The Heart

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People with MS may be more physically fit than tests indicate, study finds

Conventional methods of assessing cardiorespiratory fitness and muscular strength among people with multiple sclerosis may underestimate participants' capabilities, prompting clinicians to prescribe exercise therapies that are less effective than they could be, according to new research by scientists at the University of Illinois.

In a study of 64 patients with MS, kinesiology and community health professor Lara Pilutti and her colleagues found that participants had significantly higher peak aerobic capacity and muscle strength when recumbent steppers and computerized dynamometers were used for the tests, compared with arm ergometers and handheld dynamometers.

Participants' muscle strength ranged from 60 to 173 percent greater, depending on the leg muscle group tested, when measured with a computerized dynamometer versus a handheld device. Accordingly, participants' peak aerobic capacity was 32 percent greater when tested with a recumbent stepper versus an arm ergometer, an upper-body exercise machine that is similar to pedaling a bike with one's hands.

Computerized dynamometers measure the amount of torque or muscle force that users exert to move a lever with their legs. The accuracy of handheld dynamometers in muscle-strength testing has been challenged in prior research because the results can vary greatly, depending on the strength of the person administering the test and providing the resistance as the participant pushes against the device, Pilutti said.

Participants in the study ranged in age from 18 to 64 and had mobility disabilities from MS that varied from mild to severe.

Published in the Journal of Neurologic Physical Therapy, the paper is believed to be the first study to evaluate the use of computerized dynamometers in testing strength deficits in people who have severe mobility impairments from advanced MS.

People who have the most significant disability from the disease frequently are excluded from research studies, either because facilities lack the necessary adaptive equipment or because of other barriers to exercise participation, such as transportation problems.

However, people with the most disabling symptoms could reap great benefits from exercise training, Pilutti said. For the 2.5 million people worldwide who have MS, appropriate exercise can help manage many symptoms of the disease, including fatigue, muscle weakness and problems with balance and coordination.

Sedentary behavior is a significant health threat among people with MS, who, like their counterparts in the general population, spend an average of about eight hours each day sitting, the researchers found.

"We know there are some serious health consequences in terms of morbidity and mortality, so inactivity is a pretty significant issue," Pilutti said. "We need to develop some interventions for both people with MS and in the general population to get everyone to be more active. But that's going to be a challenge for people who have more severe mobility disabilities."

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No need to stop antidepressants before plastic surgery, evidence suggests

For patients undergoing plastic surgery procedures, there's no consistent evidence that taking antidepressants increases the risk of bleeding, breast cancer, or other adverse outcomes, concludes a research review in the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications--and might increase the risk of postoperative problems related to the patient's underlying depression, according to the report by Dr. Isabel Teo of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh.

Do Antidepressants Increase Complications after Plastic Surgery?

Antidepressant use has increased in recent years, with one study reporting that 1 out of 10 US adults and adolescents use these medications. Rates of antidepressant use may be even higher among patients undergoing cosmetic plastic surgery, or patients with breast cancer undergoing breast reconstruction.

While plastic surgeons are alert for use of medications that might increase complications, such as blood thinners, they are typically not concerned about antidepressants. Dr. Teo and Mr. Song performed an in-depth review of research data on the risks of antidepressant treatment in plastic surgery. They analyzed 26 studies assessing the effects of antidepressants on various plastic surgery risks, including:

Bleeding. Six studies assessed the impact of antidepressants and bleeding risk in more than 34,000 patients undergoing breast cancer surgery and 2,500 undergoing cosmetic plastic surgery. The results were inconsistent: while some studies found increased bleeding rates in patients taking antidepressants, others found no such risk.

So while the evidence doesn't rule out an increase in bleeding risk, stopping antidepressants before surgery--especially the widely used selective serotonin reuptake inhibitors (SSRIs)--might worsen depression symptoms or lead to a potentially disastrous "discontinuation syndrome." The authors conclude, "Therefore, routine discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided."

Breast cancer risk. Six reports--mainly large meta-analyses of previous data--examined the risk of breast cancer among patients taking antidepressants. Again, the results were conflicting: some reviews found a "modest" increase of breast and ovarian cancer among antidepressant users while others found no relationship. Breast cancer outcomes. Six studies including more than 11,000 patients examined whether antidepressants might interfere with tamoxifen--a drug used to lower the risk of recurrent breast cancer. Most studies found no evidence that this drug combination increased the risk of recurrent breast cancer. However, there was a possible interaction between tamoxifen and one specific antidepressant--the potent SSRI paroxetine. Breast enlargement. One study of 59 patients suggested a possible increase in the risk of breast enlargement and pain among women taking SSRIs. However, most patients with breast enlargement also had weight gain--a known side effect of SSRI use.

A handful of studies looked at various other complications. One reported an increased risk of seromas (fluid collections) after plastic surgery in patients taking SSRIs. Another reported a possible interaction between SSRIs and methylene blue dye used for lymph node mapping in patients with breast cancer.

While acknowledging the limitations of the available data, Dr. Teo and Mr. Song note their review finds no consistent evidence of increased complications related to antidepressants. The risks of stopping prescribed antidepressant therapy in "psychologically vulnerable" patients likely outweigh any increase in complications.

However, plastic surgeons should consider the impact of the underlying depressive symptoms in patients taking these medications, the authors believe. They conclude, "The use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications and sufficient exploration into the patient's indications for the prescription is crucial."

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Aspirin: is it really a 'wonder drug'?

It is an effective pain reliever and has been linked to reduced risk of a number of health conditions, including heart attack, stroke and cancer. But is aspirin really the "wonder drug" many health experts claim it is?
[A bottle of aspirin]
Because of the numerous health benefits it has been linked with, aspirin is often hailed as the "wonder drug."

Earlier this month, it was announced that researchers from the UK would be embarking on the biggest clinical trial of aspirin to date - the Add-Aspirin phase 3 trial - investigating whether the drug is effective for preventing cancer recurrence through a study of around 11,000 people.

The announcement has caused much excitement in the medical world, with many health experts claiming the trial could be "game-changing" if the drug is found effective, offering a non-expensive strategy to improve survival for cancer patients.

Cancer is just one in a long line of illnesses that aspirin may combat. But in the midst of potential health benefits comes a number of risks, a fact some health professionals believe is often overlooked.

"Because it's been around a long time people think 'it must be safe and it can't do me any harm,'" Prof. Peter Weissberg, medical director of the British Heart Foundation in the UK, told The Independent. "They are taking it 'just in case,' but it's much more dangerous than some other drugs which people get concerned about, like statins."

In this Spotlight, we take a closer look at the potential health benefits of aspirin, as well as the risks associated with the drug.

Aspirin: one of the most commonly used drugs worldwide

Aspirin is a drug that was developed by German research chemist Felix Hoffman, of pharmaceutical company Bayer, in 1897.

Hoffman created aspirin by developing a process to synthesize acetylsalicylic acid (ASA) - a synthetic derivative of a compound called salicin, which is found naturally in plants such as the willow tree.

Early clinical trials of aspirin found it was an effective treatment for pain, fever and inflammation. It is believed the drug produces these effects by inhibiting the production of pain-producing chemicals called prostaglandins. As such, aspirin is commonly used to help ease headache, muscle pain, toothaches and common colds, as well as swelling in arthritis.

More recently, however, researchers have discovered aspirin may also be an effective blood thinner, preventing the formation of blood clots in the arteries by blocking the production of a prostaglandin called thromboxane, which plays a key role in blood clotting.

As such, studies have shown daily aspirin therapy may lower the risk for heart attack and stroke, and it is often recommended for adults at high risk for these conditions.

The possible risks of aspirin use

However, as with any drug, there is a risk for side effects with regular aspirin use.

One of the most severe side effects of regular aspirin use is gastrointestinal bleeding, which can raise the risk of developing a stomach ulcer. If one already has a stomach ulcer, taking aspirin could cause further bleeding and be potentially life-threatening.

Aspirin may also interact with other drugs and increase risk of internal bleeding, particularly drugs with anti-clotting properties, such as warfarin, apixaban and dabigatran. Taking aspirin with some dietary supplements, such as evening primrose oil and fish oil, may also raise internal bleeding risk.

[A close-up of a man's eye]
Studies have associated aspirin use with increased risk of age-related macular degeneration.

Some individuals are allergic to aspirin, with people who have asthma most at risk. An allergic reaction to the drug may cause swelling of the lips, mouth or throat, breathing problems and a skin rash.

Other side effects of aspirin include headache, nausea and vomiting, tinnitus and bruising.

Some studies have linked aspirin use with increased risk for other health conditions. In 2013, for example, a study published in JAMA Internal Medicine suggested long-term use of the drug may increase the risk of age-related macular degeneration - the primary cause of blindness among older adults.

Previous research has also linked aspirin use to greater risk for Reye's syndrome - a rare disorder characterized by swelling in the brain and liver, most common among children and teenagers.

Despite these potential risks, however, aspirin has become one of the most widely used over-the-counter drugs around the globe; more than 100 million standard aspirin tablets are produced every year.

But people are not just using the drug to relieve the odd headache or cold. It seems aspirin is growing in popularity as more people are taking the drug regularly with the aim of preventing numerous health conditions for which studies have suggested it is effective against.

Aspirin and heart health

As mentioned previously, one of the many benefits of aspirin is believed to be its ability to prevent the formation of blood clots.

Last year, Medical News Today reported on a study by researchers from Australia that found individuals with venous thromboembolism (VTE) - a condition comprised of deep vein thrombosis (blood clots in the legs) and pulmonary embolism (in which a blood clot breaks off and travels to the lungs) - saw a 42% reduction in blood clot recurrence with a 100-mg dose of aspirin daily.

This and numerous other studies hailing the anticoagulant properties of aspirin have led to recommendations that people at high risk for heart attack or stroke may benefit from daily aspirin therapy.

The American Heart Association (AHA), for example, recommend daily low-dose aspirin - under the instruction of a health care provider - for heart attack survivors and others at high risk of heart attack.

And last month, MNT reported on new guidelines issued by the US Preventive Services Task Force (USPSTF) that recommend daily low-dose aspirin for heart attack and stroke prevention for individuals aged 50-59 who are at high risk for cardiovascular disease.

The debate over whether aspirin should be administered to prevent first heart attack or stroke, however, continues. Last year, the US Food and Drug Administration (FDA) concluded that, while daily aspirin use can help prevent heart attack and stroke in high-risk individuals, there is insufficient evidence to suggest it is beneficial for primary prevention.

But despite the FDA's conclusion, a study reported by MNT earlier this year revealed that 1 in 10 patients in the US are inappropriately receiving daily low-dose aspirin to prevent a first heart attack or stroke.

First study author Dr. Ravi S. Hira, of the Baylor College of Medicine in Houston, TX, said the findings are a concern because the risks of daily aspirin use may outweigh the benefits for healthy individuals.

"Major coronary events are reduced 18% by aspirin, but at the cost of an increase of 54% of major extracranial bleeding," he explained. "Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied."

What is more, some studies have associated regular aspirin use with increased risk of hemorrhagic stroke - a type of stroke caused by a blood leakage in the brain.

On the next page, we look at some of the other risks and benefits of aspirin use.

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The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery

A ground-breaking study undertaken on behalf of the Association of Cardiothoracic Anaesthetists (ACTA) looked at survival after cardiac surgery of 110,000 patients over 10 years in 10 centres across the UK, and shows for the first time that death after heart surgery is determined overwhelmingly by patient risk factors, rather than by which professionals or which hospitals provide the care. Published in the journal Anaesthesia, the study found the major contributing factors to patient death are their underlying fitness and the presence of co-existing disease - these account for 96% of the risk attributed to surgery. It also quantified for the first time in a large multi-centre UK-wide study the contribution made by the anaesthetist to outcomes following cardiac surgery.

Death rates following cardiac surgery are low and consistently improving in the UK. The study showed a small amount of variability in surgical practice, which accounted for 4% of the risk of death. However, once these risks were taken into account, there was no variability in anaesthetic practice amongst the 190 consultant anaesthetists studied, and the individual anaesthetist did not contribute to patient death following surgery.

This lack of variability in consultant cardiothoracic anaesthetist performance is tremendously reassuring. The implication of this research is that the many years of training and experience gained in the UK health system ensures that practice is uniform and does not unduly put patients at risk. The international anaesthetic community has been engaged in a discussion as to whether death following cardiac surgery should be attributed to the individual named anaesthetist and published, similar to the data publically available for cardiac surgeons. On the basis of this work, the Association of Cardiothoracic Anaesthetists has concluded that collection and publication of outcome by named anaesthetist is not warranted.

Together with the excellent results of cardiac surgery in the UK, the findings of this study will be reassuring to patients and their families. Resources and research should now be targeted at improving the fitness of patients who need to undergo cardiac surgery. The publication of this study in Anaesthesia, one of the leading anaesthetic journals, guarantees widespread circulation amongst healthcare professionals and others worldwide.

This study is accompanied by an editorial that describes this study as one of the most important pieces of research in cardiac anaesthesia published in the last 30 years. It asks and answers a fundamental question: do anaesthetists contribute any harm to patients undergoing cardiac surgery as measured by mortality? The categorical answer is no, and this is a very important finding.

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New incretin-based medicines will allow weight and diabetes control with a single weekly dose

The new generation of incretin-based medicines will allow a coordinated action against the combination diabetes/obesity, also known as diabesity, in some cases with only a single weekly dose, and with the likelihood of additional beneficial effects on other health complications related to this condition, such as cardiovascular and neurodegenerative diseases.

The experts in diabesity who met in Vigo at the third BIOCAPS workshop all highlighted the highly promising therapeutic pathways currently being opened up as regards a pharmacological approach to this combination of the two worst epidemics of the 21st century in developed countries. The increasing incidence of this disease has driven recent research efforts, and the exchange of ideas and opinions concerning the latest breakthroughs, which is a key objective of the Biomedical Research Institute (IBI) when organising its most prestigious annual scientific meeting, is considered to be essential.

During the opening of the workshop, the chairwoman of the Fundación Biomédica Galicia Sur, Beatriz Gil de Araújo, highlighted that "the BIOCAPS project has placed the IBI, which now hosts more than 500 scientists, as a centre of reference in the field of biomedical research".

The coordinator of BIOCAPS, Africa González, asserted that the programme"is an excellent opportunity to open the IBI up to society, the biomedical community and also to industry" and reiterated her confidence in the continuity of this line once the project concludes. The incorporation of scientific talent, the establishment of new collaborations, the acquisition of infrastructures, the greater visibility of the institute and the boost to its innovation activities highlight compliance with the targets set at the launch of BIOCAPS, as explained by its coordinator.

Alternatives to insulin

During the opening lecture, Flavia Mulè, from the University of Palermo (Italy), discussed the possible uses of glucagon-like peptide 2 (GLP-2), one of the main types of incretin, as an alternative to insulin for the treatment of diabetes. After noting that its role in the control of glycaemia (blood sugar levels) has been studied to date in animal models, Dr. Mulè reiterated her conviction that "this strategy deserves far greater attention for the treatment of obesity-related type 2 diabetes and future research should focus on determining its efficacy in humans".

According to Mulè, the main advantage of this option is that it improves sensitivity to insulin (ability to correctly metabolise glucose) and, therefore, the control of blood sugar levels in conditions of obesity. "In addition, its action is related to anti-inflammatory effects, thus meaning that it could be beneficial for associated disorders, such as high blood fat levels (hyperlipidaemia), fatty liver and hypertension", she added.

New generation of medicines

Physical inactivity and poor eating habits increase the risk of suffering from type 2 diabetes. This occurs because an increase in weight, and therefore in adipose tissue, produces insulin resistance, thus meaning that this hormone is unable to perform its role in the different tissues of the body correctly. This results in hyperglycaemia and the onset of diabetes.

The new generation of medicines aims to provide a more effective and broader spectrum action. The views of Flavia Mulè were complemented on the closing day of the workshop by Javier Salvador, from the University of Navarra, who discussed the major breakthrough that two families of medicines associated with incretins represent for the treatment of diabesity. "When faced with the onset of these conditions we previously had not medicines that allowed glucose levels to be controlled without a risk of hypoglycaemia (low sugar levels) while also promoting weight loss or preventing it from increasing", he explained. "Sulfonylureas, glitazones and insulin are medicines with a known ability to control glucose levels but which also tend to result in weight gain and can provoke hypoglycaemia".

Salvador noted that new compounds such as dulaglutide, which, in addition to having a satiating effect and eliminating the risk of hypoglycaemia,will be administered as a single weekly injection, will shortly become available. Although some types of incretin-based medicines are already being used to treat type 2 diabetes, the researcher from the University of Navarra considers that "an awareness of the role of obesity in the onset and deterioration of control in diabetes, and the availability of formulations with a more prolonged action, will help to increase their use".

As is the case for some of the compounds mentioned by Flavia Mulè, these also present potential cardioprotective, antiarteriosclerotic and anti-inflammatory effects and may also protect against neurodegenerative diseases.

Experts from nine countries

As noted by the workshop's organiser, Federico Mallo, during his institutional inauguration, the scientific meeting "has the honour of including presentations by experts from nine European countries: Germany, the UK, Sweden, France, Italy, Portugal, Ireland, Austria and Spain". In addition, he hoped that the workshop will serve to "plant the seeds of future collaborations".

The themed session commenced with a round of presentation on the physiopathology of adipose tissue, in other words the disorders that arise in fatty tissue. The next day was dedicated to diabesity-related complications, which range from Parkinson's disease to arteriosclerosis, ophthalmological diseases and other conditions. The session closed with a plenary speech by Donal O'Shea, from the University of Dublin (Ireland), who reviewed recent progress in incretin therapy for treating obesity and inflammation.

Finally, the third day was dedicated to the most innovative approaches and the greatest challenges in the treatment of diabesity. The closing lecture was given by Timo Muller, from the IDO in Munich, who presented the new generation of incretin complexes for specific therapies to the audience. His group, in collaboration with industry, has made significant breakthroughs in the design and evaluation of new medicines for diabesity. "We have experience in creating molecules that are able to activate mechanisms which benefit metabolism, correcting problems such as obesity and insulin resistance", he explained.

Some of these medicines are already in the clinical evaluation phase and others will shortly be tested in trials, although it is difficult to know if and when their use will become widespread. However, whenever this occurs, Müller expects them to have a promising future as their characteristics confer highly advantageous possibilities on them with respect to currently available formulations. "We can transport the medicine directly to target cells while keeping it away from other tissues, thus minimising undesired side-effects", he explained.

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Married people recover better after heart surgery

People who are married are more likely to fully recover after heart surgery, according to a new study published in JAMA Surgery.
[couple walking]
Married people have a better chance of a good outcome after heart surgery, researchers find.

Among more than 1,500 adults who underwent a cardiac intervention, those who were divorced, separated or widowed were more likely to have died or develop a new functional disability after the surgery, compared with the married participants.

A previous survey of 127,545 American adults found that married men are healthier and live longer, especially those who marry after age 25; and the longer a man stays married, the greater his survival advantage.

In terms of heart health, a Japanese study has claimed that men who never marry are three times more likely to die of cardiovascular disease, while another 10-year US study of 3,682 men found a 46% lower risk of heart disease in married men.

Dr. Mark Neuman and colleagues, of the Perelman School of Medicine at the University of Pennsylvania, used data from the University of Michigan Health and Retirement Study, which has enrolled 29,053 adults aged 50 years or older since 1998.

The participants undergo interviews every 2 years regarding health, functioning, medical care and family structure. The team studied participants who had undergone cardiac surgery since the preceding interview.

The researchers gathered information on marital status, age, sex and existing comorbidities, as well as ability to carry out six activities of daily living independently: dressing, ambulation, bathing, eating, toileting and getting in and out of bed.

Of 1,576 participants, 65% were married at the time of entering the study, 12% were divorced or separated, 21% were widowed and 2% had never been married.

Married participants were more likely to be male and to demonstrate lower levels of other illnesses and disability before surgery.

At the time of the interview after the surgery, the percentage of people who had either died or developed a new disability was: 19% of married participants, 29% of divorced or separated individuals, 34% of widowed participants and 20% of participants who had never been married.

Developing a new disability was classed as losing the ability to perform an activity of daily living independently, such as dressing, walking or eating.

The results show a significant link between marital status and death or a new functional disability. Participants who were divorced, separated or widowed had an approximately 40% greater chance of dying or developing a new functional disability during the first 2 years after cardiac surgery, compared with the married participants.

The findings support prior work that has suggested a better chance of survival after major surgery among married persons, but little is known regarding the association between marital status and postoperative function.

According to the authors:

"Survival advantages for married people [...] may relate to the role of social supports in influencing patients' choices of hospitals and their self-care."

Reasons proposed in the past have included levels of social support and biological factors, among others. One study found that for 66% of men, their wives are their primary social support; if their spouse leaves or dies, they have no support. Conflict and stress lead to higher adrenaline levels, higher blood pressure and inflammation, which is detrimental to cardiac health in the long term. Loneliness and the stress of divorce or widowhood could play a role.

The researchers call for further efforts to establish the mechanisms linking marital status and postoperative outcomes in order to counsel patients and identify at-risk groups for whom targeted interventions could aid recovery.

A limitation of the study was that the married and unmarried participants may have differed in ways that were not observable in the study data.

Medical News Today previously reported that married lung cancer patients have a better chance of survival than those who are unmarried.

Written by Yvette Brazier

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TV viewing linked to increased risk of death from major causes

It is no surprise that spending long hours in front of a television is not doing us any favors when it comes to our health. But a new study links many hours of this sedentary behavior to increased risks for eight of the major causes of death.
Man watching TV
Watching 3-4 hours of TV per day significantly increases risks for major causes of death.

The study, previously published online, will appear in the December issue of the American Journal of Preventive Medicine.

According to the study authors - who were led by Sarah K. Keadle, PhD, from the National Cancer Institute - on average, 80% of adults in the US watch 3.5 hours of television each day.

Previous studies have shown a link between TV viewing and poorer health; there are already established links between prolonged TV viewing and increased risk of death from cancer and cardiovascular disease, for example.

Because 92% of Americans have a TV at home, and watching it takes up over half of their leisure time, it likely displaces more physical activities, which is why there are associated health risks.

"We know that television viewing is the most prevalent leisure-time sedentary behavior, and our working hypothesis is that it is an indicator of overall physical inactivity," says Keadle.

To further investigate, she and her team studied over 221,000 adults between the ages of 50-71 years old who were chronic disease-free at the start of the study in 1995. Study participants were followed until either death or December 31, 2011.

Death risk increases with 3-4 hours of TV viewing per day

Results of the study confirmed the previous link between television viewing and higher risk of death from cancer and heart disease.

However, they also found new links with higher risks of death from diabetes, influenza, pneumonia, Parkinson's disease and liver disease.

In detail, the study found that compared with those who watched less than an hour of TV per day, those who watched 3-4 hours were 15% more likely to die from any cause. And those who watched 7 or more hours were 47% more likely to die during the study period.

"In this context," says Keadle, "our results fit within a growing body of research indicating that too much sitting can have many different adverse health effects."

The researchers note that risk began to increase at 3-4 hours of TV viewing per day for most causes they assessed. In addition, after controlling for other factors that might explain the links - such as caloric and alcohol intake, smoking and the population's health status - the team says the associations persisted.

Interestingly, the adverse health effects of TV viewing applied to both active and inactive participants. Keadle says exercise did not completely diminish the risks associated with prolonged TV viewing, but she adds that for those who want to reduce time spent in front of the TV, "exercise should be the first choice to replace that previously inactive time."

TV viewing: an important public health intervention target

The researchers say although the links have "plausible biological mechanisms," many of these associations are reported for the first time in this study, and as such, further research is warranted.

Keadle adds that she hopes their study "will spur additional research," particularly to determine whether the same associations are observed when people are sitting in other contexts, including driving, working or doing other sedentary activities during leisure time.

She concludes:


"Older adults watch the most TV of any demographic group in the US. Given the increasing age of the population, the high prevalence of TV viewing in leisure time, and the broad range of mortality outcomes for which risk appears to be increased, prolonged TV viewing may be a more important target for public health intervention than previously recognized."

Although this study focuses on adults, previous studies have shown that many children watch more TV than what the American Academy of Pediatrics (AAP) recommend. For children under 2, the AAP recommend no TV time, while older children should watch fewer than 2 hours per day.

This latest study contrasts a recent one published in the International Journal of Epidemiology, which suggested prolonged sitting does not damage health, as long as the individual takes part in regular exercise.

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Reducing strokes may prevent the development of dementia

A worldwide call to action, spearheaded by Western University researcher Dr. Vladimir Hachinski, is calling for more attention to the link between reducing strokes and preventing dementia.

Approximately 747,000 Canadians live with dementia, including Alzheimer's diseases, which represents 14.9 per cent of Canadians 65 and older. If no action is taken, that number is expected to increase to 1.4 million Canadians by 2031. By 2040, the cost of dementia could cost the health care system $293 billion a year.

Dr. Hachinski, distinguished university professor at Western's Schulich School of Medicine & Dentistry, in collaboration with 15 international researchers, has led the development of the Stroke and Potentially Preventable Dementias Proclamation, on behalf of the World Stroke Organization, to mark World Stroke Day on October 29, 2015.

All major dementias have a vascular component, including 80 per cent of Alzheimer's disease incidents. "Silent" strokes - strokes which are not readily visible - occur five times as often as visible strokes which affect the body noticeably. These "silent" strokes may affect thinking, mood, personality and ultimately lead to dementia.

The proclamation outlines key steps to preventing and reducing strokes and dementia internationally, in developed countries, such as Canada, as well as developing nations without the health resources to deal with the rising incidence of stroke and dementia. With an aging global population, implementing reduction strategies can reduce millions of deaths and disabilities over the next decade, and reduce the significant economic burden.

"One in three of us will develop stroke or dementia," said Dr. Hachinski. "But, there is something we can do about it. Recent evidence suggests that there are many ways to reduce our risk, for example addressing common risk factors such as tobacco use, alcohol misuse, physical inactivity, and diets high in salt, fats and sugar. Further steps include identifying 'silent' strokes, developing transdisciplinary teams for stroke and dementia care to improve outcomes, supporting people living with strokes, their caregivers and families, and giving individuals the tools to impact their own future risk and treatment."

Published in Stroke and the International Journal of Stroke, the proclamation has international support from Alzheimer's Disease International, World Federation of Neurology, World Heart Federation, World Federation for NeuroRehabiliation, American Academy of Neurology, American Heart Association, the Alzheimer's Association, Alzheimer Society of Canada, Heart and Stroke Foundation of Canada and other regional, national and international organizations.

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Drug-device combination opens potential new path to treat stroke

Fully obstructed blood clots in the brain could one day be cleared using a device that opens a small channel through the blockage in combination with a clot-busting drug that specifically targets obstructed sites.

Scientists at the Wyss Institute for Biologically Inspired Engineering at Harvard University developing novel nanotherapeutics for clearing obstructed blood vessels have teamed up with researchers at University of Massachusetts' New England Center for Stroke Research (NECSTR) to develop a new, highly effective drug-device combination for treating life-threatening blood clots in patients with stroke.

In a new study that will appear in the December 2015 issue of Stroke journal, the team co-led by Wyss Institute Founding Director Donald Ingber, M.D., Ph.D., and U. Mass Medical Professor of Radiology Ajay Wakhloo, M.D., Ph.D., FAHA, describe their novel method to quickly dissolve away clots that completely obstruct blood vessels in the brain. Their approach combines an injectable clot-busting nanotherapeutic that targets blockages with an intra-arterial device that restores blood flow to obstructed vessels.

The Wyss Institute nanotherapeutic is composed of an aggregate of biodegradable nanoparticles coated with a clot-busting drug called tissue plasminogen activator (tPA), which mimics the way blood platelets behave inside our own bodies. When blood vessels narrow, the shear force of blood flow increases at that location to produce a physical cue that causes platelets to stick to the vessel wall. Similarly, the nanotherapeutic reacts to fluid shear force, releasing tPA-coated nanoparticles in these narrowed regions where vessels are partially occluded, binding to the blood clot and dissolving it away.

But until now, the mechanically activated nanotherapeutic would not be effective in complete vascular blockages where there is no blood flow, as is the case for most stroke patients. The most effective treatment today for stroke is known as a "stent-retriever thrombectomy" procedure, originally described by Wakhloo and his colleague Matthew Gounis, Ph.D., Associate Professor of Radiology at UMass. The procedure involves placing a small tube through the blockage, passing a closed stent through it, and then opening the stent to physically pull the large blood clot out of the vessel.

"Even with the retriever thrombectomy procedure, not all clots can be removed with a successful outcome," said Gounis. "Clot fragments can be dislodged, which can lead to microclots and tissue damage downstream in the brain circulatory system, and physical dragging of the stent through the vessel can potentially be damaging as well."

Instead, the new advance describes using the stent not to drag out the clot, but to create a narrow channel restoring blood flow through an opening in the center of the vascular blockage. Doing so creates a high level of shear force generated by restored flow, activating the nanotherapeutic to release and target the clot-busting drug along the opened channel in the clot. After the blood clot is fully dissolved, the stent is re-sheathed and harmlessly removed from the vessel. If during the process any clot fragments break off and travel away through the circulatory system, the drug-coated nanoparticles will remain bound to them and continue to dissolve them locally wherever they go.

"What's progressive about this approach is that the temporary opening of a tiny hole in the clot - using a stent device that is already commonly used clinically - results in a local rise in mechanical forces that activate the nanotherapeutic to deploy the clot-busting drug precisely where it can best do its job," said Ingber, who is also the Judah Folkman Professor of Vascular Biology at Boston Children's Hospital and Harvard Medical School and Professor of Bioengineering at the Harvard John A. Paulson School of Engineering and Applied Sciences.

In clinically relevant large animal studies, the team has demonstrated that the drug-device combination works very efficiently, showing that it dissolves clots that fully occlude brain blood vessels that are the same size as they would be in humans.

"This has been a great collaboration between experts in the field of treating stroke and experts in mechanobiology and bioengineering," said co-first author of the study Netanel Korin, Ph.D., former Wyss Technology Development Fellow and current Assistant Professor in Biomedical Engineering at the Technion, Israel, who first described the nanotherapeutic in a 2012 Science publication with Ingber. "We hope that one day it will have a positive impact on patients suffering from a range of medical crises resulting from blood clot occlusions."

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Heart CT scans outperform stress tests in spotting clogged arteries

Fast Facts:

CT scans outperform stress tests in spotting clogged arteries. CT angiograms detect blockages in nine out of 10 people. Tests can miss four out of 10 patients with clogged heart vessels.

Results of a head-to-head comparison study led by Johns Hopkins researchers show that noninvasive CT scans of the heart's vessels are far better at spotting clogged arteries that can trigger a heart attack than the commonly prescribed exercise stress that most patients with chest pain undergo.

A report on the findings comparing CT angiograms and stress tests, published online Oct. 14 in the journal Circulation: Cardiovascular Imaging, show the scans correctly identified blockages in nine out of 10 people, while stress tests picked up blockages in six out of 10.

What renders the results of the new study particularly powerful, researchers say, is that each patient underwent all three tests for providing a direct, head-to-head comparison of their ability to accurately spot blockages.

"No tests is 100 percent accurate 100 percent of the time, but our findings indicate CT angiograms get pretty close to that coveted threshold," says lead investigator Armin Zadeh, M.D., Ph.D., associate professor of medicine at the Johns Hopkins University School of Medicine. "We hope our findings will settle any residual uncertainty about the effectiveness of these two common noninvasive heart tests."

The researchers note that the gold standard for detecting blocked arteries remains invasive cardiac angiography, a test using dye and X-rays that requires a catheter to be threaded into the heart's vessels. But cardiologists have long relied on so-called stress testing as a simpler, cheaper "gatekeeper" procedure to identify people more likely to benefit from the riskier, more invasive and more costly catheterizations.

CT angiograms have recently emerged as yet another non-invasive alternative. A handful of studies, Zadeh says, have suggested CT angiographies may be superior, but uncertainty has persisted due the small number of people involved in these analyses, and stress tests have remained the more popular choice among clinicians.

Results of the new study, the research team says, should help settle lingering doubts among physicians and the nearly 15 million Americans who seek medical attention each year for symptoms that signal a clogged artery, including chest pain, shortness of breath and extreme fatigue.

In CT angiography, clinicians use dye injected into the circulation to visualize blockages inside the arteries. When the dye reaches impenetrable or narrowed passages clogged by fatty buildups or clots, the scan shows a blockage. The so-called nuclear exercise stress tests also use dye and CT scans but instead of directly visualizing the interior of the arteries, they measure blood flow to the heart muscle immediately after a patient walks on a treadmill. Reduced blood flow to the heart muscle is a signal that a narrowed or blocked artery is not supplying the muscle with enough blood. Although exercise stress testing is generally safe for most people, it can rarely trigger an abnormal heart rhythm or even an actual heart attack in people with seriously clogged arteries.

Researchers emphasize that both nuclear stress tests and CT angiograms expose patients to radiation. While many newer CT scans deliver substantially lower doses of radiation than the scans used in nuclear stress tests, the dose and protocols can vary widely from hospital to hospital, researchers say. CT angiograms and nuclear stress tests carry similar price tags --between $750 and $1,200. Researchers say the total tab stemming from either test, including downstream costs related to additional testing due to unclear or unrelated findings, remains unclear and should be an important consideration in crafting any new testing recommendations.

For the current study, 391 patients, ages 45 to 85, seen at 16 hospitals in eight countries, underwent noninvasive CT angiograms, followed by traditional, catheter-based coronary angiographies. Within two months, each patient also underwent an exercise stress test. All patients had symptoms suggestive of heart disease, but not all had a previous diagnosis of the condition.

Overall, non-invasive CT angiograms accurately detected or ruled out artery blockages in 91 percent of patients, compared with 69 percent for stress testing. When researchers analyzed test performance in a subgroup of 111 patients with very high-risk disease as identified on traditional angiography, the diagnostic accuracy of CT angiograms went up to 96 percent, compared with 80 percent for stress testing. In other words, researchers report, stress tests missed two out of every 10 patients with severe disease, marked by multiple blockages.

Current guidelines from the American Heart Association and the American College Cardiology call for a stress tests in all patients who show signs of coronary artery disease to confirm the diagnosis and define the severity of the blockage. CT angiograms are generally reserved only for patients with borderline stress test results. But given its much higher accuracy, the researchers say, CT angiography may be a better first-line test in people with symptoms suggestive of a blocked artery.

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Heart CT scans outperform stress tests in spotting clogged arteries

Fast Facts:

CT scans outperform stress tests in spotting clogged arteries. CT angiograms detect blockages in nine out of 10 people. Tests can miss four out of 10 patients with clogged heart vessels.

Results of a head-to-head comparison study led by Johns Hopkins researchers show that noninvasive CT scans of the heart's vessels are far better at spotting clogged arteries that can trigger a heart attack than the commonly prescribed exercise stress that most patients with chest pain undergo.

A report on the findings comparing CT angiograms and stress tests, published online Oct. 14 in the journal Circulation: Cardiovascular Imaging, show the scans correctly identified blockages in nine out of 10 people, while stress tests picked up blockages in six out of 10.

What renders the results of the new study particularly powerful, researchers say, is that each patient underwent all three tests for providing a direct, head-to-head comparison of their ability to accurately spot blockages.

"No tests is 100 percent accurate 100 percent of the time, but our findings indicate CT angiograms get pretty close to that coveted threshold," says lead investigator Armin Zadeh, M.D., Ph.D., associate professor of medicine at the Johns Hopkins University School of Medicine. "We hope our findings will settle any residual uncertainty about the effectiveness of these two common noninvasive heart tests."

The researchers note that the gold standard for detecting blocked arteries remains invasive cardiac angiography, a test using dye and X-rays that requires a catheter to be threaded into the heart's vessels. But cardiologists have long relied on so-called stress testing as a simpler, cheaper "gatekeeper" procedure to identify people more likely to benefit from the riskier, more invasive and more costly catheterizations.

CT angiograms have recently emerged as yet another non-invasive alternative. A handful of studies, Zadeh says, have suggested CT angiographies may be superior, but uncertainty has persisted due the small number of people involved in these analyses, and stress tests have remained the more popular choice among clinicians.

Results of the new study, the research team says, should help settle lingering doubts among physicians and the nearly 15 million Americans who seek medical attention each year for symptoms that signal a clogged artery, including chest pain, shortness of breath and extreme fatigue.

In CT angiography, clinicians use dye injected into the circulation to visualize blockages inside the arteries. When the dye reaches impenetrable or narrowed passages clogged by fatty buildups or clots, the scan shows a blockage. The so-called nuclear exercise stress tests also use dye and CT scans but instead of directly visualizing the interior of the arteries, they measure blood flow to the heart muscle immediately after a patient walks on a treadmill. Reduced blood flow to the heart muscle is a signal that a narrowed or blocked artery is not supplying the muscle with enough blood. Although exercise stress testing is generally safe for most people, it can rarely trigger an abnormal heart rhythm or even an actual heart attack in people with seriously clogged arteries.

Researchers emphasize that both nuclear stress tests and CT angiograms expose patients to radiation. While many newer CT scans deliver substantially lower doses of radiation than the scans used in nuclear stress tests, the dose and protocols can vary widely from hospital to hospital, researchers say. CT angiograms and nuclear stress tests carry similar price tags --between $750 and $1,200. Researchers say the total tab stemming from either test, including downstream costs related to additional testing due to unclear or unrelated findings, remains unclear and should be an important consideration in crafting any new testing recommendations.

For the current study, 391 patients, ages 45 to 85, seen at 16 hospitals in eight countries, underwent noninvasive CT angiograms, followed by traditional, catheter-based coronary angiographies. Within two months, each patient also underwent an exercise stress test. All patients had symptoms suggestive of heart disease, but not all had a previous diagnosis of the condition.

Overall, non-invasive CT angiograms accurately detected or ruled out artery blockages in 91 percent of patients, compared with 69 percent for stress testing. When researchers analyzed test performance in a subgroup of 111 patients with very high-risk disease as identified on traditional angiography, the diagnostic accuracy of CT angiograms went up to 96 percent, compared with 80 percent for stress testing. In other words, researchers report, stress tests missed two out of every 10 patients with severe disease, marked by multiple blockages.

Current guidelines from the American Heart Association and the American College Cardiology call for a stress tests in all patients who show signs of coronary artery disease to confirm the diagnosis and define the severity of the blockage. CT angiograms are generally reserved only for patients with borderline stress test results. But given its much higher accuracy, the researchers say, CT angiography may be a better first-line test in people with symptoms suggestive of a blocked artery.

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Four microRNAs identified as playing key roles in cholesterol, lipid metabolism

Four tiny segments of RNA appear to play critical roles in controlling cholesterol and triglyceride metabolism. In their report receiving advance online publication in Nature Medicine, a Massachusetts General Hospital (MGH)-based research team describes finding how these microRNAs could reduce the expression of proteins playing key roles in the generation of beneficial HDL cholesterol, the disposal of artery-clogging LDL cholesterol, control of triglyceride levels and other risk factors of cardiovascular disease.

"While we and others have recently identified microRNAs that control cholesterol and fat metabolism and trafficking, no studies to date have systematically looked at all non-coding factors - such as microRNAs - in genetic studies of human diseases and other traits," says Anders Näär, PhD, of the MGH Center for Cancer Research, corresponding author of the current study. "Using human genetic data from almost 190,000 individuals, we have linked 69 microRNAs to increased genetic risk for abnormal cholesterol and triglyceride levels, and showed that four of these act to control proteins we know are involved in those metabolic activities."

Less than 2 percent of human DNA represents genes that code for the production of proteins. While it was originally hypothesized that the other 98 percent had no function - leading to the term "junk DNA" - it has now become apparent that these DNA sequences play essential roles in determining how, when and where protein-coding DNA is expressed. One such control mechanism is through single-stranded microRNAs, which block the expression of protein-coding genes by binding to messenger RNAs and preventing their translation into protein. In previous studies, Näär and his colleagues found that a microRNA called miR-33 suppresses production of beneficial HDL cholesterol and that antisense blocking of miR-33 increased HDL levels in an animal model.

The current study began with analysis of genome-wide association studies involving more than 188,000 individuals, which identified 69 microRNAs located near gene variants previously associated with lipid abnormalities. Using a tool that predicts the targets of microRNAs based on matches between their nucleotide sequences and those of protein-coding genes and a database of identified gene functions, the researchers arrived on four microRNAs that appear to control genes involved in cholesterol and triglyceride levels and in other metabolic functions, such as glucose metabolism. Two of these - miR-128-1 and miR-148a - were found to control the expression of proteins essential to the regulation of cholesterol/lipid levels in cells and in animal models; miR-128-1 was also found to regulate fatty liver deposits, insulin signaling and maintenance of blood sugar levels.

"We are following up these findings with studies to address whether antisense blocking of these microRNAs could decrease atherosclerosis, cardiovascular disease and inflammatory fatty liver diseases in animals," says Näär, a professor of Cell Biology at Harvard Medical School and an MGH research scholar. "We hope these findings will lead to new, more effective ways of treating or even preventing cardiovascular disease and other metabolic disorders."

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Fewer deaths from leading causes

The number of fatalities caused by heart disease, cancer, stroke, unintentional injuries and diabetes - the five leading causes of death in the US - has fallen, according to a report published in JAMA.
[heart and monitor]
Deaths from heart disease fell by 68% from 1969-2013.

The analysis of deaths in the US between 1969-2013 was carried out by Jiemin Ma, PhD - of the American Cancer Society in Atlanta, GA - and colleagues, using death certificate records.

The study is expected to contribute to health planning, priority setting and identification of modifiable factors that may contribute to health trends.

The team analyzed US national vital statistics data to determine total number and annual percent change in age-standardized death rates and years of potential life lost before age 75 years for all causes combined and for the leading causes.

Between 1969-2013, the age-standardized death rate for all causes decreased from 1,279 per 100,000 population to 730, a 43% reduction and an average annual decrease of 1.3%. However, the rate of decrease slowed more recently for heart disease, stroke, and diabetes.

There was an overall decline in the death rate of 5 out of 6 leading causes during this time. The death rate per 100,000 decreased for stroke by 77%; for heart disease by 68%; for unintentional injuries by 40%; for cancer by 18%; and for diabetes by 17%.

In contrast, the death rate for chronic obstructive pulmonary disease (COPD) increased from 21 to 42 per 100,000 - or 101% - during this period. However, from 2010-13, the death rate for COPD in men began to decrease; at the same time, the drop in rates for heart disease, stroke and diabetes also slowed. The annual decline for heart disease slowed from 3.9% in 2000-10 to 1.4% in 2010-13.

Fewer years of potential life lost

In terms of the number of years of potential life lost per 1,000 years:

Fast facts about leading causes of death

The leading cause of death in the US in 2014 was heart disease, with 611,105 fatalities The second cause of death was cancer, with 584,881 deaths Third was COPD, which killed 149,205 people.

Learn more about leading causes of death

For diabetes, the number of years lost decreased from 1.9 to 1.6, a 14.5% reduction For cancer, it fell from 21.4 to 12.7, or 40.6% For unintentional injuries, the number of years lost dropped from 19.9 to 10.4, a fall of 47.5% For heart disease, the figure declined from 28.8 to 9.1, or 68.3% For stroke, it fell from 6.0 to 1.5 years lost, a drop of 74.8%.

For COPD, there was no decrease in the number of years of potential life lost.

The progress against heart disease and stroke is believed to be due to improvements in control of hypertension and hyperlipidemia, smoking cessation and medical treatment.

The lower number of cancer deaths since the early 1990s is probably thanks to tobacco control efforts, as well as advances in early detection and treatment of disease.

The number of years of potential life lost because of cancer has been decreasing since 1969, some 20 years ahead of the decline in cancer death rates. This may reflect the importance of smoking cessation in preventing early deaths.

The overall decrease in the death rate for unintentional injuries is thought to reflect continuous declines in deaths related to motor vehicles.

The observed recent slowing of the decline in death rates for obesity-related diseases, such as heart disease, stroke and diabetes, may reflect the delayed consequences of increased obesity prevalence since the 1980s.

Death rate assessment 'requires more textured insights'

The team calls for further disease-specific studies to investigate these trends. Despite the changes in death rates, they predict that the increasing numbers of older persons in the US and growth of the US population will pose a considerable challenge for health care delivery in the coming decades.

They predict that a shortage of primary care physicians and geriatricians, increasing cost of health care, and the gap between healthy life and life expectancies will be areas of concern.

Dr. J. Michael McGinnis, of the National Academy of Medicine in Washington, DC, says in an accompanying editorial:

"Death rate may have at one time served as a sufficient measure of health system performance, but assessment now requires more textured insights, including those that reflect the improving capacity to measure health status, risk prevalence, and service access, effectiveness, and affordability."

Limitations of the study include possible inaccuracies in reporting on the death certificates; the data was generally found to be accurate for cancer and injuries, whereas deaths from COPD, stroke and diabetes tended to be under-reported, and deaths from heart disease tend to be overreported, according to the researchers.

Medical News Today reported previously that stroke had fallen one place to the fifth leading cause of death in the US, swapping places with unintentional injuries.

Written by Yvette Brazier

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Many young heart attack patients, especially women, unaware of risk

Only half of younger heart attack patients believed that they were at risk before the onset of an attack, and even fewer discussed health risks with their doctors, according to Yale School of Public Health researchers. The findings were more pronounced among women than men.

The new study, led by the Yale School of Public Health and published Oct. 26 in the Journal of the American College of Cardiology, examined 3,501 heart attack survivors and found that only 53% had considered themselves at risk. Even fewer, 46%, of the patients reported being told they were at risk by a healthcare provider, and only 49% reported discussing heart disease and risk modification with a doctor.

Women were 11% less likely than men to be told by their doctors that they were at risk for a heart attack and were 16% less likely to report having a healthcare provider discuss heart disease and ways that they could reduce their risk.

"We've made great strides in heart disease awareness in recent decades, but our findings suggest there is more work to be done," said Erica Leifheit-Limson, the study's lead author and an associate research scientist at the Yale School of Public Health. "Many younger women and men, even those with multiple cardiac risk factors, are not receiving adequate counseling on heart disease."

Each year in the United States more than 15,000 women under the age of 55 die from heart disease, ranking it as a leading cause of death for this age group. Moreover, younger women are more likely to die after being hospitalized for a heart attack than men of the same age.

Leifheit-Limson and colleagues used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study to analyze medical records and the results of interviews with heart attack patients from more than 100 hospitals in the United States and Spain. Study participants ranged in age from 18 to 55.

Researchers compared the prevalence of five cardiac risk factors (diabetes, high cholesterol, hypertension, obesity, and smoking status) as well as reports of clinical counseling on heart disease. They found that 97% of the women and 99% of the men had at least one risk factor, and nearly two-thirds had three or more. The most common risk factor was high cholesterol.

About half the U.S. patients reported that prior to their heart attack, they considered themselves at risk, were told by a healthcare provider they were at risk, or had a healthcare provider talk to them about heart disease and ways to lower their risk. Spanish study subjects were less likely to report they were aware of the risk. Only 36% reported a prior perceived risk of a heart attack, and only 22% said that a healthcare provider had spoken with them about heart disease and ways to reduce their risk.

"Current clinical guidelines emphasize risk assessment and patient education, but these are not being adequately applied to younger individuals at risk for heart disease, particularly younger women," said Judith Lichtman, associate professor at the Yale School of Public Health and the study's senior author. "We need to empower individuals to seek information about heart health, and we need to ensure that care providers are educating patients about risk factor management."

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Many young heart attack patients, especially women, unaware of risk

Only half of younger heart attack patients believed that they were at risk before the onset of an attack, and even fewer discussed health risks with their doctors, according to Yale School of Public Health researchers. The findings were more pronounced among women than men.

The new study, led by the Yale School of Public Health and published Oct. 26 in the Journal of the American College of Cardiology, examined 3,501 heart attack survivors and found that only 53% had considered themselves at risk. Even fewer, 46%, of the patients reported being told they were at risk by a healthcare provider, and only 49% reported discussing heart disease and risk modification with a doctor.

Women were 11% less likely than men to be told by their doctors that they were at risk for a heart attack and were 16% less likely to report having a healthcare provider discuss heart disease and ways that they could reduce their risk.

"We've made great strides in heart disease awareness in recent decades, but our findings suggest there is more work to be done," said Erica Leifheit-Limson, the study's lead author and an associate research scientist at the Yale School of Public Health. "Many younger women and men, even those with multiple cardiac risk factors, are not receiving adequate counseling on heart disease."

Each year in the United States more than 15,000 women under the age of 55 die from heart disease, ranking it as a leading cause of death for this age group. Moreover, younger women are more likely to die after being hospitalized for a heart attack than men of the same age.

Leifheit-Limson and colleagues used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study to analyze medical records and the results of interviews with heart attack patients from more than 100 hospitals in the United States and Spain. Study participants ranged in age from 18 to 55.

Researchers compared the prevalence of five cardiac risk factors (diabetes, high cholesterol, hypertension, obesity, and smoking status) as well as reports of clinical counseling on heart disease. They found that 97% of the women and 99% of the men had at least one risk factor, and nearly two-thirds had three or more. The most common risk factor was high cholesterol.

About half the U.S. patients reported that prior to their heart attack, they considered themselves at risk, were told by a healthcare provider they were at risk, or had a healthcare provider talk to them about heart disease and ways to lower their risk. Spanish study subjects were less likely to report they were aware of the risk. Only 36% reported a prior perceived risk of a heart attack, and only 22% said that a healthcare provider had spoken with them about heart disease and ways to reduce their risk.

"Current clinical guidelines emphasize risk assessment and patient education, but these are not being adequately applied to younger individuals at risk for heart disease, particularly younger women," said Judith Lichtman, associate professor at the Yale School of Public Health and the study's senior author. "We need to empower individuals to seek information about heart health, and we need to ensure that care providers are educating patients about risk factor management."

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Eat more fruits and vegetables in young adulthood for a healthier heart

It is well established that fruits and vegetables are good for us. Now, a new study provides further evidence of this, finding that eating more fruits and vegetables in young adulthood may benefit heart health 20 years later.
[Fruits and vegetables]
Eating more fruits and vegetables in young adulthood may lead to better heart health in later life.

Published in the journal Circulation, the research reveals that young adults who ate an average of seven to nine portions of fruits and vegetables daily were significantly less likely to have calcified coronary artery plaque 2 decades later than those with low intake of fruits and vegetables.

The presence of calcified coronary artery plaque can be an indicator of atherosclerosis - a hardening of the arteries that can increase the risk of heart attack and coronary heart disease.

This is not the first study to associate consumption of fruits and vegetables with heart health. Last year, for example, Medical News Today reported on a study suggesting eating more green vegetables may protect against heart conditions, while other studies have linked a diet high in fruits and vegetables with lower risk for heart disease.

However, Dr. Michael D. Miedema, lead author of this latest study and senior consulting cardiologist at the Minneapolis Heart Institute in Minnesota, says their research is the first to assess whether consumption of fruits and vegetables in young adulthood influences heart health later in life.

The team enrolled 2,506 participants who were a part of the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Fast facts about fruits and veg intake in the US

Recommendations state adults who engage in more than 30 minutes of moderate physical activity daily should consume 1.5-2 cups of fruits and 2-3 cups of vegetables a day However, only 13.1% of American adults eat enough fruits and only 8.9% eat enough vegetables Adding more fruits and vegetables to a diet can lower the risk of heart disease, stroke and some cancers.

Learn more about a healthy diet

At study baseline in 1985, participants were asked to complete a questionnaire detailing their diet, smoking status, weight, cardiovascular risk factors - such as blood pressure - among other lifestyle factors.

The subjects were allocated to one of three groups based on their daily intake of fruits and vegetables. In the group with the highest intake of fruits and vegetables, women consumed an average of nine portions a day, while men ate an average of seven portions daily.

In the group with the lowest intake of fruits and vegetables, women consumed an average of 3.3 servings daily, while men consumed an average of 2.6 servings a day.

All participants underwent a computed tomography (CT) scan 20 years later to assess the buildup of calcium on the walls of the heart's arteries - information that was used to calculate a coronary artery calcium score; the higher the score, the greater the risk for heart attack and other events related to coronary heart disease.

The researchers found that subjects who consumed the highest amount of fruits and vegetables in young adulthood were 26% less likely to have developed calcified coronary artery plaque 20 years later, compared with participants who ate the lowest amounts of fruits and vegetables as young adults.

The team believes their findings highlight the importance of eating more fruits and vegetables in young adulthood in order to benefit later-life heart health. Dr. Miedema says:

"People shouldn't assume that they can wait until they're older to eat healthy - our study suggests that what you eat as a young adult may be as important as what you eat as an older adult. Our findings support public health initiatives aimed at increasing fruit and vegetable intake as part of a healthy dietary pattern."

The researchers conclude that further studies are warranted in order to pinpoint what other foods consumed in young adulthood may influence heart health later on.

While fruits and vegetables are good for health, a study reported by Medical News Today earlier this year suggested men's sperm quality could be at risk if they eat fruits and vegetables with high pesticide residue.

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Reduction in Amazon deforestation avoids 1,700 deaths per year

Study shows a decrease in dry-season particulate matter produced from Amazon forest fires over southwestern Brazil and Bolivia in the period 2002-11, especially in years with lower deforestation rates

Because of decreasing deforestation and emissions from forest fires in the Amazon over the past ten years, the amount of particulate matter (aerosols), ozone, carbon monoxide, nitrogen oxide and other atmospheric pollutants released by burning biomass has fallen by 30% on average during the dry season in southern Brazil, Paraguay, northern Bolivia and Argentina.

This improvement in the region's air quality may be helping to prevent the premature deaths of some 1,700 adults per year throughout South America.

These estimates come from a study performed by researchers at the University of São Paulo (USP) in Brazil in collaboration with colleagues from the Universities of Leeds and Manchester in England and the Massachusetts Institute of Technology (MIT) in the United States.

"The study shows for the first time that reducing deforestation results in improved air quality, which in turn leads to a reduction in the number of deaths due to exposure to atmospheric pollution in most of South America," told Paulo Artaxo, Full Professor of Physics at USP and one of the authors of the paper.

According to the researchers, since 2004, Brazil has achieved substantial reductions in deforestation, as well as in the number of fires deliberately set to clear undergrowth and prepare areas for planting and grazing. Forest fires release large quantities of particulate matter and toxic gas into the atmosphere.

Between 2001 and 2012, deforestation in Brazil fell by some 40%, from 37,800 square kilometers (km²) per year in 2002-04 to 22,900 km² per year in 2009-11, according to the authors of the paper.

To explore whether the reduction in deforestation led to observable impacts on air quality and human health, the researchers analyzed records for 2001-12 showing aerosol volumes from forest fire emissions over southwestern Brazil and Bolivia during the dry season (August-October), when the concentration of particulate matter in the atmosphere is especially high.

Measurements by satellite and ground-based sensors showed that total emissions of particulate matter from fires decreased during the dry season in Amazon forest areas with the largest number of fires during the period 2002-12, especially in years with lower deforestation rates.

When they input these measurements into a global atmospheric circulation model, the researchers found that concentrations of particles with diameters of less than 2.5 microns?(μm), which have the worst impact on health, were 30% lower than in years with high deforestation rates during the dry season in southern Brazil, as well as in Paraguay, northern Bolivia and Argentina.

Impact on health

To estimate the impact of the particulate matter emitted by forest fires on human health, the researchers calculated rates of premature adult mortality from cardiopulmonary disease and lung cancer due to exposure to aerosols with diameters of less than 2.5 μm in 2002-11.

Mortality rates were calculated for adults older than 30 years in age using consistent epidemiological data from the literature, Artaxo explained.

The study concludes that the greatest risk to health arises close to deforestation fires, but most premature deaths occur outside the Amazon region, owing to atmospheric transport of smoke to more densely populated regions.

Based on their calculations, the researchers estimate that the 40% reduction in deforestation in Brazil in the 2001-12 period prevented some 1,700 premature adult deaths annually throughout South America due to a decrease in forest fire emissions.

According to the authors of the study, to maximize these benefits, public policy should aim at zero deforestation and the end of slash-and-burn in all moist tropical forest areas.

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Snake venom helps hydrogels stop the bleeding

A nanofiber hydrogel infused with snake venom may be the best material to stop bleeding quickly, according to Rice University scientists.

The hydrogel called SB50 incorporates batroxobin, a venom produced by two species of South American pit viper. It can be injected as a liquid and quickly turns into a gel that conforms to the site of a wound, keeping it closed, and promotes clotting within seconds.

Rice chemist Jeffrey Hartgerink, lead author Vivek Kumar and their colleagues reported their discovery in the American Chemical Society journal ACS Biomaterials Science and Engineering. The hydrogel may be most useful for surgeries, particularly for patients who take anti-coagulant drugs to thin their blood.

"It's interesting that you can take something so deadly and turn it into something that has the potential to save lives," Hartgerink said.

Batroxobin was recognized for its properties as a coagulant - a substance that encourages blood to clot - in 1936. It has been used in various therapies as a way to remove excess fibrin proteins from the blood to treat thrombosis and as a topical hemostat. It has also been used as a diagnostic tool to determine blood-clotting time in the presence of heparin, an anti-coagulant drug.

"From a clinical perspective, that's far and away the most important issue here," Hartgerink said. "There's a lot of different things that can trigger blood coagulation, but when you're on heparin, most of them don't work, or they work slowly or poorly. That obviously causes problems if you're bleeding.

"Heparin blocks the function of thrombin, an enzyme that begins a cascade of reactions that lead to the clotting of blood," he said. "Batroxobin is also an enzyme with similar function to thrombin, but its function is not blocked by heparin. This is important because surgical bleeding in patients taking heparin can be a serious problem. The use of batroxobin allows us to get around this problem because it can immediately start the clotting process, regardless of whether heparin is there or not."

The batroxobin combined with the Rice lab's hydrogels isn't taken directly from snakes, Hartgerink said. The substance used for medicine is produced by genetically modified bacteria and then purified, avoiding the risk of other contaminant toxins.

The Rice researchers combined batroxobin with their synthetic, self-assembling nanofibers, which can be loaded into a syringe and injected at the site of a wound, where they reassemble themselves into a gel.

Tests showed the new material stopped a wound from bleeding in as little as six seconds, and further prodding of the wound minutes later did not reopen it. The researchers also tested several other options: the hydrogel without batroxobin, the batroxobin without the hydrogel, a current clinical hemostat known as GelFoam and an alternative self-assembling hemostat known as Puramatrix and found that none were as effective, especially in the presence of anti-coagulants.

The new work builds upon the Rice lab's extensive development of injectable hydrogel scaffolds that help wounds heal and grow natural tissue. The synthetic scaffolds are built from the peptide sequences to mimic natural processes.

"To be clear, we did not discover nor do any of the initial investigations of batroxobin," Hartgerink said. "Its properties have been well-known for many decades. What we did was combine it with the hydrogel we've been working on for a long time.

"We think SB50 has great potential to stop surgical bleeding, particularly in difficult cases in which the patient is taking heparin or other anti-coagulants," he said. "SB50 takes the powerful clotting ability of this snake venom and makes it far more effective by delivering it in an easily localized hydrogel that prevents possible unwanted systemic effects from using batroxobin alone."

SB50 will require FDA approval before clinical use, Hartgerink said. While batroxobin is already approved, the Rice lab's hydrogel has not yet won approval, a process he expects will take several more years of testing.

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Eat more fruits and vegetables in young adulthood for a healthier heart

It is well established that fruits and vegetables are good for us. Now, a new study provides further evidence of this, finding that eating more fruits and vegetables in young adulthood may benefit heart health 20 years later.
[Fruits and vegetables]
Eating more fruits and vegetables in young adulthood may lead to better heart health in later life.

Published in the journal Circulation, the research reveals that young adults who ate an average of seven to nine portions of fruits and vegetables daily were significantly less likely to have calcified coronary artery plaque 2 decades later than those with low intake of fruits and vegetables.

The presence of calcified coronary artery plaque can be an indicator of atherosclerosis - a hardening of the arteries that can increase the risk of heart attack and coronary heart disease.

This is not the first study to associate consumption of fruits and vegetables with heart health. Last year, for example, Medical News Today reported on a study suggesting eating more green vegetables may protect against heart conditions, while other studies have linked a diet high in fruits and vegetables with lower risk for heart disease.

However, Dr. Michael D. Miedema, lead author of this latest study and senior consulting cardiologist at the Minneapolis Heart Institute in Minnesota, says their research is the first to assess whether consumption of fruits and vegetables in young adulthood influences heart health later in life.

The team enrolled 2,506 participants who were a part of the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Fast facts about fruits and veg intake in the US

Recommendations state adults who engage in more than 30 minutes of moderate physical activity daily should consume 1.5-2 cups of fruits and 2-3 cups of vegetables a day However, only 13.1% of American adults eat enough fruits and only 8.9% eat enough vegetables Adding more fruits and vegetables to a diet can lower the risk of heart disease, stroke and some cancers.

Learn more about a healthy diet

At study baseline in 1985, participants were asked to complete a questionnaire detailing their diet, smoking status, weight, cardiovascular risk factors - such as blood pressure - among other lifestyle factors.

The subjects were allocated to one of three groups based on their daily intake of fruits and vegetables. In the group with the highest intake of fruits and vegetables, women consumed an average of nine portions a day, while men ate an average of seven portions daily.

In the group with the lowest intake of fruits and vegetables, women consumed an average of 3.3 servings daily, while men consumed an average of 2.6 servings a day.

All participants underwent a computed tomography (CT) scan 20 years later to assess the buildup of calcium on the walls of the heart's arteries - information that was used to calculate a coronary artery calcium score; the higher the score, the greater the risk for heart attack and other events related to coronary heart disease.

The researchers found that subjects who consumed the highest amount of fruits and vegetables in young adulthood were 26% less likely to have developed calcified coronary artery plaque 20 years later, compared with participants who ate the lowest amounts of fruits and vegetables as young adults.

The team believes their findings highlight the importance of eating more fruits and vegetables in young adulthood in order to benefit later-life heart health. Dr. Miedema says:

"People shouldn't assume that they can wait until they're older to eat healthy - our study suggests that what you eat as a young adult may be as important as what you eat as an older adult. Our findings support public health initiatives aimed at increasing fruit and vegetable intake as part of a healthy dietary pattern."

The researchers conclude that further studies are warranted in order to pinpoint what other foods consumed in young adulthood may influence heart health later on.

While fruits and vegetables are good for health, a study reported by Medical News Today earlier this year suggested men's sperm quality could be at risk if they eat fruits and vegetables with high pesticide residue.

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Two mutations are better than one

Two wrongs don't make a right, but in the case of genetic mutations, having two mutations in the same gene could be better than having either one individually. Recent research by biologists at San Diego State University found that two separate genetic modifications each greatly reduced the function of the myosin muscle protein in fruit flies, but flies with both mutations had nearly three-quarters of the protein function restored. The findings are important for researchers looking to better understand and treat heart muscle disease in humans.

Myosin is a motor protein involved in muscle contraction. The proper functioning of this protein depends on a series of chemical bonds that hold the protein in its proper configuration. Mutating the protein to destroy some of these bonds can cause the protein to lose some or all of its function, leading to abnormal muscle contraction in the organism.

Earlier studies had suggested that within the myosin protein, the interaction between two amino acid subunits called E497 and R712 is charge-dependent. In other words, in order to normally function, a negative charge on one amino acid interacts with a positive charge on the other. In humans, mutations in either of these amino acids can result in hypertrophic cardiomyopathy, a common form of inherited heart muscle disease. In a recent study, investigators at SDSU looked further into how exactly disrupting the charges of these amino acids might lead to muscle defects.

Mutant muscles

SDSU biologist Sanford Bernstein and colleagues experimented with fruit flies with genetically modified proteins in the flies' flight muscles to see what effects that would have on the proteins' functioning. The researchers bred two versions of fruit flies in which either the fly version of the E497 or the R712 myosin protein amino acids were mutated by having their charges reversed. Those flies lost their flight ability completely. Using a combination of biochemical techniques, the researchers found that the myosin proteins were about five times less active in these flies.

A third line of genetically modified flies had the charges reversed in both E497 and R712 myosin protein amino acids. These flies still couldn't fly, but the researchers found that the proteins were about 73-percent as active as those in normal, unmodified flies--a vast improvement over having either single mutation by itself.

Interestingly, heterozygous flies (those with copies of both normally functioning and genetically modified genes) in the study did manage to fly when they were young. However, this occurred only for the double-mutant. Overall, the double-mutation restored most of the protein activity that was lost in the other two mutant lines, demonstrating that both amino acids need to interact in a charge-dependent manner in order for normal muscle protein function to occur. The researchers published their results earlier this month in the Journal of Biological Chemistry.

Helping humans

Because the myosin protein modified in the flies is so similar to the one known to be involved in some human cardiomyopathy, and since the same amino acids are affected, Bernstein said that a similarly dysfunctional process probably underlies the disease caused by mutations in these specific amino acids in humans.

"In humans, it's a different type of mutation, but it's one that we predict is disruptive to normal interaction within the protein, resulting in decreased or possibly increased myosin function," he said.

For that reason, researchers can further study these proteins in flies to learn more about the disease. Bernstein said that the team's results suggest that the abnormal function in human heart muscle cells is largely a result of structural failings in the myosin protein that lead to biochemical dysfunction and an unsuccessful attempt to compensate for these defects, resulting in abnormal heart structure and function.

What's more, the findings point to the potential for drugs that can modify myosin function to overcome connection errors within abnormally charged myosin proteins, which might improve functioning in human heart muscle cells.

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