Few Heart Attack Survivors Get Recommended Physical Activity

Newswise, May 2, 2017—Only 16 percent of heart attack survivors get the recommended amount of physical activity in the weeks after hospitalization, according to a study by researchers at Columbia University Medical Center (CUMC) and NewYork-Presbyterian.

The study was published online earlier this week in the Journal of the American College of Cardiology.

Exercise has been proven to lower the risk of having another heart attack in patients with acute coronary syndrome (ACS), which includes heart attack and unstable angina (chest pain).

Current guidelines strongly recommend that ACS patients get at least 30 minutes of moderate aerobic activity, such as brisk walking, at least five days per week in the first two weeks after hospital discharge. Previous studies, which relied on self-reporting, have been unable to provide a reliable estimate of how many patients achieve this goal.

In this study, the researchers measured the amount and intensity of physical activity with a wearable activity monitor in 620 heart attack survivors. Participants were instructed to wear the device for 10 hours, or more, at least three days per week during the first month after hospitalization.

“In prior decades, heart attack survivors were counseled to remain in bed for many weeks,” said Ian M. Kronish, MD, MPH, Florence Irving Assistant Professor of Medicine at CUMC, assistant professor of medicine in Columbia’s Center for Behavioral Cardiovascular Health, cardiologist at NewYork-Presbyterian/Columbia and lead author of the paper.

“Despite current evidence to the contrary, many ACS patients fear that straining their heart through exertion will cause chest pain or another heart attack.”

Clinician-supervised exercise programs for heart attack survivors have been shown to counteract patients’ fears and encourage more physical activity. However, participation in these programs remains poor.

“Researchers and clinicians need to find ways of getting more people to participate in such supervised exercise programs,” Dr. Kronish said.

“Nowadays, there are several consumer products that can be used to track physical activity at home. Perhaps the future holds ways to remotely monitor patients and to provide positive feedback and counseling outside of a hospital setting.”

The paper is titled, “Objectively Measured Adherence to Physical Activity Guidelines after Acute Coronary Syndrome.”

Additional authors included Keith M. Diaz (Columbia University Medical Center, New York, NY), Jeff Goldsmith (Columbia University Mailman School of Public Health), Nathalie Moise (CUMC), and Joseph E. Schwartz (Stony Brook University School of Medicine, Stony Brook, NY).

Adjusting Meds May Reduce Fall Risk in Older Adults

Newswise, May 2, 2017--Simply adjusting the dose of an older adult's psychiatric medication could reduce their risk of falling, a new University of Michigan study suggests.

The study found that a moderate increase in depressive symptoms among people over 65 was associated with a 30 percent increase in experiencing a fall over the next two years, said Geoffrey Hoffman, research fellow and assistant professor at the U-M School of Nursing.

This association appeared, in part, to reflect greater use of psychiatric medications, he said. The study didn't formally measure the impact of medication use on falls, but when psychiatric medication was included in the experimental model, the relationship between falls and depressive symptoms became nonsignificant, he said.

"We've pinpointed that we think the relationship between depression and falls involves medication use with important implications for patient safety and fall risk reduction," Hoffman said.

"Many interventions to prevent falls are expensive and time-intensive, but this is a simple and inexpensive matter of encouraging continued use of psychiatric medication while improving monitoring of fall risk and adjusting medication appropriately."

While Hoffman and colleagues found that depressive symptoms among older adults preceded falls, they didn't find the reverse—that a fall is followed by symptoms of depression over the next two years. This is positive in the sense that depression didn't seem to set in—at least in the time period researchers examined in this study.

The team looked at the risk of falls between 2006 and 2010 among those 65 and older surveyed for the National Health and Retirement Study. When they examined medication use, the strength of the relationship between depressive symptoms and falls decreased.

The takeaway for older adults? Stay active and always be careful to reduce fall risks. Talk to a family member or a physician if you think you're depressed, and talk to a physician if you have questions about medications.

For families and physicians? Watch for depressive symptoms, and trust that physicians are weighing the risks and benefits of psychiatric medication use. Physicians should pay special attention to properly choosing and dosing medication, and ask older patients about symptoms that indicate fall risks.

For purposes of the study, those medications included tranquilizers, antidepressants, and pills for nerves.

Hoffman also said that specialty geriatric societies should highlight depression and medication use in fall risk assessment protocols and encourage physicians treating older adults to be sensitive to fall risks.

Falls among the elderly cost about $30 billion a year, and up to half of nursing home admissions follow a fall. About one-third of Americans 65 or older fall annually and about 10 percent of all elderly people are injured during falls.

The study, "Depressive symptomatology and fall risk among community-dwelling older adults," appeared in the journal Social Science and Medicine.

How People who are Visually Impaired Can Walk the Monday Mile

Lighthouse Guild Doctor Offers Tips for National Walking Day

Newswise, April 3, 2017-- Nearly 14 million Americans - about one out of every 20 people - have low vision, according to The Centers for Disease Control and Prevention. Eye-care professionals use the term “low vision” to describe significant visual impairment that cannot be corrected with standard glasses, contact lenses, medicine or eye surgery.

According to the National Federation of The Blind, each year, 75,000 more people in the United States will become blind or visually impaired. Though the condition mainly afflicts the elderly, younger Americans are increasingly at risk of irreversible vision loss, particularly as cases of diabetes continue to rise.

Low vision means that even with regular glasses, contact lenses, medicine, or surgery, people find everyday tasks, such as reading, shopping, cooking, watching TV, writing, and exercising difficult to do.

Because of this difficulty, individuals with visual impairments often exhibit lower levels of fitness than their sighted peers, often due to fear and lack of confidence.

Walking, a simple form of exercise with many health benefits, is considered a good choice for people who are visually impaired, according to Laura Sperazza, OD, Director of Low Vision Services at Lighthouse Guild in New York City.

Dr. Sperazza encourages people with low vision, who have been hesitant to venture out and walk for fitness, to participate in the American Heart Association’s National Walking Day on April 5.

The day promotes all the benefits of walking, and people can keep the momentum going throughout the year by starting a Monday Mile in their community.

The Monday Mile is an initiative of The Monday Campaigns, the nonprofit public health organization, associated with Johns Hopkins, Columbia and Syracuse universities. The Monday Mile mission is to encourage people from all walks of life to walk for their health, by using Monday as the starting day.

Research by Johns Hopkins shows that people view Monday as a day for a fresh start and are more likely to begin new healthy behaviors on a Monday, and carry them out for the rest of the week.

What are the best ways for people who are visually impaired to walk the Monday Mile with confidence? Dr. Sperazza offers these tips:

• Walk during daylight hours in order to avoid obstacles.
• Walk with a normally sighted buddy to help avoid obstacles and unforeseen conditions.
• Don’t walk in bad weather.
• Wear proper shoes to avoid slipping.
• Walk in familiar areas so you can anticipate the path.
• Use a ‘sighted cane’ which notifies others that you have an impairment
• For people with a greater level of impairment, train in the use of a ‘sighted cane’ with a mobility specialist, which can help them adjust to different surfaces and unfamiliar areas

For more information on low vision services, visit lighthouseguild.org.

About Lighthouse Guild

Lighthouse Guild, headquartered in New York City, is the leading not-for-profit vision and healthcare organization with a long history of addressing the needs of people who are blind or visually impaired, including those with multiple disabilities or chronic medical conditions. 

With more than 200 years of experience and service, Lighthouse Guild brings a level of understanding to vision care that is unmatched. By integrating vision and healthcare services and expanding access through its programs and education and awareness, we help people lead productive, dignified and fulfilling lives. For more information, visit lighthouseguild.org.

About The Monday Mile
The Monday Mile is part of The Monday Campaigns, a nonprofit organization, which dedicates the first day of every week to health. The organization offers a free Monday Mile Starter Kit and resources for workplaces, campuses and community groups to start their own program. At Syracuse University, Monday Mile routes have been created with accessibility in mind, and are well-lit and feature many flat routes. This Monday Mile program can serve as a great example of how to create an accessible Monday Mile in your community.
Download the Monday Mile Starter Kit at: www.moveitmonday.org/mondaymile
For a Monday Mile infographic: h

A Beach Lover’s Dream: A Step Toward Long-Lasting Sunscreen

Newswise, April 3, 2017 — In a perfect world, people would diligently reapply suncreen every couple of hours to protect their delicate skin from damaging solar radiation. But in reality, few people actually adhere to reapplication guidelines, and those who do hardly relish the task.

To develop longer-lasting sunscreens, researchers are trying to answer a basic question: How do sunblock ingredients work?

The researchers presented their work at the 253rd National Meeting & Exposition of the American Chemical Society (ACS). ACS, the world’s largest scientific society, is holding the meeting here through Thursday. It features more than 14,000 presentations on a wide range of science topics.

“Sunscreens have been around for decades, so you’d think we know all there is to know about them — but we really don’t,” Vasilios Stavros, Ph.D., says.

 “If we better understand how the molecules in sunscreen absorb light, then we can manipulate the molecules to absorb more energy, and we can protect the molecules from degradation. If the molecule doesn’t break down, there's no need to reapply.”

A typical sunscreen sold at a drug store contains many different ingredients, Stavros explains.

 “We wanted to break these lotions and creams down like a jigsaw puzzle — take one of the ingredients and understand it from a molecular point of view without interactions from the other component parts.”

The researchers, who are at the University of Warwick (U.K.), started by focusing on sunscreen ingredients called chemical filters, which are molecules that absorb UV light. They have studied about 10 common chemical filters so far.

When these molecules absorb energy from the sun, Stavros explains, they enter into an excited electronic state. Other molecules are likely to break under the sun's glare, sometimes releasing dangerous free radicals. But instead of breaking, chemical filters can shimmy and shake themselves back into the more stable ground state, releasing energy as harmless heat. The problem is that these chemical filters can fail, breaking into pieces or getting stuck in the excited state.

To figure out how to prevent chemical filter dysfunction, Stavros’ team used lasers to simulate the sun’s energy and to monitor the flow of energy through the chemical filters as the molecules traverse from the ground state to the excited state and back again (or not).

For example, the researchers found that about 10 percent of the molecules of the sunscreen ingredient oxybenzone get locked in an excited state when the laser is shone on them.

 “When that chemical filter is in an excited state, its atoms are rotating around certain bonds,” Stavros says. “If we can manipulate this rotation by adding different chemical groups, we could help the molecule find its way back to the ground state,” he says, noting that they plan to work on this project soon.

In addition, the researchers are beginning to study the filters in a context that is more similar to an actual sunscreen, rather than in isolation. “We are increasing molecular complexity, building the jigsaw puzzle,” Stavros says.

He adds that analyzing the data has been a challenge, but one that the team is tackling head-on. In the end, the data analyses and chemical manipulations should shed more light on how sunscreens protect against sun damage so researchers can develop longer-lasting concoctions.

Stavros acknowledges funding from the Engineering and Physical Sciences Research Council, the Royal Society, The Leverhulme Trust and the University of Warwick (all in U.K.).

The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With nearly 157,000 members, ACS is the world’s largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. ACS does not conduct research, but publishes and publicizes peer-reviewed scientific studies. Its main offices are in Washington, D.C., and Columbus, Ohio.

Brain-Aging Gene Discovered

Genetic variant accelerates normal brain aging in older people by up to 12 years

Newswise, March 20, 2017—Columbia University Medical Center (CUMC) researchers have discovered a common genetic variant that greatly impacts normal brain aging, starting at around age 65, and may modify the risk for neurodegenerative diseases.

 The findings could point toward a novel biomarker for the evaluation of anti-aging interventions and highlight potential new targets for the prevention or treatment of age-associated brain disorders such as Alzheimer’s disease.

The study was published online   in the journal Cell Systems.

“If you look at a group of seniors, some will look older than their peers and some will look younger,” said the study’s co-leader Asa Abeliovich, PhD, professor of pathology and neurology in the Taub Institute for Alzheimer's Disease and the Aging Brain at CUMC.

“The same differences in aging can be seen in the frontal cortex, the brain region responsible for higher mental processes. Our findings show that many of these differences are tied to variants of a gene called TMEM106B. People who have two ‘bad’ copies of this gene have a frontal cortex that, by various biological measures, appears 12 years older that those who have two normal copies.”

Studies have identified individual genes that increase one’s risk for various neurodegenerative disorders, such as apolipoprotein E (APOE) for Alzheimer's disease.

“But those genes explain only a small part of these diseases,” said study co-leader Herve Rhinn, PhD, assistant professor of pathology and cell biology in the Taub Institute.

“By far, the major risk factor for neurodegenerative disease is aging. Something changes in the brain as you age that makes you more susceptible to brain disease. That got us thinking, ‘What, on a genetic level, is driving healthy brain aging?’”

In the current study, Drs. Abeliovich and Rhinn analyzed genetic data from autopsied human brain samples taken from 1,904 people without neurodegenerative disease. First, the researchers looked at the subjects’ transcriptomes (the initial products of gene expression), compiling an average picture of the brain biology of people at a given age.

Next, each person’s transcriptome was compared to the average transcriptome of people at the same age, looking specifically at about 100 genes whose expression was found to increase or decrease with aging.

From this comparison, the researchers derived a measure that they call differential aging: the difference between an individual’s apparent (biological) age and his or her true (chronological) age. “This told us whether an individual’s frontal cortex looked older or younger than expected,” said Dr. Abeliovich.

The researchers then searched the genome of each individual, looking for genetic variants that were associated with an increase in differential age.

“One variant stood out: TMEM106B,” said Dr. Rhinn. “It’s very common. About one-third of people have two copies and another third have one copy.”

“TMEM106B begins to exert its effect once people reach age 65,” said Dr. Abeliovich. “Until then, everybody’s in the same boat, and then there’s some yet-to-be-defined stress that kicks in. If you have two good copies of the gene, you respond well to that stress. If you have two bad copies, your brain ages quickly.”

The researchers found a second variant—inside the progranulin gene—that contributes to brain aging, though less so than TMEM106B. Progranulin and TMEM106B are located on different chromosomes but are involved in the same signaling pathway. Both have also been associated with a rare neurodegenerative disease called frontotemporal dementia.

The study did not address what role the two genetic variants might have in neurodegenerative disease. “We were studying healthy individuals, so it is not about disease, per se,” said Dr. Abeliovich.

“But of course, it’s in healthy tissue that you start to get disease. It appears that if you have these genetic variants, brain aging accelerates and that increases vulnerability to brain disease. And vice versa: if you have brain disease, the disease accelerates brain aging. It’s a vicious cycle.”

The study is titled, “Genetic determinants of aging in human brain.”

The study was supported by grants from the National Institute of Aging (AG042317), the National Institute of Neurological Disorders and Stroke, and the Michael J. Fox Foundation for Parkinson's Research.

Dr. Abeliovich is a co-founder of and consultant for Alector. Dr. Rhinn is a consultant for Alector. The researchers declare no other financial conflicts of interest.