PH, co-author, the first Sir Richard Doll Professor of Medicine, and senior academic advisor, FAU Schmidt College of Medicine. “Analytic epidemiologic research is needed to test the many hypotheses formulated from these descriptive data.”

According to the National Institute of Mental Health, nearly 1 in 5 adults live with a mental illness. Mental illnesses, including depression and anxiety, are leading causes of morbidity, disability and mortality.

People with an obsessive urge to constantly check the news are more likely to suffer from stress, anxiety, as well as ill health.

 People with an obsessive urge to constantly check the news are more likely to suffer from stress, anxiety, as well as physical ill health, finds a new study published in the peer-reviewed journal Health Communication.

During the last two years we have lived through a series of worrying global events, from the COVID pandemic to Russia invading Ukraine,large-scale protests, mass shootings and devastating wildfires. For many people, reading bad news can make us feel temporarily powerless and distressed.

For others, being exposed to a 24-hour news cycle of continually evolving events can have serious impacts on mental and physical wellbeing -- as these new findings, out today, show, with those who have a high-levels of news addiction reporting "significantly greater physical ill-being."

"Witnessing these events unfold in the news can bring about a constant state of high alert in some people, kicking their surveillance motives into overdrive and making the world seem like a dark and dangerous place," says Bryan McLaughlin, associate professor of advertising at the College of Media and Communication at Texas Tech University.

"For these individuals, a vicious cycle can develop in which, rather than tuning out, they become drawn further in, obsessing over the news and checking for updates around the clock to alleviate their emotional distress. But it doesn't help, and the more they check the news, the more it begins to interfere with other aspects of their lives."

To study this phenomenon, known colloquially as news addiction, McLaughlin and his colleagues, Dr Melissa Gotlieb and Dr Devin Mills, analysed data from an online survey of 1,100 US adults.

In the survey, people were asked about the extent to which they agreed with statements like "I become so absorbed in the news that I forget the world around me," "my mind is frequently occupied with thoughts about the news," "I find it difficult to stop reading or watching the news," and "I often do not pay attention at school or work because I am reading or watching the news."

Respondents were also asked about how often they experienced feelings of stress and anxiety, as well as physical ailments such as fatigue, physical pain, poor concentration, and gastrointestinal issues.

The results revealed that 16.5% of people surveyed showed signs of 'severely problematic' news consumption. Such individuals frequently became so immersed and personally invested in news stories that the stories dominated the individual's waking thoughts, disrupted time with family and friends, made it difficult to focus on school or work, and contributed to restlessness and an inability to sleep.

Perhaps not surprisingly, people with higher levels of problematic news consumption were significantly more likely to experience mental and physical ill-being than those with lower levels, even when controlling for demographics, personality traits, and overall news use.

When asked how frequently survey participants experienced mental health or physical illness symptoms over the past month, results show:

• 73.6% of those recognized to have severe levels of problematic news consumption reported experiencing mental ill-being "quite a bit" or "very much" -- whilst frequent symptoms were only reported by 8% of all other study participants.
• 61% of those with severe levels of problematic news reported experiencing physical ill-being "quite a bit" or "very much" compared to only 6.1% for all other study participants.

According to McLaughlin, the findings show that there is a need for focused media literacy campaigns to help people develop a healthier relationship with the news.

"While we want people to remain engaged in the news, it is important that they have a healthier relationship with the news," he says.

"In most cases, treatment for addictions and compulsive behaviors centers on complete cessation of the problematic behavior, as it can be difficult to perform the behavior in moderation.

"In the case of problematic news consumption, research has shown that individuals may decide to stop, or at least dramatically reduce, their news consumption if they perceive it is having adverse effects on their mental health.

"For example, previous research has shown that individuals who became aware of and concerned about the adverse effects that their constant attention to sensationalized coverage of COVID-19 was having on their mental health reported making the conscious decision to tune out.

"However, not only does tuning out come at the expense of an individual's access to important information for their health and safety, it also undermines the existence of an informed citizenry, which has implications for maintaining a healthy democracy. This is why a healthy relationship with news consumption is an ideal situation."

In addition, the study also calls out the need for a wider discussion about how the news industry may be fuelling the problem.

"The economic pressures facing outlets, coupled with technological advances and the 24- hour news cycle have encouraged journalists to focus on selecting "newsworthy" stories that will grab news consumers' attention," says McLaughlin.

"However, for certain types of people, the conflict and drama that characterize newsworthy stories not only grab their attention and draw them in, but also can lead to a maladaptive relationship with the news. Thus, the results of our study emphasise that the commercial pressures that news media face are not just harmful to the goal of maintaining a healthy democracy, they also may be harmful to individuals' health."

Limitations of this study include reliance on a data collected at one point in time, where the authors could not establish the exact relationship between problematic news consumption and mental and physical ill-being.

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Octogenarians should walk 10 minutes a day to prolong life

One hour of walking per week is associated with greater longevity in people aged 85 years and above, according to research presented at ESC Congress 2022.1

Regardless of age, adults are advised to do at least 150 minutes a week of moderate intensity activity or 75 minutes a week of vigorous intensity activity, or an equivalent combination.2 However, in adults, sedentary time tends to increase with age3 while the amount of physical activity declines.4

“Adults are less likely to meet activity recommendations as they get older,” said study author Dr. Moo-Nyun Jin of Inje University Sanggye Paik Hospital, Seoul, Republic of Korea. “Our study suggests that walking at least one hour every week is beneficial for people aged 85 years and older. Put simply, walk for 10 minutes every day.”

This study examined the association between walking and the risks of all-cause and cardiovascular mortality among adults aged 85 years and older. The researchers used information from the Korean National Health Insurance Service (NHIS) Senior database. The study included 7,047 adults aged 85 or older who underwent the Korean National Health Screening Programme in 2009 to 2014. Participants completed a questionnaire on leisure-time physical activity which asked the length of time spent each week on walking at a slow pace, moderate intensity activity such as cycling and brisk walking, and vigorous intensity activity such as running.   

The average age of participants was 87 years and 4,813 (68.3%) were women. Participants were classified into five groups according to the time spent walking at a slow pace per week. Some 4,051 (57.5%) participants did no slow walking, 597 (8.5%) walked less than one hour, 849 (12.0%) walked one to two hours, 610 (8.7%) walked two to three hours, and 940 (13.3%) walked more than three hours per week.

In the entire study population of 7,047 adults, 1,037 (14.7%) participants did moderate intensity physical activity and 773 (10.9%) did vigorous intensity physical activity. Only 538 participants (7.6%) met the guideline recommendations for moderate-to-vigorous intensity physical activity. Of the 2,996 participants who walked at a slow pace every week, 999 (33%) also did moderate or vigorous intensity physical activity.

The researchers analysed the associations between walking, all-cause mortality, and cardiovascular mortality after adjusting for energy expended on moderate-to-vigorous intensity physical activity. Compared to inactive individuals, those who walked at least one hour per week (i.e. the three highest walking categories) had 40% and 39% lower relative risks of all-cause and cardiovascular mortality, respectively.

Dr. Jin said: “Walking was linked with a lower likelihood of dying in older adults, regardless of whether or not they did any moderate-to-vigorous intensity physical activity. Identifying the minimum amount of exercise that can benefit the oldest old is an important goal since recommended activity levels can be difficult to achieve. Our study indicates that walking even just one hour every week is advantageous to those aged 85 years and older compared to being completely inactive. The take home message is to keep walking throughout life.”

 

References and notes

1The abstract “Association of usual walking with mortality in oldest old adults aged 85 years and older: a nationwide senior cohort study” will be presented during the session Multiple risk factors on Sunday 28 August at 12:15 to 13:00 CEST at Station 4.

2Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.

3Kim Y, Lee E. The association between elderly people's sedentary behaviors and their health-related quality of life: focusing on comparing the young-old and the old-old. Health Qual Life Outcomes. 2019;17:131.

4Milanović Z, Pantelić S, Trajković N, et al. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8:549–556.

Statins provide protective immune benefits for females

 Cholesterol tends to get a bad rap through its association with cardiovascular disease. But its role in the body is much more nuanced.

When we have too much cholesterol, it can build up in the walls of our arteries and cause cardiovascular disease. But cholesterol molecules play a critical role in our cells’ structure and signaling pathways, and – as scientists are beginning to understand – immune function.

Catherine Andersen, associate professor of nutritional sciences in the College of Agriculture, Health and Natural Resources, recently published her findings uncovering a new piece of this puzzle in Frontiers in Medicine. Andersen found that statins, commonly prescribed lipid-lowering drugs, provide a protective immune function in females.

Previous studies in cell and animal models showed that lipids play an important role in modulating immune cells, but there was little evidence of this relationship in humans.

To investigate this connection, Andersen looked to see if there was an association between serum lipid levels (which include measures of total cholesterol, HDL- and LDL-cholesterol, and triglycerides) and antinuclear antibodies (ANA). ANA are the most common type of autoantibodies, and serve as diagnostic and predictive markers of current or future autoimmune disease, in addition to cardiovascular disease and death. The presence of ANA can also be an indicator of immune activation or dysfunction in response to cell turnover or pathogens – including SARS-CoV2 infection, as ANA have been detected in COVID-19 patients with worse prognoses.

“We wanted to start out by seeing if there was an association between serum lipids and antinuclear antibodies,” Andersen says. “Having really elevated lipid levels can prime our immune cells to be more reactive. And there’s some evidence in animal studies that really high lipid levels can induce autoimmunity.”

Andersen did not find a strong association between serum lipid levels and ANAs, so she considered another variable: statin use.

The effects of statin use in autoimmunity is controversial. While some studies report anti-inflammatory benefits of statins in populations with autoimmune conditions, other studies suggest that statins may promote the development of autoimmune disorders. So, Andersen was surprised to see that statin use had a beneficial effect for women, but not men. Women taking statins were 75% less likely to be ANA+ than those who did not.

Andersen says this finding is especially significant because historically, drug trials have used predominantly male participants. This means females often experience more severe or unexpected side effects.

“I think that’s really important because women tend to have more adverse reactions to statins,” Andersen says. “Oftentimes, adherence to statin treatment might not be as strong [among women] because they experience more side effects, and they might not feel as heard when they go to their physician to express their concerns.”

Andersen did not find any significant differences in this relationship for women across race/ethnicity and educational level.

“That’s something that’s as important to include,” Andersen says. “Because when we’re drawing conclusions and saying that one therapeutic treatment may be beneficial to women, we do want to ensure that we’re really basing this on a diverse sample and our conclusion would be applicable to all or as many populations as [possible].”

This study was only looking at the correlation between statin use and ANAs. Andersen says potential follow-up studies may help identify what causes this sex-specific phenomenon.

“I think, to date, the research has been siloed,” Andersen says. “We know that there are sex-specific differences in the immune response. We know that there are sex-specific differences in lipid metabolism. But the relationship between lipid metabolism and immune response? There has been much more limited investigation, especially in humans, to elucidate how these lipid-immune interactions might be different – or how traditional cardiovascular drugs that are targeting lipid metabolism might confer benefit to males versus females within the context of immunity in different ways. I think it certainly warrants more investigation and our study supports that.”

Andersen is now looking to use the same data from the National Health and Nutrition Examination Survey to look at infection outcomes, and if certain dietary patterns can bolster the relationship between lipid metabolism and immunity.

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JOURNAL

Frontiers in Medicine

Many types of leisure time activities may lower risk of death for older adults

 : Older adults who participate weekly in many different types of leisure time activities, such as walking for exercise, jogging, swimming laps, or playing tennis, may have a lower risk of death from any cause, as well as death from cardiovascular disease and cancer, according to a new study led by researchers at the National Cancer Institute, part of the National Institutes of Health.

The findings suggest that it’s important for older adults to engage in leisure time activities that they enjoy and can sustain, because many types of these activities may lower the risk of death, the authors wrote.

The findings appear August 24 in JAMA Network Open.

Using data from 272,550 adults between the ages of 59 and 82 who had completed questionnaires about their leisure-time activities as part of the NIH-AARP Diet and Health Study, the researchers looked at whether participating in equivalent amounts of seven different exercise and recreational activities—including running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise—was associated with lowered risk of death.

The researchers found that achieving the recommended amount of physical activity per week through any combination of these activities was associated with a 13% lower risk of death from any cause compared with no participation in these activities. When they looked at the role of each activity individually, playing racquet sports was associated with a 16% reduction in risk and running with a 15% reduction. However, all the activities investigated were similarly associated with lower risks of death.

The second edition of the Physical Activity Guidelines for Americans recommends that adults engage in 2.5 to 5 hours of moderate-intensity aerobic physical activity, or 1.25 to 2.5 hours of vigorous-intensity aerobic physical activity, each week.

The levels of activity by the most active individuals (those who exceeded the recommended levels of physical activity) were associated with even greater reductions in the risk of death, but there were diminishing returns as activity levels increased. Even people who did some recreational activity, though less than the recommended amount, had a 5% reduction in risk of death than those who did not participate in any of the activities studied.

These activities were also associated with a lower risk of death from cardiovascular disease and cancer. Playing racquet sports was associated with the greatest reduction in risk of cardiovascular deaths (27% reduction), while running was associated with the greatest reduction in risk of cancer deaths (19% reduction).

Who: Eleanor L. Watts, D.Phil., M.P.H., Division of Cancer Epidemiology and Genetics, National Cancer Institute

Reference: “Associations of leisure time physical activity types and risks of all-cause, cardiovascular, and cancer mortality among older adults” appears August 24 in JAMA Network Open.

 visit nih.gov.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.28510 

Leading urologists release consensus statements advocating for the role of saw palmetto extract to support prostate health

 An international panel of seven leading urologists from North America and Europe reviewed over 50 original clinical research studies and developed seven consensus statements outlined in their paper “Rethinking the Role of Saw Palmetto Extract for Men with Lower Urinary Tract Symptoms in North America,” which was recently published in the journal Uro.

The group concluded that a high-quality saw palmetto extract, also known as lipidosterolic extract of Serenoa repens and available as a natural dietary supplement, should be considered as an option for men with mild-to-moderate lower urinary tract symptoms associated with an enlarged prostate.

“Across the globe, there has been a lack of consensus with regards to the effectiveness of saw palmetto extract resulting in differing recommendations by health organizations around the world,” said Dr. Jamin Brahmbhatt, one of the co-authors and board-certified urologist. “The goal of this expert panel was to contribute to our collective understanding of the science and generate discussion about the role a high-quality saw palmetto extract can play in men’s health.”

The berry produced by saw palmetto palm trees native to the Southeastern U.S. is the most studied natural ingredient for prostate health. However, the primary challenge influencing how urologists view saw palmetto supplements in patient care has been the variability of quality of products, especially those commonly found on store shelves in the United States. 

The panel highlighted that the current evidence suggests that high-quality lipidosterolic extracts with a profile defined by the United States Pharmacopeia (USP) monograph, like that found in Flomentum®, are likely important for clinical effectiveness. 

“Our panel recognized that the literature on the benefit of saw palmetto extract for lower urinary tract symptoms was specific to a high-quality extract used at 320 mg daily,” said lead author Dr. J. Curtis Nickel. 

The Urology Care Foundation reports that an enlarged prostate impacts about half of men aged 50 to 60 and 90% of men over the age of 80. Many of these men will experience lower urinary tract symptoms, such as increased urination, sudden urgency and a weak stream. These symptoms can reduce overall quality of life, including disrupting sleep. 

“This 2022 review suggests that a high-quality saw palmetto extract can play a positive role supporting the care physicians’ provide to aging men in the United States,” said Dr. Leigh Vinocur, board-certified physician and chief medical officer of Flomentum Health.

Flomentum is the first and only USP Verified prostate health supplement available to men to support lower urinary tract symptoms with no sexual side effects.*^

*Adapted from: Carraro JC, et al. Prostate. 1996;29:231-240; Debruyne F, et al. Eur Urol. 2002;41:497-506; Latil A, et al. Prostate. 2015;75:1857-1867; Pytel YA, et al. Adv Ther. 2002;19:297-306; Zlotta AR, et al. Eur Urol. 2005;48:269-276
^These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.

 

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JOURNAL

Uro

DOI

10.3390/uro2030017 

ARTICLE TITLE

Rethinking the Role of Saw Palmetto Extract for Men with Lower Urinary Tract Symptoms in North America