Immediate aspirin after mini-stroke substantially reduces risk of major stroke

Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events, a group of European researchers has found. Writing in the Lancet, the team say that immediate self-treatment when patients experience stroke-like symptoms would considerably reduce the risk of major stroke over the next few days.

Aspirin is already given to people who have had a stroke or transient ischaemic attack (TIA -- often called a 'mini-stroke') to prevent further strokes after they have been assessed in hospital and in the longer-term, reducing the subsequent stroke risk by about 15%. However, based on a previous study in Oxford (the EXPRESS Study) the team suspected that the benefits of more immediate treatment with aspirin could be much greater.

Lead researcher Professor Peter Rothwell, a stroke expert from the University of Oxford, explained: 'The risk of a major stroke is very high immediately after a TIA or a minor stroke (about 1000 times higher than the background rate), but only for a few days. We showed previously in the 'EXPRESS Study' that urgent medical treatment with a 'cocktail' of different drugs could reduce the one-week risk of stroke from about 10% to about 2%, but we didn't know which component of the 'cocktail' was most important.'

'One of the treatments that we used was aspirin, but we know from other trials that the long-term benefit of aspirin in preventing stroke is relatively modest. We suspected that the early benefit might be much greater. If so, taking aspirin as soon as possible after 'warning symptoms' event could be very worthwhile.'

The team -- from Oxford (UK), University Medical Center Utrecht (Netherlands), University Duisburg-Essen (Germany), and Lund University (Sweden) -- therefore revisited the individual patient data from twelve trials (about 16,000 people) of aspirin for long-term secondary prevention -- that is, to prevent a further stroke -- and data on about 40,000 people from three trials of aspirin in treatment of acute stroke.

They found that almost all of the benefit of aspirin in reducing the risk of another stroke was in the first few weeks, and that aspirin also reduced the severity of these early strokes. Rather than the 15% overall reduction in longer-term risk reported previously in these trials, aspirin reduced the early risk of a fatal or disabling stroke by about 70-80% over the first few days and weeks.

Professor Rothwell said: 'Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke -- and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.'

'The findings also have implications for public education. Public information campaigns have worked in getting more people to seek help sooner after a major stroke, but have been less effective in people who have had minor strokes or TIAs. Many patients don't seek medical attention at all and many delay for a few days. Half of recurrent strokes in people who have a TIA happen before they seek medical attention for the TIA. Encouraging people to take aspirin if they think they may have had a TIA or minor stroke -- experiencing sudden-onset unfamiliar neurological symptoms -- could help to address this situation, particularly if urgent medical help is unavailable.'

Dr Dale Webb, Director of Research and Information at the Stroke Association, said: 'A TIA is a medical emergency and urgent neurological assessment must always be sought. We welcome this research which shows that taking aspirin after TIA can dramatically reduce the risk and severity of further stroke. The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent medical attention can, if they are able, take one dose of 300 mg aspirin.

'The research findings are also timely, as the stroke community is currently working to develop a new set of national clinical guidelines on stroke.'

Older adults with a busy daily lifestyle do better on tests of cognitive function

Are you busy on an average day? Do you often have too many things to do to get them all done? Do
you often have so many things to do that you go to bed later than your regular bedtime?

If you are over 50 and the answer to these questions is a weary yes, here is some good news: older adults with a busy daily lifestyle tend to do better on tests of cognitive function than their less busy peers, shows a new study in Frontiers in Aging Neuroscience. The research is part of the Dallas Lifespan Brain Study, one of the most comprehensive studies of age-related changes in cognition and brain function in healthy adults currently underway in the USA.

"We show that people who report greater levels of daily busyness tend to have better cognition, especially with regard to memory for recently learned information," says Sara Festini, a postdoctoral researcher at the Center for Vital Longevity of the University of Texas at Dallas and lead author of the study.

"We were surprised at how little research there was on busyness, given that being too busy seems to be a fact of modern life for so many," says Denise Park, University Distinguished Chair at the Center for Vital Longevity, Director of the Dallas Lifespan Brain Study.

The researchers surveyed 330 participants in the Dallas Lifespan Brain Study - healthy women and men between 50 and 89 from the Dallas/Fort Worth area, Texas, recruited through media advertisements and community notices-- about their daily schedule. The participants also visited the Park Aging Mind laboratory at the Center for Vital Longevity, where they took part in a long series of neuropsychological tests to measure their cognitive performance.

The results show that at any age, and regardless of education, a busier lifestyle is associated with superior processing speed of the brain, working memory, reasoning, and vocabulary. Especially strong is the association between busyness and better episodic memory, the ability to remember specific events in the past.

Festini et al. warn that the present data do not allow the conclusion that being busy directly improves cognition. It is also possible that people with better cognitive function seek out a busier lifestyle, or that busyness and cognition reinforce each other, resulting in reciprocal strengthening. But one mediating factor accounting for the relationship might be new learning, propose the researchers. Busy people are likely to have more opportunities to learn as they are exposed to more information and encounter a wider range of situations in daily life. In turn, learning is known to stimulate cognition: for example, a recent study from the Center for Vital Longevity found that a sustained effort in learning difficult new skills, such as digital photography or quilting, boosts episodic memory.

"Living a busy lifestyle appears beneficial for mental function, although additional experimental work is needed to determine if manipulations of busyness have the same effect," says Festini.

Higher consumption of potatoes may increase risk of hypertension

 In a new study, researchers at Brigham and Women's Hospital (BWH) and the Harvard T.H. Chan School of Public Health have found that a higher intake of potatoes and French fries may be associated with an increased risk of high blood pressure (hypertension) in adults.

The findings are published online in the British Medical Journal on May 17, 2016.

"In our observational study participants who did not have high blood pressure at baseline, and consumed four or more servings a week of potatoes (boiled, baked or mashed) later had a higher risk of developing hypertension compared to those who consumed one or less than one serving a month," said lead author Lea Borgi, MD, a physician in the Renal Division at BWH. "Additionally, we found that if a participant replaced one serving of boiled, baked or mashed potato per day with a non-starchy vegetable, it was associated with a lower risk of hypertension."

Through three prospective, longitudinal, US, cohort studies, researchers followed 62,175 women in the Nurses' Health Study, 88,475 women in Nurses' Health Study II and 36,803 men in the Health Professionals Follow-Up Study who did not have high blood pressure at the beginning of the study.

Compared with consumption of less than one serving a month, participants who consumed 4 or more than 4 servings a week had an increased risk of hypertension of 11% for boiled, baked or mashed potatoes and of 17% for French fries. The researchers did not find an association between the consumption of potato chips and a higher risk of developing hypertension.

The researchers acknowledge the possible limitations of their study, including the fact that participants self reported a diagnosis from a health care provider of high blood pressure. "We take into account all of the data that are available to us and make the relevant statistical adjustments. However, because this is an observational study, there is always a possibility that our findings can be explained by something that we were not able to consider in our analysis," Borgi and colleagues note. Although the study did not specifically ask participants what kind of potatoes they consumed, white potatoes are considered the most commonly eaten.

Future research will continue to focus on the association between potato consumption and increased risk for disease, including hypertension.

Sesame-based ingredients reduce oxidative stress

The antioxidant boosting properties of sesame, and especially sesame oil, can have a significant effect on oxidative stress, improving human health, according to a systematic review published in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Medicinal Food website until June 17, 2016.

Luciana de Almeida Vittori Gouveia and coauthors, Rio de Janeiro State University and Rio de Janeiro Federal University, Brazil, assessed the published evidence on the effects of consuming sesame-based ingredients on markers of oxidative stress in people with high blood pressure, elevated cholesterol, and type 2 diabetes. Multiple clinical trials reported increased levels of antioxidants and a reduction in oxidative stress with sesame consumption, particularly for individuals with hypertension and also with type 2 diabetes.

The article "Effects of the Intake of Sesame Seeds (Sesamm indicum L.) and Derivatives on Oxidative Stress: A Systematic Review" includes further discussion of the potential positive effects of sesame on different populations.

"In addition to the clinical trial results reviewed in this article, preclinical studies have also shown that sesame oil is very effective in preventing atherosclerosis," says Journal of Medicinal Food Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences and Interim Associate Dean, College of Medicine, University of Central Florida.

Melatonin reduces blood pressure and tunes up disrupted circadian rhythms in the elderly

The older we get, the more likely our circadian rhythms are disrupted. For example, blood pressure (BP), not only tends to increase but as well become more irregular. Luckily, as we show in our research, melatonin helps to ameliorate both trends.

63 senior respondents of a mean age of 80 were studied during 3 consecutive weeks. First week control data were collected for 7 successive days. Over the next 2 weeks, the seniors were administered a low dose of melatonin (1.5 mg) each day by night at 10:30 p.m. On the third week data were monitored again.

Melatonin significantly reduced BP. The hypotensive effect was dependent on time. The maximum systolic BP lowering effect of melatonin falls between 3:00 and 8:00 in the morning, the time of the highest risk of heart attacks and strokes. Nighttime and morning BP decreased more profoundly on average -8/3.5 mm Hg for SBP/DBP, respectively.

Moreover, the higher the mean systolic BP was during the first week, the more it dropped on the second week of melatonin administration. Melatonin also decreased the overall variability in BP.

Melatonin ws effective in synchronizing disrupted circadian rhythms of BP, heart rate and body temperature, making these circadian rhythms smoother and less irregular. None of these effects was found in 34 placebo treated seniors, thus ruling out the possibility that rhythms could be improved just because of regular schedule and presence of medical personal who took measurements.

In conclusion, melatonin can be of great value for aged people suffering from hypertension as an adjuvant substance complementing basic medication as it is able to stabilize circadian BP, heart rate profiles and their phase relationships. The improvement of circadian pacemaker functions may also provide a new strategy in the treatment of hypertension.

High blood pressure linked to vascular dementia

High blood pressure could significantly raise the risk of developing the second most common form of dementia, according to a new study from The George Institute for Global Health.

The medical records of more than four million people were analysed with researchers finding heightened blood pressure was associated with a 62 per cent higher risk of vascular dementia between the ages of 30-50.

Lead author Professor Kazem Rahimi, of The George Institute for Global Health, said: "Vascular dementia rates are increasing all over the world and will pose a significant economic and social burden in both developed and developing countries. So these results are particularly important.

"We already know that high blood pressure can raise the risk of stroke and heart attack. Our research has shown that high blood pressure is also associated with a significantly higher risk of vascular dementia."

Key Findings

• The team at The George Institute analysed the medical records of 4.28 million people.
• They found over a seven year period 11,114 people went onto develop vascular dementia.
• The study found patients aged 30-50, who had high blood pressure, had a 62 per cent higher risk of vascular dementia, and a 26 per cent higher risk at age 51-70.
• The study also found that high blood pressure was still a risk factor even after adjusting for the presence of stroke, the leading cause of vascular dementia.

Professor Rahimi, deputy director of The George Institute UK, said: "Our results suggest that lowering blood pressure, either by exercise, diet or blood pressure lowering drugs, could reduce the risk of vascular dementia."

Vascular dementia affects around 9.3 million people globally and is caused by reduced blood supply to the brain due to diseased blood vessels.

High blood pressure cause problems by damaging and narrowing the blood vessels in the brain. Over time, this raises the risk of a blood vessel becoming blocked or bursting. It's a known risk factor for stroke and cardiovascular disease but until now studies were conflicting over the risks for vascular dementia with several even indicating that low blood pressure was associated with an increased risk of dementia.

Risks of a gluten-free diet for children without celiac disease

The prevalence of celiac disease (CD), an autoimmune disease, is increasing. The only treatment for CD is a gluten-free diet. However, the increasing prevalence of CD does not account for the disproportionate increase in growth of the gluten-free food industry (136% from 2013 to 2015). A Commentary scheduled for publication in The Journal of Pediatrics discusses several of the most common inaccuracies regarding the gluten-free diet.

Little is known about the motives of individuals who adopt a gluten-free lifestyle. In a study conducted in 2015 of 1,500 Americans, "no reason" was the most common explanation for choosing gluten-free foods.

According to the author of this Commentary, Dr. Norelle R. Reilly, from New York-Presbyterian/Columbia University Medical Center, "Out of concern for their children's health, parents sometimes place their children on a gluten-free diet in the belief that it relieves symptoms, can prevent CD, or is a healthy alternative without prior testing for CD or consultation with a dietitian." Given the frequent misunderstanding about gluten, available data regarding the gluten-free diet warrant clarification.

One misconception is that the gluten-free diet is a healthy lifestyle choice with no disadvantages. In fact, in individuals without CD or wheat allergy, there are no proven health benefits. It could increase fat and calorie intake, contribute to nutritional deficiencies, and obscure an actual diagnosis of CD.

Another misconception is that gluten is toxic; there are no data to support this theory. A gluten-free diet also is not necessary for healthy first-degree relatives of individuals with CD or for healthy infants at risk of developing CD.

For a small subset of patients who are guided by an experienced registered dietitian, a gluten-free diet can lead to better health and an improved quality of life. However, there is no scientific evidence that a gluten-free diet is beneficial for children without a verified diagnosis of CD or wheat allergy.

Due to potential nutritional deficiencies and quality of life issues, it could actually pose more risk than benefit. Dr. Reilly notes that "parents should be counseled as to the possible financial, social, and nutritional consequences of unnecessary implementation of a gluten-free diet." Healthcare providers may not be able to stop the move to a gluten-free diet, but they can play a larger role in educating patients and parents.