Low-dose aspirin associated with a 15% lower risk of developing diabetes in people aged over 65 years

 

New research to be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October) shows that use of low dose (100mg daily) aspirin among older adults aged 65 years and older is associated with a 15% lower risk of developing type 2 diabetes. The authors, led by Professor Sophia Zoungas, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, say the results show that anti-inflammatory agents such as aspirin warrant further study in the prevention of diabetes.

The effect of aspirin on incident type 2 diabetes among older adults remains uncertain. This study investigated the randomised treatment effect of low dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults. The authors did a follow-up study of the ASPREE trial - a double-blind, placebo-controlled trial of aspirin, the principal results of which were published in NEJM in 2018. The original study showed that aspirin conferred a 38% increased risk of major haemorrhage in older adults without any reduction in incidence of cardiovascular disease.

The study enrolled community-dwelling individuals aged 65 years or over, and free of cardiovascular disease, independence-limiting physical disability and dementia. Participants were randomised 1:1 to 100 mg daily aspirin or placebo. Incident diabetes was defined as self-report of diabetes, commencement of glucose lowering medication, and/or a fasting plasma glucose (FBP) level of 7.0 mmol/L or higher at annual follow-up visits. Patients with diabetes at the start of the study were excluded. Computer and statistical modelling assessed the effect of aspirin on incident diabetes and FPG levels respectively.

A total of 16,209 participants were included in the analysis (8,086 randomised to aspirin and 8,123 to placebo). Over a median follow-up of 4.7 years, 995 incident diabetes cases were recorded (aspirin: 459, placebo: 536). Compared with placebo, the aspirin group had a 15% reduction in incident diabetes and a slower rate of increase in FPG (difference in annual FPG change: -0.006 mmol/L).

The authors say: “Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults. Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents like aspirin to prevent type 2 diabetes or improve glucose levels needs further study.”

However, Professor Zoungas adds: “The earlier published trial findings from ASPREE in 2018 showed aspirin did not prolong healthy independent living, but was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract. Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack.” 

“Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time.” 

Extreme dietary habits for carbohydrates and fats affect life expectancy

 

IMAGE: EXTREME DIETARY HABITS FOR CARBOHYDRATES AND FATS AFFECT LIFE EXPECTANCY: FINDINGS FROM A LARGE-SCALE COHORT STUDY IN JAPAN view more 

CREDIT: REIKO MATSUSHITA

A new study, published in The Journal of Nutrition, suggests that extreme dietary habits involving carbohydrates and fats affect life expectancy. Researchers from Nagoya University Graduate School of Medicine in Japan led by Dr. Takashi Tamura found that a low carbohydrate intake in men and a high carbohydrate intake in women are associated with a higher risk of all-cause and cancer-related mortality and that women with higher fat intake may have a lower risk of all-cause mortality. Their findings suggest that people should pursue a balanced diet rather than heavily restricting their carbohydrate or fat intake. 

 

While low-carbohydrate and low-fat diets are becoming popular as a way to promote weight loss and improve blood glucose levels, their long-term effects on life expectancy are less clear. Interestingly, recent studies conducted in Western countries suggest that extreme dietary habits for carbohydrates and fats are associated with a higher risk of mortality. However, few studies have explored these associations in East Asian populations, including Japanese individuals who typically have relatively low fat and high-carbohydrate dietary intakes. 

 

The authors conducted a follow-up survey over a period of 9 years with 81,333 Japanese people (34,893 men and 46,440 women) to evaluate the association between carbohydrate and fat intakes and the risk of mortality. Daily dietary intakes of carbohydrates, fats, and total energy were estimated using a food frequency questionnaire and calculated as a percentage of total energy intake for carbohydrates and fats. Carbohydrate intake quality (i.e., refined compared with minimally processed carbohydrate intake) and fat intake quality (i.e., saturated compared with unsaturated fat intake) were also assessed to examine the impact of food quality on the association with mortality. 

 

They found that men who consumed less than 40% of their total energy from carbohydrates experienced significantly higher risks of all-cause and cancer-related mortality. The trend was observed regardless of whether refined or minimally processed carbohydrate were considered. On the other hand, among women with 5 years or longer of follow-up, those with a high carbohydrate intake of more than 65% had a higher risk of all-cause mortality. No clear association was observed between refined or minimally processed carbohydrate intake and the risk of mortality in women. 

 

For fats, men with a high fat intake of more than 35% of their total energy from fats had a higher risk of cancer-related mortality. They also found that a low intake of unsaturated fat in men was associated with a higher risk of all-cause and cancer-related mortality. In contrast, total fat intake and saturated fat intake in women showed an inverse association with the risk of all-cause and cancer-related mortality. They concluded that this finding does not support the idea that high fat intake is detrimental to longevity in women.  

 

“The finding that saturated fat intake was inversely associated with the risk of mortality only in women might partially explain the differences in the associations between the sexes,” Dr. Tamura stated. “Alternatively, components other than fat in the food sources of fat may be responsible for the observed inverse association between fat intake and mortality in women.” 

 

This study is extremely important because restricting carbohydrates and fats, such as extremely low-carbohydrate and low-fat diets, are now popular dieting strategies aimed at improving health, including the management of metabolic syndrome. However, this study shows that low-carbohydrate and low-fat diets may not be the healthiest strategy for promoting longevity, as their short-term benefits could potentially be outweighed by long-term risk.  

 

Overall, an unfavorable association with mortality was observed for low-carbohydrate intake in men and for high carbohydrate intake in women, whereas high fat intake could be associated with a lower mortality risk in women. The findings suggest that individuals should carefully consider how to balance their diet and ensure that they are taking in energy from a variety of food sources, while avoiding extremes. 

Recommendations to reduce cardiovascular risk in patients with diabetes

 

  Patients with type 2 diabetes are more than twice as likely to develop cardiovascular disease (CVD) than their healthy peers. Advice to lower that risk is launched today in the 2023 European Society of Cardiology (ESC) Guidelines for the management of cardiovascular disease in patients with diabetes, published in European Heart Journal.1

“Patients with type 2 diabetes have a two- to four-fold higher risk of coronary artery disease, stroke, heart failure, atrial fibrillation and peripheral artery disease compared to those without type 2 diabetes and when CVD occurs, the prognosis is worse. For example, death due to cardiovascular disease is 50–90% higher in patients with heart failure and diabetes compared to those with heart failure alone. It is therefore essential to have dedicated recommendations to guide the prevention and management of CVD in patients with diabetes. Interdisciplinary, patient-centred care is mandatory to reduce morbidity and mortality and to improve quality of life,” said Guidelines task force chairperson Professor Nikolaus Marx of University Hospital Aachen, Germany.

It is estimated that 25-40% of patients with CVD have undetected diabetes. Given that the presence of both conditions has a major impact on prognosis and treatment, the Guidelines recommend systematic screening for diabetes in all patients with CVD. It is equally important to evaluate all patients with diabetes for the risk and presence of CVD. The Guidelines introduce a novel score, called SCORE2-Diabetes, to estimate the 10-year risk of fatal and non-fatal myocardial infarction and stroke in patients with type 2 diabetes. The score integrates information on conventional CVD risk factors (age, smoking, blood pressure, cholesterol) with diabetes-specific information (age at diagnosis, blood sugar level, kidney function) to classify patients as low, moderate, high or very high risk.

The Guidelines recommend lifestyle changes for all patients with diabetes to reduce the likelihood of CVD. In obese patients with diabetes, weight reduction is one of the cornerstones of treatment, and the Guidelines recommend weight reduction and daily exercise. All patients with diabetes should stop smoking and adopt a Mediterranean or plant-based diet high in unsaturated fat to lower cardiovascular risk. In addition, they should increase activity to 150 minutes of moderate intensity or 75 minutes of vigorous intensity exercise per week according to the concept “every step counts”.

Recommendations for patients with diabetes and existing CVD have been revised following the results of large clinical trials. The Guidelines now recommend SGLT2 inhibitors and/or GLP-1 receptor agonists to reduce the risk of heart attack and stroke in all patients with diabetes and CVD, independent of glucose control and concomitant glucose medication, and in addition to standard of care antiplatelet, antihypertensive and lipid-lowering therapies. “Just as the presence of type 2 diabetes informs the prescription of other cardioprotective therapies such as statins regardless of glycaemic considerations, the same should now apply to prescribing SGLT2 inhibitors and/or GLP-1 receptor agonists,” said Guidelines task force chairperson Professor Massimo Federici of the University of Rome Tor Vergata, Italy.

A special focus of the Guidelines is managing heart failure in patients with diabetes. Those with diabetes have a two- to four-fold risk of developing heart failure compared to patients without diabetes and many are unaware that they have heart failure. The Guidelines recommend systematic screening for heart failure signs and symptoms during each clinical encounter to allow early use of life-saving therapies. Based on data from large clinical trials, the Guidelines recommend that patients with diabetes and chronic heart failure receive SGLT2 inhibitors to reduce the likelihood of heart failure hospitalisation or cardiovascular death.

Diabetes-induced kidney damage is a leading cause of chronic kidney disease globally. In patients with diabetes, chronic kidney disease is associated with a high risk of kidney failure and CVD. The Guidelines recommend screening patients with diabetes for chronic kidney disease at least annually by measuring glomerular filtration rate and albumin levels in the urine. Patients with both type 2 diabetes and chronic kidney disease should receive an SGLT2 inhibitor and/or finerenone, since these agents reduce the risk of CVD and kidney failure on top of standard of care.

Each year with diabetes confers a 3% increase in the risk of atrial fibrillation, which raises the likelihood of stroke, heart failure and death. For the first time, the Guidelines recommend opportunistic screening for atrial fibrillation by pulse taking or electrocardiogram (ECG) in patients with diabetes aged 65 years and above. Opportunistic screening is also advised in those below 65 years of age, particularly when other risk factors such as high blood pressure are present. Also new is a recommendation for regular blood pressure measurements in all patients with diabetes to detect and treat hypertension and reduce the risk of CVD.

Diabetes is a stronger risk factor for CVD in women compared with men. Data from large clinical trials do not indicate that women and men require different treatments, but women have been under-represented in trials and are less likely to receive recommended therapies. The Guidelines recommend sex-balanced recruitment strategies for future clinical trials alongside pre-specified analyses addressing sex differences. The document states: “Most importantly, every effort should be made to ensure women receive equal healthcare opportunities in managing CVD in diabetes.”

Getting the most health benefits from fruit smoothies

 

Researchers find adding a banana decreased the level of flavanols in smoothies

Smoothies can be a tasty and convenient way to get the important fruits and vegetables you need for a healthy diet. But is a banana and blueberry smoothie the best combo? Researchers at the University of California, Davis, suggest that blending certain ingredients in smoothies can influence whether your body is getting a nutritional boost.

The study, published today in the Royal Society of Chemistry’s journal Food and Function, used smoothies to test how various levels of polyphenol oxidase, an enzyme in many fruits and vegetables, affects the levels of flavanols in food to be absorbed by the body. Flavanols are a group of bioactive compounds that are good for your heart and cognitive health and are naturally found in apples, pears, blueberries, blackberries, grapes and cocoa — common smoothie ingredients.

“We sought to understand, on a very practical level, how a common food and food preparation like a banana-based smoothie could affect the availability of flavanols to be absorbed after intake,” said lead author Javier Ottaviani, director of the Core Laboratory of Mars Edge, which is part of Mars, Inc., and an adjunct researcher with the UC Davis Department of Nutrition.

Slice an apple or peel a banana and the fruit will quickly turn brown. That happens because of polyphenol oxidase, or PPO, an enzyme naturally present in those foods. The browning occurs when the food containing that enzyme is exposed to air, cut or bruised. The researchers wanted to know whether consuming freshly prepared smoothies made with different PPO-containing fruits impacted the amount of flavanols available to the body.

Bananas versus berries

The researchers had participants drink a smoothie made with banana, which has naturally high PPO activity, and a smoothie made with mixed berries, which have naturally low PPO activity. Participants also took a flavanol capsule as a control. Blood and urine samples were analyzed to measure how much flavanols were present in the body after ingesting the smoothie samples and capsule. The researchers found that those who drank the banana smoothie had 84% lower levels of flavanols in their body compared to the control.

“We were really surprised to see how quickly adding a single banana decreased the level of flavanols in the smoothie and the levels of flavanol absorbed in the body,” Ottaviani said. “This highlights how food preparation and combinations can affect the absorption of dietary compounds in foods.”

Last year, the Academy of Nutrition and Dietetics issued a dietary recommendation, advising people to consume 400 to 600 milligrams of flavanols daily for cardiometabolic health. Ottaviani said for people who are trying to consume those flavanols, they should consider preparing smoothies by combining flavanol-rich fruits like berries with other ingredients that also have a low PPO activity like pineapple, oranges, mango or yogurt.

He also said bananas remain a great fruit to be eaten or consumed in smoothies. For those who want to consume smoothies with bananas, or other high PPO activity fruits and vegetables such as beet greens, the suggestion is to not combine them with flavanol-rich fruits such as berries, grapes and cocoa.

The findings of this study could spur future research into how other foods are prepared and the effects on flavanols, for example, Ottaviani said tea is a major dietary source of flavanols and depending on how it is prepared, a different amount of flavanols would be available for absorption.

“This is certainly an area that deserves more attention in the field of polyphenols and bioactive compounds in general,” said Ottaviani.

People taking adult education classes run lower risk of dementia

 

How can we best keep our brain fit as we grow older? It’s well known that regular cognitive activity, for example brainteasers, sudokus, or certain video games in middle and old age tends to protect against cognitive decline and dementias like Alzheimer’s. But many of us regularly engage in adult education classes, for example learning a language or a new skill. Is such adult education likewise associated with a lower risk of cognitive decline and dementia?

Yes, according to researchers from the Institute of Development, Aging and Cancer of Tohoku University in Sendai, Japan who have shown for the first time, in a new study in Frontiers in Aging Neuroscience.

“Here we show that people who take adult education classes have a lower risk of developing dementia five years later,” said Dr Hikaru Takeuchi, the study’s first author. “Adult education is likewise associated with better preservation of nonverbal reasoning with increasing age.”

UK Biobank

Takeuchi and his co-author, Dr Ryuta Kawashima, a professor at the same institute, analyzed data from the UK Biobank, which holds genetic, health, and medical information from approximately half a million British volunteers, of which 282,421 participants were analyzed for this study. These had been enrolled between 2006 and 2010, when between 40 and 69 years old. On average, they had been followed for seven years by the time of the present study.

Based on their genotype at 133 relevant single-locus polymorphisms (SNPs) in their DNA, participants were given an individual predictive ‘polygenic risk score’ for dementia. Participants self-reported if they took any adult education classes, without specifying the frequency, subject, or academic level.

The authors focused on data from the enrollment visit and third assessment visit,  between 2014 and 2018. At those visits, participants were given a battery of psychological and cognitive tests, for example for fluid intelligence, visuospatial memory, and reaction time.

1.1% of participants in the sample developed dementia over the study’s time window.

Reduced risk of developing dementia

Takeuchi and Kawashima showed that participants who were taking part in adult education at enrollment had 19% lower risk of developing dementia than participants who did not. This held true for both Caucasian people and those of other ethnicities.

Importantly, results were similar when participants with a history of diabetes, hyperlipidemia, cardiovascular diseases, cancer, or mental illness were excluded. This means that the observed lower risk wasn’t exclusively due participants with incipient dementia being prevented from following adult education by symptoms of these known co-morbidities.

The results also showed that participants who took part in adult education classes kept up their fluid intelligence and nonverbal reasoning performance better than peers who did not. However, adult education didn’t affect the preservation of visuospatial memory or reaction time.

Randomized clinical trials necessary

“One possibility is that engaging in intellectual activities has positive results on the nervous system, which in turn may prevent dementia. But ours is an observational longitudinal study, so if a direct causal relationship exists between adult education and a lower risk of dementia, it could be in either direction,” said Kawashima.

Takeuchi proposed that a randomized clinical trial be done to prove any protective effect of adult education.

“This could take the form of a controlled trial where one group of participants is encouraged to participate in an adult education class, while the other is encouraged to participate in a control intervention with equivalent social interaction, but without education,“ said Takeuchi.

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Heart attack and stroke survivors neglect LDL cholesterol despite increased risk

 

Large consumer survey from the American Heart Association demonstrates need for new initiative, Lower Your LDL Cholesterol Now™

Business Announcement

AMERICAN HEART ASSOCIATION

DALLAS, August 23, 2023 — A 2023 survey from the American Heart Association conducted by The Harris Poll, found that a majority (70%) of heart attack and stroke survivors are unaware that LDL cholesterol is commonly referred to as 'bad cholesterol.' This matters because LDL cholesterol (low-density lipoprotein cholesterol) significantly contributes to the development of cardiovascular disease, increasing the risk of heart attacks and strokes. According to the Centers for Disease Control and Prevention, heart attack occurs every 40 seconds in the U.S.

Survey Highlights:

• 75% of heart attack and stroke survivors reported having high cholesterol.
• Survey shows 47% of heart attack and stroke survivors are unaware of their LDL cholesterol number.

The survey, conducted on behalf of the Association, the world’s leading voluntary organization dedicated to building healthier lives for all, found that 75% of heart attack and stroke survivors reported having high cholesterol[1]. However, only 49% recognized the need to prioritize lowering their cholesterol.

“There’s a pervasive lack of public awareness and understanding around bad cholesterol and its impact on your cardiovascular health. As bad cholesterol usually has no symptoms, we often find that many patients are walking around without knowing they’re at risk or how to mitigate it,” said Joseph C. Wu, MD, PHD, FAHA, American Heart Association volunteer president and director, Stanford Cardiovascular Institute and Simon H. Stertzer, MD, Professor of Medicine & Radiology at Stanford School of Medicine.

Through its Lower Your LDL Cholesterol Now™ initiative, sponsored nationally by Amgen Inc., the American Heart Association is encouraging people to ask their doctor to check their cholesterol levels. In the Harris Poll study, 98% of heart attack and stroke survivors surveyed say they are willing to take a simple blood test if recommended by their health care professional.

"What's eye-opening about these survey results is that nearly half of those who have suffered a heart attack or stroke don’t know their LDL cholesterol levels, which is a vital step in helping to prevent a second heart attack or stroke," said Paul Burton, M.D., Ph.D., senior vice president and chief medical officer, Amgen. “Amgen is committed to working with other health care leaders, like the American Heart Association, to empower people to know more and do more about their cardiovascular disease. For patients, this starts with talking to your doctor about your LDL cholesterol number and appropriate steps for testing and treatment.”

Among those who have experienced a heart attack and/or stroke, 69% say they have heard of LDL cholesterol. However, a substantial proportion (47%) remain unaware of their LDL number. LDL cholesterol plays a crucial role in the buildup of fatty deposits within arteries, leading to a condition known as atherosclerosis. This narrowing of arteries significantly escalates the risk of heart attacks, strokes, and peripheral artery disease (PAD).

“At the American Heart Association, we recommend that all adults 20 or older should have their cholesterol checked every 4 to 6 years as long as their risk remains low. After age 40, your health care professional will also want to use an equation to calculate your 10-year risk of having a heart attack or stroke. People who have had a prior heart attack or stroke may need their cholesterol checked more often,” said Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, past volunteer president of the American Heart Association and chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago. “This is very much a case where knowledge is power. The more you know, the more you can do to decrease your risk of heart attack and stroke in the future.”

An encouraging finding from the survey is that 65% of heart attack and stroke survivors polled correctly believe high cholesterol poses a moderate to high increased risk for heart attack and stroke. “However, there's still progress to be made,” emphasizes Lloyd-Jones, ”as this statistic underlines that a considerable portion of survivors require further understanding, particularly regarding the specific risk associated with LDL cholesterol. It's essential for heart attack and stroke survivors to grasp the profound impact of high LDL cholesterol, often referred to as the ‘bad’ cholesterol, on their cardiovascular health.”

According to American Heart Association guidelines, lifestyle habits like eating a healthy and balanced diet, regular exercise and eliminating tobacco use can all help you control your cholesterol and should be the first line of defense. However, some individuals, especially heart attack and stroke survivors, should have a conversation with their doctor about cholesterol-lowering medications. There are also several medications available including statins, PCSK9 targeting agents, Ezetimibe, Bile Acid Sequestrants, and ATP citrate lyase (ACLY) Inhibitors. 

Visit heart.org/LDL to learn more about LDL cholesterol, access a treatment plan discussion guide and find the answers to many commonly asked questions about LDL cholesterol.

Additional Resources:

• Multimedia is available on the right column of the release link.
• Spanish news release
• AHA health information: Why Should I Know My LDL? (PDF)
• AHA health information: What Does My LDL Number Mean? (PDF)
• AHA news release: Cholesterol Guidelines and Exercise/Diet (June 2021)
• Follow AHA/ASA news on X (formerly known as Twitter) @HeartNews 

Vaccine may reduce severity of long-haul COVID symptoms

 

 Getting a COVID-19 vaccine may not only reduce a person's risk of getting long-haul COVID, but also could mean fewer symptoms for people who develop the condition.

Mayo Clinic researchers discovered that long-haul COVID patients who were vaccinated before contracting the virus were less likely to experience symptoms such as abdominal pain, chest pain, dizziness, and shortness of breath, according to a study published in the Journal of Investigative Medicine. The study is believed to be among the first to examine COVID-19 vaccines' potential to reduce long-haul COVID symptoms.

"These results were quite surprising to us," says Greg Vanichkachorn, M.D., medical director of Mayo Clinic's COVID Activity Rehabilitation Program and the study's lead author. "This study shows that vaccines can be really important for long-haul COVID and can help reduce the severity of the condition."

Journalists: Broadcast-quality soundbites are available for download on the Mayo Clinic News Network. Please courtesy: "Greg Vanichkachorn, M.D./Occupational Medicine/Mayo Clinic.”

Since 2020, there have been more than 768 million confirmed cases of COVID-19 globally, according to the World Health Organization. Of those infected, an estimated 20% younger than 65 and 25% over 65 will go on to develop post-COVID-19 conditions, also known as long-haul COVID-19. Symptoms can include fatigue, shortness of breath, difficulty concentrating, chest pain and abdominal pain.

The study involved 477 patients who sought treatment for long-haul COVID at Mayo Clinic between May 27, 2021 and July 26, 2022. Slightly over half of the patients had received a COVID-19 vaccine prior to contracting the virus. The study found that vaccinated patients were half as likely to experience abdominal pain as compared to unvaccinated patients. Vaccinated patients were also less likely to report other symptoms including loss of smell, chest pain, dizziness, numbness, shortness of breath, tremors and weakness. There was no significant difference between vaccinated and unvaccinated patients in reports of fatigue, muscle pain and tachycardia, or irregular heartbeat.

Dr. Vanichkachorn says more research will help scientists understand how the COVID-19 vaccine affects long-haul COVID symptoms – especially with newer virus variants.

"It has been three years since we first started working with patients who have Long COVID," Vanichkachorn says. "We need more research to get an understanding of what is going on at the cellular level to cause these symptoms. If we can better understand that it will hopefully bring about new treatments for long-haul COVID."