For women, high blood pressure in your 40s may be tied to increased risk of Dementia

Women who develop high blood pressure in their 40s may be more likely to develop dementia years later, according to a study published in the October 4, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"High blood pressure in midlife is a known risk factor for dementia, but these results may help us better understand when this association starts, how changes in blood pressure affect the risk of dementia and what the differences are between men and women," said study author Rachel A. Whitmer, PhD, of Kaiser Permanente Division of Research in Oakland, Calif.

The study involved 7,238 people who were part of the Kaiser Permanente Northern California health care system. They all had blood pressure checks and other tests from 1964 to 1973 when they were an average age of 33, then again when they were an average age of 44. About 22 percent of the participants had high blood pressure in their 30s (31 percent of men and 14 percent of women). In their 40s, 22 percent overall had high blood pressure, but the makeup was 25 percent of men and 18 percent of women.

Next the researchers identified the 5,646 participants who were still alive and part of the Kaiser Permanente system in 1996 and followed them for an average of 15 years to see who developed dementia. During that time, 532 people were diagnosed with dementia.

Having high blood pressure in early adulthood, or in one's 30s, was not associated with any increased risk of dementia. But having high blood pressure in mid-adulthood, or in one's 40s, was associated with a 65-percent increased risk of dementia for women. Women who developed high blood pressure in their 40s were 73 percent more likely to develop dementia than women who had stable, normal blood pressure throughout their 30s and 40s.

The results were the same when researchers adjusted for other factors that could affect risk of dementia, such as smoking, diabetes and body mass index.

"Even though high blood pressure was more common in men, there was no evidence that having high blood pressure in one's 30s or 40s increased the risk of dementia for men," Whitmer said. "More research is needed to identify the possible sex-specific pathways through which the elevated blood pressure accelerates brain aging."

For women who made it to age 60 without dementia, the cumulative 25-year risk of dementia was 21 percent for those with high blood pressure in their 30s compared to 18 percent for those who had normal blood pressure in their 30s.

One limitation of this study is that many developments have been made since the study started in screening for high blood pressure and the use and effectiveness of drugs for it, limiting the ability to generalize the results to today's population.

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Safety, effectiveness of cognitive enhancers for Alzheimer's ranked

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A new study ranking the safety and effectiveness of four drugs taken to enhance concentration, memory, alertness and moods, found that donepezil was most likely to effectively improve cognition in patients with Alzheimer's dementia.

However, patients who took donepezil were more likely to experience side effects including nausea, vomiting and diarrhea than those who received a placebo, according to the study, published online in the Journal of the American Geriatrics Society.

In 2015, 46 million people worldwide had Alzheimer's disease, according to the study. In 2013, 146,593 people aged 65 and older in Ontario alone used cognitive enhancers, according to a 2016 Ontario Drug Policy Research report.

"Alzheimer's dementia is the most common form of dementia in North America, and most people who have moderate to severe Alzheimer's will be on these medications," said Dr. Andrea Tricco, a scientist in the Li Ka Shing Knowledge Institute of St. Michael's Hospital and lead author of the study. "This analysis will give both patients and clinicians a full picture of how each of these drugs will likely affect their cognition, as well as their overall health."

Although there have been previous reviews of the safety and effectiveness of cognitive enhancers in treating Alzheimer's dementia, the authors said this was the first to rank their comparative safety and effectiveness.

The study used network meta-analysis, an advanced statistical analysis technique, to systematically review existing evidence from 142 clinical trials of four common cognitive enhancers administered alone or in combination published between 1996 and 2015. The number of patients in each study ranged from 13 to 2,045, and the review evaluated a total of 33,889 patients.

The researchers compared the safety and effectiveness of any combination of donepezil, rivastigmine, galantamine or memantine in treating moderate to severe Alzheimer's dementia based on the results of the clinical trials that examined a number of patient outcomes, including cognition, function behaviour, global status, mortality, serious adverse events, falls, bradycardia, headache, diarrhea, vomiting and nausea. Donepezil was likely the most effective medication for Alzheimer's dementia across all effectiveness outcomes, including cognition, behavior and overall health, according to the study.

Donepezil was also the only cognitive enhancer that reached the minimal clinically important threshold -- meaning effects on outcomes were observed clinically, as well as statistically -- on the Alzheimer's Disease Assessment cognition scale, making it the likely first choice for those patients and clinicians considering these medications, the authors said.

Although no significant risk of serious harm, falls or reduced heart rate was associated with any of the medications in the study, the data was limited on these specific outcomes.

Previous research by the authors found that cognitive enhancers do not improve cognition or function in people with mild cognitive impairment, and these patients experience significantly more nausea, diarrhea, vomiting and headaches.

The findings of the current study will help guide patients and clinicians who are making decisions about the best course of treatment for Alzheimer's dementia, said Dr. Tricco.

"The more information we are able to gather about how each of these medications can affect a patient's cognition and health, the more likely we are to be able to improve their health outcomes," she said.

One hour of exercise a week can prevent depression

A landmark study led by the Black Dog Institute has revealed that regular exercise of any intensity can prevent future depression - and just one hour can help.

Published today in the American Journal of Psychiatry, the results show even small amounts of exercise can protect against depression, with mental health benefits seen regardless of age or gender.

In the largest and most extensive study of its kind, the analysis involved 33,908 Norwegian adults who had their levels of exercise and symptoms of depression and anxiety monitored over 11 years.
The international research team found that 12 percent of cases of depression could have been prevented if participants undertook just one hour of physical activity each week.

"We've known for some time that exercise has a role to play in treating symptoms of depression, but this is the first time we have been able to quantify the preventative potential of physical activity in terms of reducing future levels of depression," said lead author Associate Professor Samuel Harvey from Black Dog Institute and UNSW.

"These findings are exciting because they show that even relatively small amounts of exercise - from one hour per week - can deliver significant protection against depression.

"We are still trying to determine exactly why exercise can have this protective effect, but we believe it is from the combined impact of the various physical and social benefits of physical activity.

"These results highlight the great potential to integrate exercise into individual mental health plans and broader public health campaigns. If we can find ways to increase the population's level of physical activity even by a small amount, then this is likely to bring substantial physical and mental health benefits."

The findings follow the Black Dog Institute's recent Exercise Your Mood campaign, which ran throughout September and encouraged Australians to improve their physical and mental wellbeing through exercise.

Researchers used data from the Health Study of Nord-Trøndelag County (HUNT study) - one of the largest and most comprehensive population-based health surveys ever undertaken - which was conducted between January 1984 and June 1997.

A healthy cohort of participants was asked at baseline to report the frequency of exercise they participated in and at what intensity: without becoming breathless or sweating, becoming breathless and sweating, or exhausting themselves. At follow-up stage, they completed a self-report questionnaire (the Hospital Anxiety and Depression Scale) to indicate any emerging anxiety or depression.

The research team also accounted for variables which might impact the association between exercise and common mental illness. These include socio-economic and demographic factors, substance use, body mass index, new onset physical illness and perceived social support.

Results showed that people who reported doing no exercise at all at baseline had a 44% increased chance of developing depression compared to those who were exercising one to two hours a week.
However, these benefits did not carry through to protecting against anxiety, with no association identified between level and intensity of exercise and the chances of developing the disorder.

According to the Australian Health Survey, 20 percent of Australian adults do not undertake any regular physical activity, and more than a third spend less than 1.5 hours per week being physically active. At the same time, around 1 million Australians have depression, with one in five Australians aged 16-85 experiencing a mental illness in any year.

"Most of the mental health benefits of exercise are realised within the first hour undertaken each week," said Associate Professor Harvey.

"With sedentary lifestyles becoming the norm worldwide, and rates of depression growing, these results are particularly pertinent as they highlight that even small lifestyle changes can reap significant mental health benefits."

Researchers review risks, recommendations for weight gain management in midlife women

A review of the weight gain risks and challenges faced by women in midlife has led Mayo Clinic researchers to a series of recommendations for this patient population. The findings are published in this month's edition of Mayo Clinic Proceedings.

The average weight gain for women in their 50s and 60s is 1.5 pounds per year. For this group of women, much of that weight gain resides in the midsection. This type of fat is linked to a higher risk of cardiovascular disease, which is also the No. 1 cause of death for postmenopausal women. In addition to cardiovascular disease, central weight distribution puts this population at risk for abnormal glucose and lipid levels and high blood pressure.

"This population of women faces multiple challenges for maintaining a healthy weight," says Ekta Kapoor, M.B.B.S., a Mayo Clinic endocrinologist and the study's lead author. "Mood changes, sleep disturbances, hot flashes and the many other changes of menopause can disrupt what may have previously been a healthy lifestyle."

Mayo Clinic Women's Health researchers recommend primary care providers screen this population of women for being overweight, and establish behavioral interventions, including psychological support, regular physical activity and changes in eating habits.

For those who are early into menopause, hormone therapy may be a consideration to manage menopausal symptoms. Decreasing menopausal symptoms enables women to focus on healthy lifestyle changes.

With hormones and metabolism against them, postmenopausal women face some of the highest rates of obesity in the country.

"In addition to the usual adverse consequences of obesity, postmenopausal women face some unique challenges posed by obesity, including worse hot flashes, sexual dysfunction and an increased cancer risk," says Dr. Kapoor. "Targeting the lifestyle habits during midlife and beyond will help prevent further health consequences down the road. It's never too late to start making healthy lifestyle choices."

Skipping breakfast associated with hardening of the arteries

Skipping breakfast is associated with an increased risk of atherosclerosis, or the hardening and narrowing of arteries due to a build-up of plaque, according to research published today in the Journal of the American College of Cardiology.

Eating a healthy breakfast has been shown to promote greater heart health, including healthier weight and cholesterol. While previous studies have linked skipping breakfast to coronary heart disease risk, this is the first study to evaluate the association between breakfast and the presence of subclinical atherosclerosis.

"People who regularly skip breakfast likely have an overall unhealthy lifestyle," said study author Valentin Fuster, MD, PhD, MACC director of Mount Sinai Heart and editor-in-chief of the Journal of the American College of Cardiology. "This study provides evidence that this is one bad habit people can proactively change to reduce their risk for heart disease."

Researchers in Madrid examined male and female volunteers who were free from cardiovascular or chronic kidney disease. A computerized questionnaire was used to estimate the usual diet of the participants, and breakfast patterns were based on the percentage of total daily energy intake consumed at breakfast.

Three groups were identified - those consuming less than five percent of their total energy intake in the morning (skipped breakfast and only had coffee, juice or other non-alcoholic beverages); those consuming more than 20 percent of their total energy intake in the morning (breakfast consumers); and those consuming between five and 20 percent (low-energy breakfast consumers). Of the 4,052 participants, 2.9 percent skipped breakfast, 69.4 percent were low-energy breakfast consumers and 27.7 percent were breakfast consumers.

Atherosclerosis was observed more frequency among participants who skipped breakfast and was also higher in participants who consumed low-energy breakfasts compared to breakfast consumers. Additionally, cardiometabolic risk markers were more prevalent in those who skipped breakfast and low-energy breakfast consumers compared to breakfast consumers. Participants who skipped breakfast had the greatest waist circumference, body mass index, blood pressure, blood lipids and fasting glucose levels.

Participants who skipped breakfast were more likely to have an overall unhealthy lifestyle, including poor overall diet, frequent alcohol consumption and smoking. They were also more likely to be hypertensive and overweight or obese. In the case of obesity, the study authors said reverse causation cannot be ruled out, and the observed results may be explained by obese patients skipping breakfast to lose weight.

"Aside from the direct association with cardiovascular risk factors, skipping breakfast might serve as a marker for a general unhealthy diet or lifestyle which in turn is associated with the development and progression of atherosclerosis," said Jose L. Peñalvo, PhD, assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and the senior author of the study. "Our findings are important for health professionals and might be used as a simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines."

Prakash Deedwania, MD, professor of medicine at the University of California, San Francisco and author of the accompanying editorial comment said that this study provides clinically important information by demonstrating the evidence of subclinical atherosclerosis in people who skip breakfast.

"Between 20 and 30 percent of adults skip breakfast and these trends mirror the increasing prevalence of obesity and associated cardiometabolic abnormalities," Deedwania said. "Poor dietary choices are generally made relatively early in life and, if remained unchanged, can lead to clinical cardiovascular disease later on. Adverse effects of skipping breakfast can be seen early in childhood in the form of childhood obesity and although breakfast skippers are generally attempting to lose weight, they often end up eating more and unhealthy foods later in the day. Skipping breakfast can cause hormonal imbalances and alter circadian rhythms. That breakfast is the most important meal of the day has been proven right in light of this evidence."

Low consumption of vitamin K by adolescents associated with unhealthy enlargement of the heart's major pumping chamber

A study of 766 otherwise healthy adolescents showed that those who consumed the least vitamin K1Scientists have found another reason for children to eat their green leafy vegetables.

A study of 766 otherwise healthy adolescents showed that those who consumed the least vitamin K1- found in spinach, cabbage, iceberg lettuce and olive oil - were at 3.3 times greater risk for an unhealthy enlargement of the major pumping chamber of their heart, according to the study published in The Journal of Nutrition. Vitamin K1, or phylloquinone, is the predominant form of vitamin K in the U.S. diet.

"Those who consumed less had more risk," says Dr. Norman Pollock, bone biologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University and the study's corresponding author.

Overall, about 10 percent of the teens had some degree of this left ventricular hypertrophy, Pollock and his colleagues report.

Left ventricular changes are more typically associated with adults whose hearts have been working too hard, too long to get blood out to the body because of sustained, elevated blood pressure. Unlike other muscles, a larger heart can become inefficient and ineffective.

The scientists believe theirs is the first study exploring associations between vitamin K and heart structure and function in young people. While more work is needed, their findings suggest that early interventions to ensure young people are getting adequate vitamin K1 could improve cardiovascular development and reduce future disease risk, they write.

In the 14-18 year olds who consumed the least vitamin K1, the study found the overall size and wall thickness of the left ventricle were already significantly greater and the amount of blood the heart pumped out significantly lower, Pollock says.

Changes were independent of other factors known to influence heart structure and function, including sex, race, body composition, physical activity and blood pressure, says Mary Ellen Fain, MCG second-year student and the study's co-first author.

Only 25 percent of the teens in the study met current adequate intake levels of the Food and Nutrition Board of the Institute of Medicine, Pollock notes.

"They had higher levels relative to the other kids," Fain said. "But even at that age, it seemed to make a difference in their hearts." Fain and Pollock noted that it was clear than none of the participants consumed large amounts of the vitamin.

Vitamin K is known to be important to blood clotting and healthy bones. There is increasing evidence of its cardiovascular impact as well. For example, one direct, negative impact of low vitamin K intake on the heart may be reduced activity of matrix Gla protein, which helps prevent calcium deposits on blood vessel walls.

Pollock, who is also leading a novel study of the cardiovascular impact of a vitamin K supplement on obese children already showing signs of diabetes risk, has early evidence that the vitamin levels are lower in obese and overweight children.

Like matrix Gla protein, vitamin K is essential to increased production of osteocalcin, a protein hormone important to bone metabolism and insulin sensitivity. Those parallels - and the fact that osteocalcin can't currently be given directly - led Pollock to pursue his ongoing clinical trial in obese children with higher-fasting glucose levels. Pollock's lab and other investigators in the United States and Europe are also looking at the impact of vitamin K supplements on adults with heart disease, but adult findings to date have been inconclusive.

Further study is needed to clarify the importance of vitamin K1 intake to cardiovascular development and to better understand how vitamin K dependent proteins, like matrix Gla protein, aid cardiovascular development and health, the scientists note.

Participants wore activity monitors for seven days and completed between three and seven 24-hour periods of self-reports about what they ate. About 70 percent had a least six days of food records, which increases the accuracy of self-reports, Pollock says. Echocardiography was used to examine the left ventricle.

Fain received a plenary poster award for the research at the American Society for Bone and Mineral Research 2017 Annual Meeting Sept. 8-11 in Denver. The research was funded by the National Heart, Lung and Blood Institute, the American Heart Association and the Medical Scholars Program at MCG and AU.

The Framingham Offspring Cohort Study found an association between higher vitamin K1 levels and higher levels of the good LDL cholesterol and lower lipid levels in the blood, both associated with healthier hearts. Adult studies, like the Nurses' Health Study and Prospective Army Coronary Calcium study, have provided conflicting evidence of its cardiovascular impact.

The short-acting vitamin is active only about six hours after it's consumed.

Statin use reduces risk of serious bacterial bloodstream infection New study published in

Users of statins, widely prescribed for prevention of cardiac disease, have a 27% lower risk of contracting a Staphylococcus aureus (S. aureus) bloodstream infection outside of a hospital, according to a new study in Mayo Clinic Proceedings. Researchers report that statin use, especially among elderly patients with preexisting chronic conditions such as diabetes, kidney, or liver disease, may be protective against this serious bloodstream infection. As the western world's population is aging and more people live with chronic medical conditions, any potential preventive effect of statins could have important clinical implications.

To investigate whether individuals treated with statins experienced a decreased risk of bloodstream infection by S. aureus, researchers from the University Hospitals in Aalborg and Aarhus, Denmark and the University Hospital in Seville, Spain analyzed records of close to 30,000 people using Danish medical registries over a 12-year period. They identified 2,638 cases of community-acquired S. aureus bacteremia (CA-SAB). An additional 26,379 individuals were matched by age, sex, and residence against the cases. For the CA-SAB cases and the controls, 368 (14.0%) and 3,221 (12.2%), respectively, were current users of statin medications.

The team also investigated the risk of infection while taking into account the duration of current or former statin use, 90-day cumulative dose, and specific sub-groups of patients who were prescribed statins for different chronic conditions like previous myocardial infarction, peripheral arterial disease, chronic heart failure, chronic kidney disease, and diabetes.

Investigators found that the risk for CA-SAB decreased gradually with increasing statin dosage, and the association was most pronounced among patients with chronic kidney disease and diabetes. Current users of statins experienced a 27% decrease in risk for CA-SAB and long-terms users (multiple prescriptions across more than 90 days) had a 30% decrease, while new users (first prescription within 90 days) showed a modest 4% decrease in risk.

"Our results indicate that statins may have an important place in the prevention of bloodstream infection caused by S. aureus, which would hold important clinical and public health implications. Nevertheless, our observations warrant confirmation in other settings and the biological mechanisms by which statin treatment may protect against this type of infection should be explored further," explained lead investigator Jesper Smit, MD, PhD, of the Department of Clinical Microbiology, Department of Infectious Diseases, Aalborg University Hospital, and Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.

In an accompanying editorial, Daniel C. DeSimone, MD, of the Division of Infectious Diseases, and Christopher V. DeSimone, MD, PhD, of the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, expand on the importance of the study's findings and provide additional insights with more details about S. aureus infections and statin pharmacology, and put these findings into clinical context.

The authors comment, "The work by Smit et al raises the exciting possibility that the pleiotropic effects of statins may also harbor important antimicrobial effects that may exert a clinically relevant benefit by conferring resistance to CA-SAB." They also state that "This persuasive study should stimulate randomized, placebo-controlled trials examining this effect of statins. Such trials in the case of statins are appealing because these drugs are relatively low cost, can easily be matched against a placebo, and would allow for enrollment at the time of an already necessary antibiotic prescription." This accompanying editorial provides exciting avenues for future human clinical trials to test statin drugs for disease prevention, especially in the field of cardiovascular infections.

S. aureus is a bacterium that can colonize skin. It has the propensity to cause serious infection which can be fatal if the bacteria disperse into the bloodstream. Statins are among the most widely used drugs for prevention of cardiovascular disease, but there have been some studies that suggest a link to an antimicrobial effect against S. aureus. Statins may also inhibit host cell invasion by S. aureus and enhance the ability of phagocytes to kill the bacterium.