Stroke Risk Increases From Stenting in Older Patients

Newswise, February 21, 2016 – Vascular surgery appears to be safer than stenting for patients over 70 years of age with carotid stenosis, or a blockage of the carotid arteries in the neck, according to new findings published today in the Lancet.

The international study, led by investigators at the University of Alabama at Birmingham, looked at the two standard methods for treating plaque buildup in the carotid arteries: a surgical procedure called carotid endarterectomy against carotid artery stenting.

The surgical procedure, or CEA, involves surgeons’ opening up the artery to remove plaque. It is an invasive surgery first done in 1946.

Stenting is a newer, less invasive procedure in which a catheter is threaded through blood vessels, usually from the groin, to the affected area in the artery. A balloon is used to open the blocked artery, and a mesh stent is placed to hold it open.

“Stenting was hailed as a less invasive alternative to surgery, one that avoided many of the hazards and risks inherent in a surgical procedure,” said George Howard, Dr.P.H., professor in the Department of Biostatistics in the UAB School of Public Health and the study’s first author.

“What we find, however, is that the risk of stroke in patients over the age of 70 is twice that with stenting than with the surgical CEA procedure.”

The study looked at data from four randomized controlled trials within the Carotid Stenosis Trialists’ Collaboration with patients with symptomatic carotid stenosis. Collectively, 4,754 patients were followed. Age was not associated with increased stroke risk for either surgery or stenting in patients under age 70; but stent patients over 70 had an increased risk, particularly in the immediate time frame of the procedure.

“These findings are very conclusive — stenting has a higher risk for stroke over carotid surgery in the older patient, older than 70,” Howard said. “This study should help drive decision-making and establish appropriate practice guidelines in the treatment of carotid stenosis.”

Howard says the stenting procedure itself seems to be causing the increased risk.

“The risk appears centered on the periprocedural period, the time during and immediately after the procedure,” Howard said. “The risk does not appear to continue in the months or years following the procedure.”

Howard acknowledges that advances in stenting, such as the routine use of closed-cell stents, which seem to be associated with lower rates of procedural stroke and the development of novel protection systems, might allow safe stenting for elderly people in the future.

“But for now, stenting in an older population needs to be done with great caution,” he said.

In addition to investigators at UAB, the international study included investigators from Cardiovascular Associates of the Southeast, Birmingham, Alabama; Clinic for Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany; Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands; Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, U.K.; Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular and Endovascular Surgery, Vascular Center, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; Department of Neurology, Hôpital Sainte-Anne, Université Paris-Descartes, DHU Neurovasc Sorbonne Paris Cité, INSERM U894, Paris, France; Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford University, Oxford, U.K.; Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, U.K.; and Department of Vascular Surgery, University of Paris, XII, Hôpital Henri Mondor, Paris.

New Predictor of Cancer

When your biological age is older than your chronological age, the risk of getting and dying of cancer rises

Newswise, February 21, 2016 --- Epigenetic age is a new way to measure your biological age. When your biological (epigenetic) age is older than your chronological age, you are at increased risk for getting and dying of cancer, reports a new Northwestern Medicine study.

And the bigger the difference between the two ages, the higher your risk of dying of cancer.

“This could become a new early warning sign of cancer,” said senior author Dr. Lifang Hou, who led the study. “The discrepancy between the two ages appears to be a promising tool that could be used to develop an early detection blood test for cancer.”

Hou is chief of cancer epidemiology and prevention in preventive medicine at Northwestern University Feinberg School of Medicine and co-leader of the cancer prevention program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

“People who are healthy have a very small difference between their epigenetic/biological age and chronological age,” Hou said. “People who develop cancer have a large difference and people who die from cancer have a difference even larger than that. Our evidence showed a clear trend.”

A person’s epigenetic age is calculated based on an algorithm measuring 71 blood DNA methylation markers that could be modified by a person’s environment, including environmental chemicals, obesity, exercise and diet. 

This test is not commercially available but is currently being studied by academic researchers, including a team at Northwestern.

In DNA methylation, a cluster of molecules attaches to a gene and makes the gene more or less receptive to biochemical signals from the body. The gene itself -- your DNA code -- does not change.

This is the first study to link the discrepancy between epigenetic age and chronological age with both cancer development and cancer death using multiple blood samples collected over time. 

The multiple samples, which showed changing epigenetic age, allowed for more precise measurements of epigenetic age and its relationship to cancer risk. Other studies have looked at blood samples collected only at a single time point.

The final paper was published Feb. 15 in EBioMedicine. 

The study was a longitudinal design with multiple blood samples collected from 1999 to 2013. Scientists used 834 blood samples collected from 442 participants who were free of cancer at the time of the blood draw.

For each one-year increase in the discrepancy between chronological and epigenetic ages, there was a 6 percent increased risk of getting cancer within three years and a 17 percent increased risk of cancer death within five years. Those who will develop cancer have an epigenetic age about six months older than their chronological age; those who will die of cancer are about 2.2 years older, the study found.

“Our results suggest future researchers should focus on the epigenetic-chronological age discrepancy for its potential to show a big picture snapshot of human health and disease at a molecular level,” said first author Yinan Zheng, a predoctoral fellow at Feinberg.

Northwestern scientists now are studying whether individuals can lower their epigenetic age through lifestyle improvements such as increasing exercise and having a healthier diet, noted Brian Joyce, co-first author and predoctoral fellow at Feinberg. 

The study is titled “Blood Epigenetic Age may Predict Cancer Incidence and Mortality.” 

The research was funded by the Epidemiology Research and Information Center, U.S. Department of Veterans Affairs grant NIEHS R01-ES015172. Additional funding support was provided by the Northwestern University Robert H. Lurie Comprehensive Cancer Center Rosenberg Research Fund.

A Shot in the Arm for Flu Vaccine Distribution

Newswise, February 19, 2016— Each fall, doctors stress the importance of getting a flu shot: influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. But on-time delivery of the vaccine can be tenuous, and there can be shortages during times of peak demand, as seen in 2014.

Research co-authored by Fuqiang Zhang, professor of operations and manufacturing management at Washington University in St. Louis’ Olin Business School, proposes a new contract scheme for the vaccine supply chain that could reduce patient wait time.

“In the past, we have seen major flu vaccine shortages during the vaccination season, even though the total supply for the flu vaccines was abundant,” Zhang said. “The major reason for this is because of late delivery.”

The process begins months in advance of influenza season. Starting in January, manufacturers make educated guesses about what flu strains the federal government will target and start production of a vaccine to match. They try to make a large quantity that will be ready to sell to retailers by vaccination season, which usually runs from late September to mid-November.

The U.S. Food and Drug Administration makes its vaccine recommendation in February or March. If manufacturers have guessed incorrectly on any of the strains, they must restart that part of production.

Retailers, aware of the manufacturers’ risk, anticipate potential delay in shipments and may commit to smaller orders to avoid requesting a large supply that could arrive in late fall, when public demand will be down, and then being left with unused doses. The manufacturers, knowing that retailers will be cautious, are reluctant to produce a large amount before the FDA’s final announcement.

The manufacturer-retail gap is called a negative feedback loop. The result can be a shortage during the period of peak demand, as happened in 2014.

“Two parties are making their own decisions, but they are dependent on each other,” Zhang said. “When you have a decentralized supply chain with independent parties and they are self-interested, they may not want to make decisions that are optimal for the entire supply chain. They will make decisions that maximize their own payoff or profit.

“That’s a key issue behind this flu vaccine shortage problem,” he said

.

Zhang teamed with Tinglong Dai of Johns Hopkins University and Soo-Haeng Cho from Carnegie Mellon University and examined the current supply chain process from start to finish.

In the research, recently accepted by the journal Manufacturing & Service Operations Management, Zhang and his partners propose a new solution called a Buyback and Late Rebate (BLR) contract.

Both buybacks (returns for time sensitive products) and rebates on late shipments have been used separately in an attempt to alleviate the flu vaccine negative feedback loop, with limited success. Zhang said the combined incentive approach will make a big difference in fixing the supply chain gaps.

“If you use buyback and late rebate separately, they don’t solve the whole problem,” Zhang said. “We found that combining these two incentive contract terms, we optimize the supply chain’s performance and maximize its efficiency.”

Zhang and his co-authors believe that the combination of 100-percent buyback and rebates on late shipments would motivate retailers to commit to larger orders, which in turn would lead manufacturers to commit to greater and more prompt production. The negative feedback loop would be broken, and a steady, reliable flow of vaccine would be available, to the benefit of manufacturers, retailers, and patients.

“We looked at incentive issues for the different parties, and then tried to provide a holistic solution to the problem,” Zhang said.

Majority of Patients with Locally Advanced Head and Neck Cancers Use Life-Altering Strategies to Cope with Cost of Treatment

Study also finds perceived social isolation affects health care utilization

Newswise, February 19, 2016—The majority of patients with locally advanced head and neck cancers (LAHNC) rely on cost-coping strategies that alter their lifestyle in order to manage the financial burden of their care, according to research presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium.

Researchers also identified perceived social isolation, or a lack of social support coupled with increased loneliness, as a risk factor for sub-optimal medication adherence and health care utilization during treatment for LAHNC.

Treatment for locally advanced head and neck cancers -- diseases marked by high morbidity and high treatment costs -- is very intense, often combining surgery, radiation therapy and chemotherapy.

Moreover, treatment often causes social side effects, such as an increased financial toxicity or financial burden, in addition to physical side effects.

This study examined factors associated with these social side effects by following patients diagnosed with head and neck cancer over six months to assess how they coped with the cost of their cancer treatment as well as whether perceived social isolation, or the lack of social support, was a barrier to their care.

This prospective longitudinal study collected six monthly lifestyle surveys from 73 patients with treatment-naive LAHNC who were diagnosed at a single, high volume institution between May 2013 and November 2014.

The survey assessed the use of several lifestyle-altering financial coping strategies, as well as out-of-pocket costs, loss of productivity, compliance with their medication regimen, and health care utilization (specifically, inpatient length of hospital stays and number of missed appointments).

Researchers also measured patients’ demographics, health insurance status, wealth, household income and type of tumor. Perceived social isolation was evaluated prior to treatment for each patient.

Most patients in the study were male (78 percent), Caucasian (74 percent) and covered by private health insurance (54.8 percent).

Multivariable regression modeling was used to assess the influence of patient characteristics on the use of cost-coping strategies and perceived social isolation.

More than two thirds (69 percent) of the LAHNC patients reported relying on one or more lifestyle-altering cost-coping strategy while managing their cancer.

The most common strategy was spending savings (62 percent), followed by borrowing money (42 percent), selling possessions (25 percent) and having family members work more hours (23 percent).

Socioeconomic factors were associated with reliance on cost-coping strategies. Patients with Medicaid used more financial coping strategies compared to patients with private insurance (Odds Ratio (OR), 42.3; p = 0.005).

In addition, increased out-of-pocket costs and decreased wealth were independently associated with the use of cost-coping strategies (p < 0.01).

“Physical side effects are not the only ones our patients endure,” said Sunny Kung, a second-year medical student at the University of Chicago Pritzker School of Medicine and lead author on the study.

 ”Our findings indicate that the majority of our patients have adopted or will adopt strategies to cope with the financial side effects of their care.”

The study also examined prevalence of perceived social isolation among LAHNC patients and its association with socioeconomic factors and health care utilization. 

Clot-Busting Therapy Reduces Mortality in Deadliest Form of Stroke

Phase-3 clinical trial results demonstrate first effective treatment for severe type of bleeding stroke

Newswise, February 19, 2016 — The use of clot-busting drugs to clear blood from the brain’s ventricles may be the first effective strategy to decrease mortality for a type of catastrophic bleeding stroke, according to phase-3 clinical trial results announced Thursday at the International Stroke Conference in Los Angeles.

The treatment also significantly reduced post-stroke disability in a subset of patients, according to data presented by trial leaders from Johns Hopkins University and the University of Chicago.

“Hemorrhage in the brain used to be an essentially untreatable condition, but we now have hope with a therapy that may be effective at saving lives,” said Issam Awad, MD, John Harper Seeley Professor of Surgery at the University of Chicago Medicine, who was co-chair and surgical director for the CLEAR III clinical trial.

CLEAR III tested the benefits of the clot-busting drug alteplase, also known as tPA, in improving outcomes for intraventricular hemorrhage. In this particularly severe form of stroke, blood pools and clots in the brain’s ventricles—cavities that normally hold cerebrospinal fluid.

The randomized, double-blinded and controlled trial enrolled 500 patients from 73 clinical sites around the world. Every patient received either tPA or saline through a brain catheter, and were otherwise treated by current standards of critical care.

Researchers found that swift application of tPA directly into the ventricle, combined with a drainage catheter, reduced overall death rates by 10 percent, or about a third relative to death rates in the saline group.

Treatment with tPA almost doubled the likelihood of good functional recovery in patients with high volume bleeds who had most of the blood removed. Patients with smaller clots did not benefit, but no adverse side effects were observed when compared to the control group.

“For many patients, this approach can significantly reduce disability after a stroke, and can be the difference between going home instead of going to a nursing home,” Awad said.

Hemorrhagic strokes are triggered by ruptured blood vessels that leak blood into the brain, increasing intracranial pressure and causing severe damage to brain tissues.

Accumulated blood quickly clots and is difficult to remove even by open brain surgery. Around 15 percent of strokes are hemorrhagic, but they account for roughly 40 percent of all stroke deaths.

Nearly half of these bleeding strokes involve some degree of intraventricular hemorrhage (IVH), a complication where blood pools in the ventricles. IVH can be particularly catastrophic, with an estimated mortality rate between 60 and 80 percent. Among those who survive, as many as 90 percent become severely disabled.

An international effort

Early studies suggested tPA, an FDA-approved clot buster for conditions such as heart attacks and non-bleeding strokes, might be effective in removing accumulated blood and alleviating its damaging effects after a hemorrhagic stroke. To study the feasibility of this approach, a phase-2 clinical trial (CLEAR-IVH), initially tested tPA in a small group of IVH patients.

After patients were stabilized, tPA was administered directly into the ventricle through an external, surgically placed catheter. The patients received the tPA for three days and a catheter continually drained blood until the ventricle cleared.

The study confirmed the safety and efficacy of the procedure, and supported the need for a large-scale phase-3 trial.

CLEAR III, which was overseen by Awad and Daniel Hanley Jr., MD, the Harriett Legum Professor of Acute Care Neurology at Johns Hopkins Medicine, began in 2009 and was completed in 2015. Roughly half of the 500 enrolled patients received tPA and the other half received saline.

Both groups had extraventricular drains and were treated by the current best standards for critical care. All patients were monitored remotely to maintain consistent treatment across centers, which could vary greatly in facilities, staff and languages. Data analysis and overall trial oversight was provided by the Johns Hopkins team.

To ensure safety and accurate catheter placement, surgical oversight was provided by Awad and his staff at the University of Chicago Medicine, which served as the surgical center for the trial. Before tPA could be given, images of catheter placement for every patient had to be sent to and analyzed by the UChicago team, who were on call 24/7 throughout the five-year trial.

“We had to verify that all the criteria were met in order to deploy that treatment safely,” Awad said. “Every single patient was monitored in real time, often over an iPad or iPhone, to make sure the drug reached the right part of the brain.”

Immediate impact

The results of CLEAR III show tPA treatment significantly decreases mortality in one of the worst forms of hemorrhagic stroke. Analyses led by Awad and his team revealed the most important factor in improving functional recovery was the volume of blood removed.

The likelihood of a good outcome in patients with larger clots, defined as greater than 20 mL of pooled blood, improved by nearly 20 percent. The more blood that was cleared, the greater the odds were of reduced disability—rising to nearly double in patients who had 90 percent of their clots removed.

Patients who received additional doses of tPA and had multiple drainage catheters inserted had higher clot removal. In patients who started with less than 20 mL of blood in the ventricles, no benefits were observed.

“Outside our study this drainage was only used in 8 percent of hemorrhagic stroke cases, and we showed this technique can really make a difference,” Hanley said. “Our results suggest that physicians should begin to think about routinely using it for stable hemorrhagic stroke patients.”

CLEAR III data now support the use of tPA and a ventricular drain as the most effective treatment for patients with high volume IVH strokes.

Awad notes that, if possible, these patients should be treated at comprehensive stroke centers, which have access to neurosurgeons, neurocritical care specialists and other resources for severe strokes. The CLEAR III team is now implementing an educational strategy on how to manage IVH with tPA at comprehensive stroke centers around the U.S.

“When we entered into the trial, we knew very little about how this therapy ought to be used, in whom it should be used, and whether it was safe,” Awad said.

“We now have clear data on how best to implement the procedure, and for at least a group of patients, we know it can nearly double the likelihood of a favorable outcome.”

A sister clinical trial, MISTIE, co-led by Awad and Hanley, is currently underway to test the safety and efficacy of tPA as a treatment for patients with hemorrhagic strokes in which bleeding occurs in brain tissue but does not leak into the ventricles. Patients for that study are currently being enrolled.

CLEAR III was supported by the National Institute of Neurological Disorders and Stroke (5U01 NS062851) and Genentech.

For more information, visit www.braininjuryoutcomes.com/clear-about and www.uchospitals.edu/specialties/neurosciences/stroke-neurovascular/stroke.html

Financial Burden of Cancer Survivorship Varies by Age, Cancer Site

Study calls for targeted efforts to address excess costs faced by those with a history of cancer

Newswise, February 13, 2016--Survivors of cancer pay thousands of dollars in excess medical expenditures every year, with the excess financial burden varying by age and cancer site, according to a study by the American Cancer Society study. 

The study, appearing in the Journal of the National Cancer Institute, says targeted efforts will be important to reduce the economic burden of cancer.

As a group, cancer survivors (estimated to number 14.5 million in the United States in 2014) face greater economic burden, including medical expenditures and productivity losses. But relatively little is known about whether that burden varies by cancer site compared to similar individuals without a cancer history.

Researchers led by Zhiyuan 'Jason' Zheng, PhD, senior health services researcher in the Surveillance and Health Services Research program at the American Cancer Society, used 2008 to 2012 Medical Expenditure Panel Survey data to measure excess economic burden attributable to the three most prevalent cancers. 

They calculated excess annual medical expenditures and productivity losses (employment disability, missed work days, and days stayed in bed) for colorectal (n = 540), female breast (n = 1568), and prostate (n = 1170) cancer survivors, and for those without a cancer history (n = 109,423). 

They stratified the data by cancer site and age (nonelderly: 18-64 years vs elderly: ?65 years), and controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region.

They found cancer survivors experienced annual excess medical expenditures compared with individuals without a cancer history. 

For the nonelderly population, annual excess expenditures were $8657 for colorectal cancer; $5119 for breast cancer; and $3586 for prostate cancer. For the elderly population, annual excess expenditures were: colorectal: $4913; breast: $2288; prostate: $3524.

Nonelderly colorectal and breast cancer survivors were more likely to have employment disability as well as productivity loss at work (7.2 days) and at home (4.5 days). In contrast, elderly survivors of all three cancer sites had comparable productivity losses as those without a cancer history.

"This study helps us quantify the excess economic burden associated with the three major cancer sites," said Dr. Zheng. 

"Understanding this burden is an important step to shape health care policies to target areas where cancer survivors are most vulnerable."

###

Article: Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States JNCI J Natl Cancer Inst (2016) 108 (5): djv382 doi: 10.1093/jnci/djv382

Couch Potatoes May Have Smaller Brains Later in Life

Newswise, February 13, 2016– Poor physical fitness in middle age may be linked to a smaller brain size 20 years later, according to a study published in the February 10, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“We found a direct correlation in our study between poor fitness and brain volume decades later, which indicates accelerated brain aging,” said study author Nicole Spartano, PhD, with Boston University School of Medicine in Boston.

For the study, 1,583 people enrolled in the Framingham Heart Study, with an average age of 40 and without dementia or heart disease, took a treadmill test.

They took another one two decades later, along with MRI brain scans. The researchers also analyzed the results when they excluded participants who developed heart disease or started taking beta blockers to control blood pressure or heart problems; this group had 1,094 people.

The participants had an average estimated exercise capacity of 39 mL/kg/min, which is also known as peak VO2, or the maximum amount of oxygen the body is capable of using in one minute.

Exercise capacity was estimated using the length of time participants were able to exercise on the treadmill before their heart rate reached a certain level.

For every eight units lower a person performed on the treadmill test, their brain volume two decades later was smaller, equivalent to two years of accelerated brain aging.

When the people with heart disease or those taking beta blockers were excluded, every eight units of lower physical performance was associated with reductions of brain volume equal to one year of accelerated brain aging.

The study also showed that people whose blood pressure and heart rate went up at a higher rate during exercise also were more likely to have smaller brain volumes two decades later.

Spartano said that people with poor physical fitness often have higher blood pressure and heart rate responses to low levels of exercise compared to people with better fitness.

Spartano noted that the study is observational. It does not prove that poor physical fitness causes a loss of brain volume; it shows the association.

“While not yet studied on a large scale, these results suggest that fitness in middle age may be particularly important for the many millions of people around the world who already have evidence of heart disease,” she said.

The study was supported by the National Heart, Lung and Blood Institute, the National Institutes of Health and the American Heart Association.

To learn more about brain health, please visit www.aan.com/patients.

The American Academy of Neurology, an association of 30,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

The Seven Heart Disease Risk Factors You Can Control, Including One Nearly All of Us Struggle With

By Mauro Moscucci, M.D.,MBA
Chief of the LifeBridge Health Cardiovascular Institute and Chairman of the Department of Medicine, Sinai Hospital

Newswise, February 13, 2016— Heart disease is the leading cause of death in developed countries. Through advances in medicine and surgery, as well as an awareness of heart disease and prevention, overall deaths due to heart disease in the United States have declined in recent years.

Still, the numbers aren’t good. Heart disease is associated with more than 700 thousand deaths annually in the United States and more than seven million hospitalizations. It affects more than 80 million adults with health care costs totaling more than $300 billion.

There are many things that can affect your risk for developing heart disease. Two of them you cannot control: your age and your family history.

However, according to the American Heart Association*, there are seven modifiable risk factors for heart disease, meaning there are things you can do to decrease your risk.

As you will see, many of them are interrelated and affect each other. Many are associated with the build-up of plaques and other fats in your blood vessels, a process known as atherosclerosis.

Fewer than one percent of Americans have all seven of their modifiable risk factors under control, and there’s one, an unhealthy diet, that seems to be the hardest for most of us to manage.

For the first three, there are medications that can help control them, and the final four are what we call “behavioral” risk factors, meaning you control them either through your own action or inaction.

Let’s take a quick look at each risk factor:

1.      High Blood Pressure – Blood pressure is a measure of the force of the blood in your arteries. Elevated or high blood pressure increases your risk for heart disease and stroke. While there are medications that can help to control high blood pressure, losing weight and getting regular physical activity can also play an important role in lowering your blood pressure. You should work with your doctor to find out what works best for you.

2. Abnormal Cholesterol – Cholesterol is a naturally occurring fat in our bodies. However, too much cholesterol can build up in blood vessels, leading to atherosclerosis. A cholesterol check is one of the basic tests to determine your risk for heart disease. Again, losing weight, a healthy diet and regular exercise can help get cholesterol numbers down, however there are medications that can be of help. Some people may have a genetic predisposition to higher cholesterol levels. You should talk to your doctor about how often you should have your cholesterol tested and whether you need medication to get it into normal ranges.

3. Diabetes – Diabetes is a disorder involving elevated blood sugar levels, often caused by too little insulin and/or insulin resistance. Diabetes can affect the blood vessels, leading to plaque build- up and heart disease.

There are medications to help control diabetes, but diet plays a key role as well. People with diabetes should work with their doctors, nutritionists and diabetes educators to learn how to monitor their blood sugar levels and manage their diets.

4. Cigarette Smoking – There is a clear causative relationship between smoking and heart disease, meaning cigarettes cause heart disease and stroke. Stopping smoking can improve survival rates for heart disease patients within two-to-three years of quitting. Quitting is associated with a 36 percent reduction in death among patients with heart disease, greater than any other invention.

If you don’t smoke, don’t start. If you do smoke, you can work with your doctor to find ways to help you quit.

5. Obesity – More than 40 million Americans are obese. For every two pounds someone is over his/her “ideal” body weight, there is a three percent increase in fatal and non-fatal heart attacks. The obesity rates in the United States have been rising steadily for several decades, and have paralleled the rise in the prevalence of diabetes.

Losing weight, while it can be challenging, can bring big benefits in lowering your risk for heart disease and diabetes.

6. Physical inactivity – We are learning more about how a sedentary lifestyle can hurt your health. Regular physical activity can increase good cholesterol and lower bad cholesterol, it helps in maintaining optimal body weight, it can reduce blood pressure, and it can lead to better control of blood sugar in patients with diabetes. Many people have jobs where they sit all day. Find ways to move more. You don’t have to invest in a big exercise program. Take a few walks during the day. Take the stairs. Find ways to make exercise fun. If you are watching TV on your couch, get up and walk during the commercials. Studies have shown that as little as 30 minutes of moderate intensity activity (such as a brisk walk) five days per week can have a beneficial effect in reducing the risk of heart disease.

7. Unhealthy diet – This may be the hardest for us to get under control. In our culture, there is food everywhere. Portion sizes have ballooned over the last several decades. For example, restaurant servings in the United States are about 25 percent larger than in France, and ice cream servings are more than 40 percent larger. The availability of processed foods with “empty calories” (high in sugar, fat, salt and calories) makes them hard to avoid. Be mindful about what you are eating. A heart healthy diet consists of lots of fruits, vegetables, whole grains and lean meats. Try to cut down on saturated fat, added sugar and sodium.

At the LifeBridge Health Cardiovascular Institute, we have many ways to treat heart disease, but we’d rather prevent it in this first place. With these seven modifiable risk factors in mind, you can talk to your doctor about ways you can work together to lower your heart disease risk.

*If you would like to see more detail heart disease statistics, you can read this report from the American Heart Association: Go A.S. et al. Heart Disease and Stroke Statistics—2014 Update – Circulation, Volume 129(3):e28-e292, January 21, 2014

Nanoparticle Therapy That Uses LDL and Fish Oil Kills Liver Cancer Cells

Newswise, February 10, 2016– An experimental nanoparticle therapy that combines low-density lipoproteins (LDL) and fish oil preferentially kills primary liver cancer cells without harming healthy cells, UT Southwestern Medical Center researchers report.

“This approach offers a potentially new and safe way of treating liver cancer, and possibly other cancers,” said study senior author Dr. Ian Corbin, Assistant Professor in the Advanced Imaging Research Center (AIRC) and of Internal Medicine at UT Southwestern. “The method utilizes the cholesterol carrier LDL, combined with fish oil to produce a unique nanoparticle that is selectively toxic to cancer cells.”

The study was published in the February issue of the journal Gastroenterology.

Primary liver cancer, or hepatocellular carcinoma, is the sixth most prevalent type of cancer and third-leading cause of cancer-related deaths worldwide, according to the National Cancer Institute (NCI). Incidence of the disease is rising in the U.S., principally in relation to the spread of hepatitis C virus infection.

An editorial in the same issue of the journal notes that drug-based treatments for liver cancer are limited and that the UT Southwestern study showed “truly remarkable results that should prompt further research under preclinical settings, given its potential to lead to a paradigm shift in treatment.” More common treatments include surgical resection, liver transplantation, and ablation.

 Fish oils are particularly rich in omega-3 fatty acids such as docosahexaenoic acid, also known as DHA. A 2012 study in Gastroenterology found that consumption of fish rich in omega-3 fatty acids was associated with protection against the development of liver cancer in patients with hepatitis B or hepatitis C infections.

Allergy Shots Effective for Baby Boomers Suffering from Seasonal Allergies

Symptoms were reduced by 55 percent after three years of therapy

Newswise, February 10, 2016--Boomer years have seen an increase in those suffering from allergies, including baby boomers. And because older people tend to have additional chronic diseases, diagnosis and management of allergic rhinitis (hay fever) can be a challenge. A new study shows immunotherapy (allergy shots) reduced symptoms by 55 percent after three years of therapy, and decreased the amount of medication needed for relief of symptoms by 64 percent.

The study, in the Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI), randomly sorted 60 hay fever sufferers, aged 65 to 75 years, into two groups. The first group received allergy shots for three years, and the second group received a placebo.

“Older people who suffer from hay fever may have health challenges that younger people do not,” said allergist Ira Finegold, MD, ACAAI past president. “Hay fever is often ignored in older patients as a less significant health problem because of diseases such as asthma, coronary heart disease, depression and high blood pressure. Also, some baby boomers might not realize they have allergies, and their physicians might not suggest allergy shots. The research indicated that allergy shots were extremely effective for this group.”

Although the guidelines for the diagnosis and treatment of allergic diseases rarely focus on older patients, according to the Polish study, hay fever is more common in patients over 65 years of age.

“It’s important that allergy treatment methods commonly used in young people are also investigated for use in older patients,” said allergist Gailen Marshall, MD, PhD, Editor-in-Chief, Annals of Allergy, Asthma and Immunology. “More and more allergists are expanding the age limit for allergy shots as the baby boomer generation enters their senior years. Although there are no doubts about the effectiveness of allergy shots for both adults and children, there hasn’t been much research until now in older patients.”

The study authors state the results of the study indicate an aging immune system doesn’t significantly influence the effectiveness of immunotherapy.

About ACAAI
The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals, headquartered in Arlington Heights, Ill. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us onFacebook, Pinterest and Twitter.

Patients with High-Risk Macular Degeneration Show Improvement with High-Dose Statin Treatment

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Newswise, February 5, 2016-- Researchers at Massachusetts Eye and Ear/Harvard Medical School and the University of Crete have conducted a phase I/II clinical trial investigating the efficacy of statins (cholesterol-lowering medications) for the treatment of patients with the dry form of age-related macular degeneration (AMD) — the leading cause of blindness in the developed world.

Although effective treatments are available for the wet form of AMD, they are currently lacking for the more prevalent dry form. The researchers found evidence that treatment with high-dose atorvastatin (80mg) is associated with regression of lipid deposits and improvement in visual acuity, without progression to advanced disease, in high-risk AMD patients.

Their findings were published in EBioMedicine—a new online journal led by editors of the journals Cell andThe Lancet—and not only further the connection between lipids, AMD and atherosclerosis, but also present a potential therapy for some patients with dry AMD.

“We found that intensive doses of statins carry the potential for clearing up the lipid debris that can lead to vision impairment in a subset of patients with macular degeneration,” said Joan W. Miller, M.D., the Henry Willard Williams Professor and Chair of Ophthalmology at Harvard Medical School and Chief of Ophthalmology at Massachusetts Eye and Ear and Massachusetts General Hospital.

“We hope that this promising preliminary clinical trial will be the foundation for an effective treatment for millions of patients afflicted with AMD.”

Affecting more than 150 million patients worldwide, AMD is associated with an accumulation of drusen (deposits of lipid and fatty proteins) under the retina, and patients with AMD experience blurred vision or blindness in the center of the visual field.

There are two forms of AMD: “wet” and “dry.” The wet form accounts for approximately 15 percent of AMD cases and is treated using therapies previously developed at Mass. Eye and Ear/Harvard Medical School. The “dry” form is more common, accounting for approximately 85 percent of cases, and effective therapies are currently lacking.

Ophthalmologists and vision researchers have long suspected that there may be a connection between dry AMD and atherosclerosis. In dry AMD, physicians often see soft, lipid-rich drusen in the outer retina, similar to the build-up of lipid material in the inner walls of blood vessels in atherosclerosis.

Statin use is widespread in middle-aged and older individuals, who also have an increased risk of AMD; however, previous studies have shown very little correlation between regular statin use and improvements in AMD. The authors of the EBioMedicine paper hypothesized that, due to the heterogeneous nature of the disease, patients with soft, lipid-rich drusen may respond better to statins prescribed at higher dosages.

“Not all cases of dry AMD are the exactly the same, and our findings suggest that if statins are going to help, they will be most effective when prescribed at high dosages in patients with an accumulation of soft, lipid material” said Demetrios Vavvas, M.D., Ph.D., a clinician scientist at Mass. Eye and Ear and Co-Director of the Ocular Regenerative Medicine Institute at Harvard Medical School.

“These data suggest that it may be possible to eventually have a treatment that not only arrests the disease but also reverses its damage and improves the visual acuity in some patients.”

Twenty-three patients with dry AMD marked by soft lipid deposits in the outer retina were prescribed a high dose (80mg) of atorvastatin, the generic name of the statin marketed as Lipitor® and several generic equivalents. Of the 23 patients, 10 experienced an elimination of the deposits under the retina and mild improvement in visual acuity.

Other techniques that have attempted to eliminate the deposits have mostly failed with the disease continuing to progress to more advanced dry AMD or a conversion to the wet form of AMD.

As the next step for this line of research, the investigators plan to expand to a larger prospective multicenter trial to further investigate the efficacy of the treatment in a larger sample of patients with dry AMD.

“This is a very accessible, FDA-approved drug that we have tremendous experience with,” said Dr. Vavvas.

“Millions of patients take it for high cholesterol and heart disease, and based on our early results, we believe it offers the potential to halt progression of this disease, but possibly even to restore function in some patients with dry AMD.”

Potential New Approaches to Treating Eye Diseases

Newswise, February 5, 2016 — Potential new approaches to treating eye diseases such as age-related macular degeneration (AMD) are described in a new study, “IL-33 amplifies an innate immune response in the degenerating retina,” in the February Journal of Experimental Medicine.

AMD is a leading cause of vision impairment in old age, and is caused by the degeneration of cells in the retinal layer of the eye.

 Retinal cell death can be induced by phagocytic immune cells that infiltrate the tissue in response to injury or infection, but the molecular signals that trigger phagocyte invasion are largely unknown. A team of researchers led by Hongkang Xi and Menno van Lookeren Campagne, of the Department of Immunology at Genentech, Inc., in South San Francisco, Calif., discovered that a pro-inflammatory signaling protein, or cytokine, called IL-33, plays a key role in recruiting phagocytes to damaged retina and inducing retinal degeneration.

Working with rats and mice, 

Xi and colleagues found that specialized retinal cells called Müller glial cells release IL-33 in response to retinal injury. The cytokine then binds to its receptor on the surface of the Müller cells and induces the release of additional inflammatory proteins that attract phagocytes to the damaged retina. Blocking the IL-33 receptor inhibited this process and prevented injury-induced retinal degeneration.

The researchers also found that IL-33 levels are increased in the retinas of AMD patients, suggesting that the same pathway may occur in humans. Inhibiting IL-33 may therefore help treat AMD and other retinal degenerative diseases.

“This study for the first time shows increased expression of IL-33 in AMD and further demonstrates a role for glia-derived IL-33 in the accumulation of myeloid cells in the outer retina, loss of photoreceptors, and functional impairment of the retina in preclinical models of retina stress,” the authors note.

© 2016 Xi et al. J Exp. Med.http://www.dx.doi.org/10.1084/jem.20150894

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About The Journal of Experimental Medicine
The Journal of Experimental Medicine (JEM) is published by The Rockefeller University Press. All editorial decisions on manuscripts submitted are made by research-active scientists in conjunction with our in-house scientific editors.JEM provides free online access to many article types immediately, with complete archival content freely available online since the journal's inception. Authors retain copyright of their published works, and third parties may reuse the content for non-commercial purposes under a creative commons license. For more information, please visit jem.org.

Alzheimer’s Plaques Found in Middle-Aged People with Brain Injuries

Newswise, February 5, 2016--A new study suggests that people with brain injuries following head trauma may have buildup of the plaques related to Alzheimer’s disease in their brains. The research is published in the February 3, 2016, online issue of Neurology®, the medical journal of the American Academy of Neurology.

A corresponding editorial states that over the past decade the rate of emergency department visits related to traumatic brain injury (TBI) has increased by 70 percent. The editorial also says an estimated three to five million Americans live with a TBI-related disability.

“The study is small and the findings preliminary, however, we did find an increased buildup of amyloid plaques in people who had previously sustained a traumatic brain injury,” said study author Professor David Sharp, MD, of Imperial College London, in the United Kingdom. 

“The areas of the brain affected by plaques overlapped those areas affected in Alzheimer’s disease, but other areas were involved. People after a head injury are more likely to develop dementia, but it isn’t clear why. Our findings suggest TBI leads to the development of the plaques which are a well-known feature of Alzheimer’s disease.”

For the study, nine people with an average age of 44 who had a single moderate to severe TBI had PET and MRI brain scans. The brain injuries occurred between 11 months and up to 17 years before the start of the study. The participants were compared to 10 people with Alzheimer’s disease and nine healthy participants.

The PET scans used a marker that detects plaques in the brain. The MRI scans used diffusion tensor imaging to detect damage to brain cells that occurs after TBI. Both the people with brain injuries and the people with Alzheimer’s disease had plaques in the posterior cingulate cortex, which is affected early in Alzheimer’s, but only those with brain injuries had plaques in the cerebellum. The researchers also found that plaques were increased in patients with more damage to the brain’s white matter.

“It suggests that plaques are triggered by a different mechanism after a traumatic brain injury,” Sharp said. “The damage to the brain’s white matter at the time of the injury may act as a trigger for plaque production.”

“If a link between brain injury and later Alzheimer’s disease is confirmed in larger studies, neurologists may be able to find prevention and treatment strategies to stave off the disease earlier,” said Sharp.

The study was supported by the Imperial College Healthcare Trust Biomedical Research Center.

To learn more about Alzheimer’s disease, please visit www.aan.com/patients.

The American Academy of Neurology, an association of 30,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.