Lack of friend or family visits is associated with increased risk of dying

 

BMC (BIOMED CENTRAL)

Never being visited by friends or family is associated with an increased risk of dying, according to a study published in BMC Medicine. The authors suggest that their findings could be used to help identify patients at a higher risk of dying due to social factors, and to develop more effective interventions to combat the increased risk of death associated with social isolation.

Although previous research has identified associations between deaths due to any causes and both a ‘sense of loneliness’ and living alone, the combined impacts of different types of social interaction on mortality has been unclear.

Hamish Foster and colleagues used data from 458,146 adults recruited to UK Biobank to investigate the association between mortality and five types of social interaction. Participants were recruited between 2006 and 2010 and had a mean age of 56.5 years. The participants completed a questionnaire on recruitment during which they answered questions about five types of social interaction: how often they were able to confide in someone close to them and how often they felt lonely (subjective measures); and how often they were visited by friends and family, how often they participated in a weekly group activity, and whether they lived alone (objective measures). After a median 12.6 years follow-up, 33,135 of the participants had died based on linked death certificates.

The authors found that all five types of social interaction were independently associated with mortality from any cause. Overall, increased mortality was more strongly associated with low levels of the objective measures of social interaction compared to low levels of the subjective measures. The strongest association was for individuals who were never visited by friends or family, who were at a 39% associated increased risk of death. Furthermore, the benefit of participating in weekly group activities was not observed in participants who never had friends or family visit — participants who never received visits but did join group activities had a comparable associated increased risk of death to those who had no visits and joined no activities (50% and 49% respectively). However, participants who received friend or family visits on at least a monthly basis had a significantly lower associated increased mortality risk, suggesting that there was potentially a protective effect from this social interaction.

The authors caution that although the overall strength of association is likely to be generalisable, the sample data from UK Biobank is not fully representative of the general UK population, and that the social interaction measures they assessed were self-reported and relatively simple. The authors suggest that further research could investigate the effects of other types of social interaction on mortality, or explore how much change in a type of interaction is needed to best benefit socially isolated people.

Strawberries, cognition and mood in middle-aged, overweight adults

 

A new study published in Nutrients shows daily consumption of strawberries for 12 weeks reduced interference in memory and depressive symptoms among middle-aged, overweight adults with self-reported mild cognitive decline. 

“Dementia is a general term that includes many different diseases, all without remedies,” says Robert Krikorian, Ph.D., principal investigator and professor in the department of psychiatry at the University of Cincinnati Academic Health Center. “It is not clear when or if effective therapy will be available; prevention and mitigation through dietary and lifestyle choices is currently the best approach we have.”  

This double-blind, randomized controlled trial included five men and 25 women. One group received a strawberry powder prepared from whole fruit that had been desiccated, freeze-dried and milled. The second group received the control powder which was designed to have the same appearance, taste and carbohydrate load as the strawberry powder and contained fiber but no polyphenolic content. Daily servings of strawberry and control powder were sealed in packets for the convenience of the participants and to control daily dosage. Each packet of strawberry powder contained 13 grams, providing 36.8 milligrams anthocyanins derived from 130 grams whole fruit and equivalent to about 1 cup whole fresh strawberries. Participants were also asked to discontinue consumption of all berry fruits, juices and extracts for the duration of the study. This was done to mitigate the potential confound related to a group difference in consumption of berry products in the background diet.  

“We wanted to work with a middle-aged, overweight population as dementia is a condition that is believed to develop over a period of decades. Furthermore, inflammation is likely a contributing factor related to metabolic disorders such as overweight/obesity, prediabetes and type 2 diabetes,” explains Krikorian. 

Specifically, the findings show that after the 12-week intervention, participants who were given the whole fruit strawberry powder made fewer ‘intrusion errors’ during a word list learning task (e.g., remembering/repeating words not included in the learning task). This has relevance in terms of identifying cognitive decline as memory interference is not uncommon in the context of aging, especially in late life dementia. Additionally, participants who were given the whole fruit strawberry powder reported lower levels of depressive symptoms which implies improved emotional coping capabilities. “Our findings can likely be attributed to the anti-inflammatory actions of the anthocyanins found in strawberries,” added Krikorian. 

In addition to providing polyphenols, strawberries are a source of many bioactive compounds. Strawberries provide100% of our daily vitamin C needs in single, 1-cup serving and contain heart-healthy nutrients like folate, potassium, fiber, phytosterols and polyphenols.  

Marijuana use linked with increased risk of heart attack, heart failure

 

American Heart Association Scientific Sessions 2023, Abstract Poster MDP250 and Abstract Poster MDP249

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

• As more people across the U.S. use marijuana for medical and recreational reasons, two new studies suggest its regular intake may damage heart and brain health.
• In one study, daily use of marijuana raised the risk of developing heart failure by about one-third, even after considering other factors, compared to people who reported never using marijuana.
• In a second study, older people with any combination of Type 2 diabetes, high blood pressure and high cholesterol who used marijuana, significantly increased their risk for a major acute heart or brain event while hospitalized, compared to those who reported not using marijuana.

 Using marijuana regularly may raise the risk for heart failure, stroke or heart attack even after accounting for other cardiovascular risk factors such as Type 2 diabetes, high blood pressure and obesity, according to two preliminary studies to be presented at the American Heart Association’s Scientific Sessions 2023. The meeting, to be held Nov. 11-13, in Philadelphia, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

The use of marijuana, medically known as cannabis, is gaining popularity across the U.S. as more states legalize it for recreational and medical use. However, how marijuana affects the heart and brain health is still not completely known. Two new studies, by separate research groups, shed light on the association for regular marijuana use with risk for heart failure, heart attack and stroke.

Daily marijuana use is associated with incident heart failure: “All of Us” Research Program (Poster Abstract MDP250)

More than 150,000 adults in the U.S. participated in the All of Us Research Program, a National Institutes of Health-sponsored program. Researchers focused on the relationship between lifestyle, biology and environment in diverse populations and analyzed the association between daily marijuana use and heart failure.

“Prior research shows links between marijuana use and cardiovascular disease like coronary artery disease, heart failure and atrial fibrillation, which is known to cause heart failure,” said lead study author Yakubu Bene-Alhasan, M.D., M.P.H., a resident physician at Medstar Health in Baltimore. “Marijuana use isn’t without its health concerns, and our study provides more data linking its use to cardiovascular conditions.”

Bene-Alhasan and colleagues followed 156,999 individuals who were free from heart failure at the time they enrolled in the research program. Study participants completed a survey about the frequency of their marijuana use and were followed for nearly 4 years (45 months). The analysis was adjusted to account for individual demographic and economic factors, alcohol use, smoking and other cardiovascular risk factors linked with heart failure, such as Type 2 diabetes, high blood pressure, high cholesterol and obesity.

The analysis found:

• During the study period, 2,958 people (almost 2%) developed heart failure.
• People who reported daily marijuana use had a 34% increased risk of developing heart failure, compared to those who reported never using marijuana. This risk was the same regardless of age, sex at birth or smoking history.
• In a secondary analysis, when coronary artery disease was added to the investigation, the risk of heart failure dropped from 34% to 27%, suggesting that coronary artery disease is a pathway through which daily marijuana use may lead to heart failure.

“Our results should encourage more researchers to study the use of marijuana to better understand its health implications, especially on cardiovascular risk,” Bene-Alhasan said. “We want to provide the population with high-quality information on marijuana use and to help inform policy decisions at the state level, to educate patients and to guide health care professionals.”

Study details:

• The definition of marijuana use was using marijuana when not prescribed for a health condition, or, if prescribed for medical purposes, using it beyond that purpose.
• The median participant age was 54 years; 60.9% of participants were female at birth; 70.7% self-identified as white adults; 21.8% were Black or African American adults; 4.2% were Asian adults; 2.2% were identified as more than one race/ethnicity; and 1.1% were from other races/ethnicities.
• The study enrollment began in June 2016. Participants were followed from when they enrolled until June 2022, a maximum of approximately 4 years (45 months).

A limitation of the study is that it relied on data that did not specify whether the marijuana was inhaled or eaten. According to researchers, how marijuana is ingested may influence cardiovascular outcomes.

Co-authors, their disclosures and funding sources are listed in the abstract.

Increased risk of major adverse cardiac and cerebrovascular events in elderly non-smokers who use cannabis (Poster Abstract MDP249)

In a second study, different researchers evaluated data from the 2019 National Inpatient Sample, the largest nationwide database of hospitalizations, to investigate whether hospital stays were complicated by a cardiovascular event, including heart attack, stroke, cardiac arrest or arrhythmia in patients who used marijuana. Researchers extracted records on adults older than age 65 years with cardiovascular risk factors who reported no tobacco use (cigarettes or other tobacco products). This group of patient records were then divided into two groups: marijuana users and non-marijuana users. The marijuana user’s hospital records were coded for cannabis use disorder which can vary from hospital to hospital.

“Since 2015, cannabis use in the U.S. has almost doubled, and it is increasing in older adults, therefore, understanding the potential increased cardiovascular risk from cannabis use is important,” said lead study author Avilash Mondal, M.D., a resident physician at Nazareth Hospital in Philadelphia. “What is unique about our study is that patients who were using tobacco were excluded because cannabis and tobacco are sometimes used together, therefore, we were able to specifically examine cannabis use and cardiovascular outcomes.”

The study found of the 28,535 cannabis users with existing cardiovascular risk factors (high blood pressure, Type 2 diabetes or high cholesterol):

• 20% had an increased chance of having a major heart or brain event while hospitalized, compared to the group who did not use cannabis.
• 13.9% of cannabis users with cardiovascular risk factors had a major adverse heart and brain event while hospitalized compared to non-cannabis users.
• Additionally, the cannabis users in comparison to non-cannabis users had a higher rate of heart attacks (7.6% versus 6%, respectively) and were more likely to be transferred to other facilities (28.9% vs. 19%).
• High blood pressure (defined as greater than 130/80 mm Hg) and high cholesterol were predictors of major adverse heart and brain events in marijuana users.

“We must be mindful about major heart and stroke events in older adults with cannabis use disorder. At this point, we need more studies to understand the long-term effects of cannabis use,” Mondal said. “Health care professionals should include the question, ‘Are you using cannabis?’ when taking a patient’s history. If you ask patients if they are smoking, people think cigarette smoking. The main public message is to be more aware of the increased risks and open the lines of communication so that cannabis use is acknowledged and considered.”

A limitation of the analysis is that the data is from a large database, which may have coding errors in the patients’ health records. In addition, the electronic health record code for cannabis use disorder may vary from hospital to hospital, thereby skewing the results of the analysis.

Study details:

• 2019 National Inpatient Sample health records were reviewed for 28,835 adults with cannabis use disorder and high blood pressure, Type 2 diabetes or high cholesterol. The comparison group included 10,680,000 adults with the same risk factors who did not use marijuana.
• Researchers examined hospitalization records to analyze the incidence of in-hospital cardiovascular disease events for adults in both groups.
• 69.5% of participants in the cannabis use disorder group were male and 30.5% were female. In contrast, 45.8% were males in the non-cannabis use group versus 54.2 in the female non-use group.
• Health records of race according to cannabis use versus non-use , respectively was: 70.2% versus 76.4 among white adults; 20.1% versus 10.8% among Black adults; 5.6% versus 7.4% among Hispanic adults; 0.70% versus 2.7% among Asian or Pacific Islander adults; and 1% versus 0.40% among Native American adults.

“The latest research about cannabis use indicates that smoking and inhaling cannabis increases concentrations of blood carboxyhemoglobin (carbon monoxide, a poisonous gas), tar (partly burned combustible matter) similar to the effects of inhaling a tobacco cigarette, both of which have been linked to heart muscle disease, chest pain, heart rhythm disturbances, heart attacks and other serious conditions,” said Robert L. Page II, Pharm.D., M.S.P.H., FAHA, chair of the volunteer writing group for the 2020 American Heart Association Scientific Statement: Medical Marijuana, Recreational Cannabis, and Cardiovascular Health. “Together with the results of these two research studies, the cardiovascular risks of cannabis use are becoming clearer and should be carefully considered and monitored by health care professionals and the public.”

Additional Resources:

• Video interview with AHA volunteer expert: Robert L. Page II, Pharm.D., M.S.P.H., FAHA,  and other multimedia is available on the right column of the release link https://newsroom.heart.org/news/marijuana-use-linked-with-increased-risk-of-heart-attack-heart-failure?preview=796f90faf6bf570f13745845188dcf12
• After Nov. 6, view Abstract Poster MDP250 and Abstract Poster MDP249 in the AHA Scientific Sessions 2023 Online Program Planner
• Spanish News Release
• AHA news release: Depression & anxiety symptoms linked to vaping nicotine and THC in teens and young adults (Feb. 2023)
• AHA news release: How does cannabis use affect brain health? Caution advised, more research needed (Feb. 2022)
• About Scientific Sessions 2023  
• For more news at AHA Scientific Sessions 2023, follow us on X (formerly known as Twitter) @HeartNews,#AHA23

Menopause and heart health – 4 tips for a healthy heart while your body is changing

 Medical experts note that hormone and body composition changes during the transition to menopause can increase the risk of developing heart disease after menopause.[1] The American Heart Association, a global force for healthier lives for all, offers tips to support women’s heart health during this transition.

“More women in the U.S. are living longer, and a significant portion of them will spend up to 40% of their lives postmenopausal,” said Brooke Aggarwal, Ed.D., M.S., F.A.H.A., assistant professor of medical sciences in Cardiology at Columbia University Medical Center and a volunteer for the American Heart Association’s Go Red for Women™ movement.

As women grow and change so does their risk for cardiovascular disease. Go Red for Women, the Association’s premier women’s movement, addresses awareness and clinical care gaps of women’s greatest health threat, and is a trusted source for health and well-being at every age, stage and season.

“Navigating through menopause isn’t one-size-fits-all, and neither is the journey to good heart health,” she added. “This makes it even more important to focus on heart and brain health at all stages of life.”

The best defense against menopause-related changes is working with your doctor to make sure your key health numbers are in a healthy range, and understanding which healthy habits you can fine tune to boost your heart health. These tips can help:

1. Health by the numbers: Blood pressure, blood sugar and body mass index should be monitored yearly. More often if your numbers are out of range. Cholesterol level is also important, and healthy numbers are more individualized based on your other risk factors. Your doctor can help you figure this one out.
2. The best way to eat: No single food is a miracle-worker for health. Instead, look at your overall pattern of eating. Experts at the American Heart Association rated 10 popular eating patterns and the DASH-style and Mediterranean-style way of eating rose to the top as having the most heart-healthy elements: high in vegetables, fruit, whole grains, healthy fat and lean protein; and low in salt, sugar, alcohol and processed foods.
3. Exercise that does double-duty: Strength and resistance training is one of the four types of exercise in a general workout routine along with endurance, balance and flexibility. Strength and resistance have the added benefit of increasing bone strength and muscle mass. As women enter menopause, bone density may take a hit and body composition tends to shift to lower muscle mass. Strength training at least twice a week can help your bones and muscles maintain strength and density.
4. Protect your sleep time: Healthy sleep is part of the 8 essential elements of heart health called Life’s Essential 8, but the transition to menopause comes with myriad interruptions to a good night’s rest – nightly restroom trips, night sweats, insomnia. Do whatever it takes to get your Z’s because better sleep has great health benefits: stronger immune system, better mood, more energy, clearer thinking and lower risk of chronic diseases. A few habit changes can improve sleep, like setting a notification or alarm to remind you it’s time to wind down, then shutting down electronic devices at that time. For stubborn sleep problems your doctor may be able to help.

Additional resources:

• Multimedia is available in the right column of the release link.
• Spanish news release will be added as available.
• What is Menopause?
• Menopause and Cardiovascular Risk
• 5 Things About Menopause Every Woman Needs to Know
• Infographic - Menopause and Heart Health
• Heart Health after Menopause
• Life’s Essential 8
• Follow AHA/ASA news on X @HeartNews

Researchers have identified a signaling pathway by which aspirin can inhibit colorectal cancer.

Colorectal cancer (bowel cancer) is the third most common form of cancer worldwide, with around 1.9 million newly diagnosed cases and 900,000 deaths every year. Therefore, preventive substances represent an urgent clinical need. Aspirin/acetylsalicylic acid has proven to be one of the most promising candidates for the prevention of colorectal cancer. Among other findings, studies have shown that when patients with cardiovascular diseases took low doses of aspirin over several years, it reduced their risk of colorectal cancer. Furthermore, aspirin can inhibit the progression of colorectal cancer. Now a team led by Heiko Hermeking, Professor of Experimental and Molecular Pathology at LMU, has investigated which molecular mechanisms mediate these effects.

As the researchers report in the journal Cell Death and Disease, aspirin induces the production of two tumor-suppressive microRNA molecules (miRNAs) called miR-34a and miR-34b/c. To do this, aspirin binds to and activates the enzyme AMPK, which in turn alters the transcription factor NRF2 such that it migrates into the cell nucleus and activates the expression of the miR-34 genes. For this activation to succeed, aspirin additionally suppresses the oncogene product c-MYC, which otherwise inhibits NRF2.

Overall, the results show that the miR-34 genes are necessary for mediating the inhibiting effect of aspirin on colorectal cancer cells. Aspirin was thus unable to prevent migration, invasion, and metastasis in miR-34-deficient cancer cells. It was already known that the miR-34 genes are induced by the transcription factor p53 and mediate its effects. “Our results show, however, that activation of the miR-34 genes by aspirin takes place independently of the p53 signaling pathway,” says Hermeking. “This is important because the p53-encoding gene is the most commonly inactivated tumor suppressor gene in colorectal cancer. In most other kinds of cancer, moreover, p53 is inactivated by mutations or viruses in the majority of cases. Aspirin could therefore be employed therapeutically in such cases in the future.”

American Cancer Society updates lung cancer screening guideline: US adults who smoke and formerly smoked now recommended for testing

 Today, the American Cancer Society (ACS) released an update of its lung cancer screening guideline to help reduce the number of people dying from the disease due to smoking history. The new guideline recommends yearly screening for lung cancer for people aged 50 to 80 years old who smoke or formerly smoked and have a 20-year or greater pack-year history. The recommended annual screening test for lung cancer is a low-dose computed tomography scan (also called a low-dose CT scan, or LDCT). The guideline, last updated in 2013, is published in the ACS flagship journal, CA: A Cancer Journal for Clinicians.

“This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” said Dr. Robert Smith, senior vice president, early cancer detection science at the American Cancer Society and lead author of the lung cancer screening guideline report. “Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives.”

About Lung Cancer

Lung cancer is the overall leading cause of cancer death in the United States and is the second most frequently diagnosed malignancy in both men and women. In 2023, ACS researchers estimate 238,340 new cases of lung cancer (117,550 in men and 120,790 in women) will be diagnosed with about 127,070 deaths from the disease (67,160 in men and 59,910 in women). Anyone at any age can get lung cancer. However, lung cancer mainly occurs in older people, as most people diagnosed with the disease are aged 65 or older.

The updated guideline report is part of the ongoing guideline development process by ACS scientists. The ACS monitors medical and scientific literature for new evidence that may support a change in current guidelines or the development of a new guideline and information about screening that should be conveyed to clinicians and target populations.

How does the new guideline differ from the previously published guideline?
 

Item	Previous Recommendations	New Recommendations
Age for eligibility	55-74 years	50-80 years
Pack-year (PY) history	30+ PY	20+ PY
Years since quitting (YSQ)	≤ 15 YSQ	No Longer Required

In addition, report authors stress it’s important for people who are going to be screened to consult with their doctor about the potential benefits, limits, and harms of yearly screening with LDCT scans. People who still smoke should receive counseling to help them quit.

Who should NOT get screened for lung cancer:
Adults with health conditions that would greatly limit life expectancy or affect their ability or willingness to get lung cancer treatment if diagnosed should not be screened for the disease.

The American Cancer Society’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) works at all levels of government to advocate for policies to expand access to lung cancer screenings and tobacco control.

“This updated guideline is critical to identify all individuals who can benefit from the early detection of lung cancer,” said Lisa Lacasse, president of ACS CAN. “ACS CAN will continue to work to improve access to care and lung cancer screening at no cost for any person at risk of the disease to decrease lung cancer deaths and help end cancer as we know it, for everyone.”

“The good news is our research shows the number of new lung cancer cases diagnosed each year continues to decrease, partly because more people are quitting smoking (or not starting),” added Smith. “The number of deaths from lung cancer continues to drop as well, due to fewer people smoking and advances in early detection and treatment, but we still have to do better. This updated guideline is a step in the right direction.”
 

Today’s published guideline report also includes a patient page, an editorial from CA editors, and a systematic review of the evidence supporting dropping the years-since-quit criterion related to the new guideline. Modeling papers and epidemiologic research that support the new ACS guideline, as well as an updated analysis of the benefit-to-radiation-risk ratio from screening, are also published today in the ACS journal Cancer.

Strawberry consumption may reduce dementia risk

 

New research from the University of Cincinnati found that daily strawberry consumption could help reduce the risk of dementia for certain middle-aged populations.

The research was recently published in the journal Nutrients.

Research background

In 2022, UC’s Robert Krikorian, PhD, and his team published research that found adding blueberries to the daily diets of certain middle-aged populations may lower the chances of developing late-life dementia. He said the current research into strawberries is an extension to the blueberry research.

“Both strawberries and blueberries contain antioxidants called anthocyanins, which have been implicated in a variety of berry health benefits such as metabolic and cognitive enhancements,” said Krikorian, professor emeritus in the UC College of Medicine’s Department of Psychiatry and Behavioral Neuroscience. “There is epidemiological data suggesting that people who consume strawberries or blueberries regularly have a slower rate of cognitive decline with aging.” 

In addition to containing anthocyanins, Krikorian said strawberries contain additional micronutrients called ellagitannins and ellagic acid that have been associated with health benefits.

About 50% of individuals in the U.S. develop insulin resistance, commonly referred to as prediabetes, around middle age, which has been shown to be a factor in chronic diseases. Krikorian said the metabolic and cardiovascular benefits of strawberry consumption have been studied previously, but there were relatively few studies on its cognitive effects.

“This study assessed whether strawberry consumption might improve cognitive performance and metabolic health in this population and, if so, whether there might be an association between cognitive enhancement and reduced metabolic disturbance,” he said.

Research methodology

A total of 30 overweight patients between 50-65 years old with complaints of mild cognitive decline were enrolled and completed the study. Krikorian said this population has an increased risk for late-life dementia and other common conditions. 

Over a period of 12 weeks, the participants were asked to abstain from berry fruit consumption of any kind except for a daily packet of supplement powder to be mixed with water and consumed with breakfast. Half of the participants received powders that contained the equivalent of one cup of whole strawberries (the standard serving size), while the other half received a placebo. 

The participants were given tests that measured certain cognitive abilities like long-term memory. The researchers also tracked their mood, intensity of depressive symptoms and metabolic data over the course of the study.

Those in the strawberry powder group had diminished memory interference, which is consistent with an overall improvement in executive ability. 

“Reduced memory interference refers to less confusion of semantically related terms on a word-list learning test,” Krikorian said. “This phenomenon generally is thought to reflect better executive control in terms of resisting intrusion of non-target words during the memory testing.” 

The strawberry-treated participants also had a significant reduction of depressive symptoms, which Krikorian said can be understood as a result from “enhanced executive ability that would provide better emotional control and coping and perhaps better problem-solving.”

Other strawberry studies have found improvement in metabolic measures including lower insulin, but there was no effect found on the patients’ metabolic health in this study.

“Those studies generally used higher dosages of strawberry powder than in our research, and this could have been a factor,” Krikorian said.

Next steps

While more research is needed, Krikorian said the strawberry treatment may have improved cognitive function by reducing inflammation in the brain.

“Executive abilities begin to decline in midlife and excess abdominal fat, as in insulin resistance and obesity, will tend to increase inflammation, including in the brain,” he said. “So, one might consider that our middle-aged, overweight, prediabetic sample had higher levels of inflammation that contributed to at least mild impairment of executive abilities. Accordingly, the beneficial effects we observed might be related to moderation of inflammation in the strawberry group.”

Moving forward, Krikorian said future research trials should include larger samples of participants and differing dosages of strawberry supplementation.