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Category: healthy aging

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This wonderful opinion piece is by Dr. John Mandrola, a cardiologist who also posts on his own blog at http://www.drjohnm.org/ . The bottom line: lifestyle is more important than drugs in preventing heart disease. The following is from Medscape:

Heart Disease and Lifestyle: Why Are Doctors in Denial?

I think and write a lot about the role of lifestyle choices as a treatment strategy. As an endurance athlete, I know that exercise, diet, sleep, and finding balance in life are the key components of success. It is the same in cardiology.

In a randomized controlled trial of primary prevention, no cardiologist would want to be compared against a good physical trainer or nutritionist. We would get trounced. Our calcium scores, biomarkers, pills, and procedures would not stand a chance. The study would be terminated early due to obvious superiority of lifestyle coaching over doctoring—which would blunt the true treatment effect and make us look less bad. (Wink to my epidemiology friends.)

I write a post about new oral anticoagulant drugs or statins or AF ablation, and people pay attention. You see it in the traffic. It's the same story at medical meetings: sessions on drugs and procedures draw the crowds. Late-breaking studies rarely involve the role of exercise or eating well. Exercise, diet, and going to bed on time have no corporate backing. The task of drawing attention to the basics is getting harder, not easier.

And this is our problem. I believe the collective denial of lifestyle disease is the reason cardiology is in an innovation rut. This denial is not active or overt. It is indolent and apathetic. Bulging waistlines, thick necks, sagging muscles, and waddling gaits have begun to look like normal. During the electronic medical record (EMR) click-fest after seeing a patient, I rarely click on "normal" physical exam. The general appearance is abnormal—either overweight or obese.

This is how I see modern cardiology. Our tricks can no longer overcome eating too much and moving too little. We approach health but never get there. If you waddle, snore at night, and cannot see your toes while standing, how much will a statin or ACE inhibitor or even LCZ696 help?

In fact, a reasonable person could make an argument that our pills and procedures might be making patients sicker.

When I started electrophysiology, I mostly treated people with fluky problems. My ablation procedures were on people with supraventricular tachycardia (SVT) due to aberrant pathways. My devices were mostly pacemakers in the elderly—a disease due to aging. These sorts of problems are (mostly) independent of how many sugar-sweetened beverages one drinks.

Now it is different. My practice is dominated by atrial arrhythmia—a disease now recognized as being due (in large part) to excesses of life, such as obesity, high blood pressure, sleep disorders, and overindulgence in alcohol. In other words: unnecessary. I make hundreds of dollars putting a hundred burns in a left atrium for a disease that a poorly paid physical trainer might prevent or treat. This has become cardiology writ large.

But the thing I cannot get over is that I am doctor, not a proceduralist. I am tasked with helping people be well. I fail in that task if I ignore the most effective and safest treatment option. I fail if I take the easy path. The prescription pad is easy. The EP lab is easy. The truth is hard... New anticoagulant drugs are easy. Ablation technology is easy. Statins are even easier. The truth—nutrition, exercise, balance in life—is hard.

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Nowadays many medical societies do NOT recommend annual physicals for healthy adults.

From Medscape: Is the Annual Physical Past Its Prime...Again?

Few medical societies still recommend healthy adults undergo annual physicals, and some groups actively recommend against them, yet many physicians continue to offer the visits to their patients. This week, oncologist and health policy expert Ezekiel Emanuel, MD, PhD, has taken the debate to the opinion pages of the New York Times, where he explains again why the formerly prescribed practice should be proscribed. Once again, however, not everyone agrees the healthy patient exam should be a thing of the past.

According to Dr Emanuel, who is vice provost, global initiatives, and chair, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, recent estimates say about 45 million Americans will have a routine general physical this year, which he likens to the human equivalent of the 15,000-mile check-up on their cars. "If you estimate the cost of the exam alone conservatively at $100, it's beginning to be a nontrivial amount of money," Dr Emanuel told Medscape Medical News.

And that is before you add in the costs of laboratory panels, follow-up tests, patient anxiety, and the overdiagnosis or overtreatment of conditions that, if left undetected, would never have become clinically significant. "We see this with prostate cancer and thyroid cancer," Dr Emanuel said.

As he writes, "If you screen thousands of people, maybe you'll find tens whose exams suggest they might have a disease. And then upon further tests, you'll find it is really only a few individuals who truly have something. And of those individuals, maybe one or two actually gain a health benefit from an early diagnosis."

From a health-promotion perspective, then, the annual physical exam is of little value, does not reduce morbidity and mortality from acute or serious chronic conditions, and may even lead to unwarranted complacency in "people who just want to make sure," he said to Medscape Medical News.

To support that statement, Dr Emanuel points to evidence from a 2012 Cochrane Collaboration review of 14 randomized controlled trials involving 182,000 people followed for a median of 9 years. The unequivocal conclusion of the analysis was that routine general check-ups, not prompted by actual symptoms, are unlikely to yield much benefit. No matter what screenings and tests were administered, annual physicals did not reduce mortality overall or specifically from the big killers, cancer and heart disease.

More recently, data from the Danish Inter99 study, a large, randomized trial, supported the conclusion that general check-ups are ineffective. The community-based trial of almost 60,000 adults aged 30 to 60 years, with screening for ischemic heart disease risk and repeated lifestyle interventions over the course of 5 years, found no effect on ischemic heart disease, stroke, or mortality at the population level after 10 years.

Dr Emanuel noted that the US Preventive Services Task Force does not recommend routine annual check-ups, and the Canadian Task Force on the Periodic Health Examination has recommended against the practice since 1979. "Those who preach the gospel of the routine physical have to produce the data to show why these physician visits are beneficial," he writes in his article.

So far, physicians' response to his op-ed piece "has been 90% supportive. They've looked at the data and are not convinced by the data [of the annual check-up's value]," he told Medscape Medical News... Many physicians, however, stand by an annual visit to the consulting room, including Peter C. Galier, MD, professor of medicine, University of California, Los Angeles, School of Medicine. "You can manipulate the data from these meta-analyses any way you want, but when you see patients regularly, you get important information that you may never get until there's an acute problem," he said.

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Exercise is the Fountain of Youth? Note that they could not come up with a biomarker of aging in these active people. From Medical Xpress;

Exercise allows you to age optimally

Staying active allows you to age optimally, according to a study by King's College London and the University of Birmingham. The study of amateur older cyclists found that many had levels of physiological function that would place them at a much younger age compared to the general population; debunking the common assumption that ageing automatically makes you more frail.

The study, published in The Journal of Physiology, recruited 84 male and 41 female cycling enthusiasts aged 55 to 79 to explore how the ageing process affects the human body, and whether specific physiological markers can be used to determine your age.

Cyclists were recruited to exclude the effects of a sedentary lifestyle, which can aggravate health problems and cause changes in the body, which might appear to be due to the ageing process. Men and women had to be able to cycle 100 km in under 6.5 hours and 60 km in 5.5 hours, respectively, to be included in the study...Participants underwent two days of laboratory testing at King's. For each participant, a physiological profile was established which included measures of cardiovascular, respiratory, neuromuscular, metabolic, endocrine and cognitive functions, bone strength, and health and well-being. Volunteers' reflexes, muscle strength, oxygen uptake during exercise and peak explosive cycling power were determined.

The results of the study showed that in these individuals, the effects of ageing were far from obvious. Indeed, people of different ages could have similar levels of function such as muscle strength, lung power and exercise capacity. The maximum rate of oxygen consumption showed the closest association with age, but even this marker could not identify with any degree of accuracy the age of any given individual, which would be the requirement for any useful biomarker of ageing.

In a basic, but important test of function in older people, the time taken to stand from a chair, walk three metres, turn, walk back and sit down was also measured. Taking more than 15 seconds to complete the task generally indicates a high risk of falling. Even the oldest participants in the present study fell well below these levels, fitting well within the norm for healthy young adults.

Overall, the study concluded that ageing is likely to be a highly individualist phenomenon...The main problem facing health research is that in modern societies the majority of the population is inactive. A sedentary lifestyle causes physiological problems at any age. Hence the confusion as to how much the decline in bodily functions is due to the natural ageing process and how much is due to the combined effects of ageing and inactivity."

"In many models of ageing lifespan is the primary measure, but in human beings this is arguably less important than the consequences of deterioration in health. Healthy life expectancy - our healthspan - is not keeping pace with the average lifespan, and the years we spend with poor health and disabilities in old age are growing."

Emeritus Professor Norman Lazarus, a member of the King's team and also a cyclist, said: "Inevitably, our bodies will experience some decline with age, but staying physically active can buy you extra years of function compared to sedentary people. Cycling not only keeps you mentally alert, but requires the vigorous use of many of the body's key systems, such as your muscles, heart and lungs which you need for maintaining health and for reducing the risks associated with numerous diseases."

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From Science Daily:

More whole grains associated with lower mortality, especially cardiovascular

Eating more whole grains appears to be associated with reduced mortality, especially deaths due to cardiovascular disease (CVD), but not cancer deaths, according to a report.

Whole grains are widely recommended in many dietary guidelines as healthful food. However, data regarding how much whole grains people eat and mortality were not entirely consistent.

Hongyu Wu, Ph.D., of the Harvard School of Public Health, Boston, and coauthors examined the association between eating whole grains and the risk of death using data from two large studies: 74,341 women from the Nurses' Health Study (1984-2010) and 43,744 men from the Health Professionals Follow-Up Study (1986-2010). All the participants were free of cancer and CVD when the studies began.

The authors documented 26,920 deaths. After the data were adjusted for potential confounding factors including age, smoking and body mass index, the study found that eating more whole grains was associated with lower total mortality and lower CVD mortality but not cancer deaths. The authors further estimated that every serving (28 grams/per day) of whole grains was associated with 5 percent lower total mortality or 9 percent lower CVD mortality.

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Again, the same message of what are healthy habits to prevent heart attacks and heart disease: not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality.From Medical Xpress:

A healthy lifestyle may prevent heart disease in nearly three out of four women

A new study that followed nearly 70,000 women for two decades concluded that three-quarters of heart attacks in young women could be prevented if women closely followed six healthy lifestyle practices.

The study, published today in the Journal of the American College of Cardiology, followed participants in a study of nurses established in 1989, which surveyed more than 116,000 participants about their diets and other health habits every two years. Researchers from Indiana University, the Harvard School of Public Health, and Brigham and Women's Hospital analyzed data on 69,247 of the participants who met the requirements for their study. "Although mortality rates from heart disease in the U.S. have been in steady decline for the last four decades, women aged 35-44 have not experienced the same reduction," said Andrea K. Chomistek, ScD, a researcher from the Indiana University School of Public Health-Bloomington and lead author of the paper.

Healthy habits were defined as not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality based on the Harvard School of Public Health healthy eating plate.

During 20 years of follow-up, 456 women had heart attacks and 31,691 women were diagnosed with one or more cardiovascular disease risk factors, including type 2 diabetes, high blood pressure or high levels of blood cholesterol. The average age of women in the study was 37.1 years at the outset; the average age of a heart disease diagnosis was 50.3, and the average age for diagnosis with a risk factor for heart disease was 46.8.

Researchers found that women who adhered to all six healthy lifestyle practices had a 92 percent lower risk of heart attack and a 66 percent lower risk of developing a risk factor for heart disease. This lower risk would mean three quarters of heart attacks and nearly half of all risk factors in younger women may have been prevented if all of the women had adhered to all six healthy lifestyle factors, the authors said.

Independently, not smoking, adequate physical activity, better diet, and lower BMI were each associated with a lower risk for heart disease. Women who consumed moderate amounts of alcohol—approximately one drink per day on average—saw the lowest risk compared to those who did not drink at all and those who drank more.

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Another excellent reason to start walking more and increasing daily physical activity. So get out there and walk, walk, walk...

From Science Daily: Significant link between daily physical activity, vascular health

As millions of Americans resolve to live healthier lives in 2015, research from the University of Missouri School of Medicine shows just how important diligent, daily physical activity is. The researchers found that reducing daily physical activity for even a few days leads to decreases in the function of the inner lining of blood vessels in the legs of young, healthy subjects causing vascular dysfunction that can have prolonged effects.

Paul Fadel, associate professor of medical pharmacology and physiology, and John Thyfault, associate professor of nutrition and exercise physiology, also found that the vascular dysfunction induced by five days of inactivity requires more than one day of returning to physical activity and taking at least 10,000 steps a day to improve.

"We know the negative consequences from not engaging in physical activity can be reversed," said Fadel. "There is much data to indicate that at any stage of a disease, and at any time in your life, you can get active and prolong your life. However, we found that skipping just five days of physical activity causes damage to blood vessels in the legs that can take a prolonged period of time to repair."

"Inactivity is typically going to lead to people being overweight and obese," said Fadel. "The next step after that is insulin resistance which leads to Type 2 diabetes and cardiovascular disease."

The researchers studied the early effects on the body's blood vessels when someone transitions from high daily physical activity -- 10,000 or more steps per day -- to low daily physical activity, less than 5,000 steps per day. Five thousand steps is the national average, but only half of the daily recommendation from the U.S. Surgeon General. The researchers found going from high to low levels of daily physical activity for just five days decreases the function of the inner lining of the blood vessels in the legs.

Counting steps and daily physical activity is different than defined exercise, such as working out at the gym. While there are significant benefits to defined exercise, Thyfault and Fadel's research is based on what amounts to 30 minutes of moderate activity per day.

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Research on a burning question for middle-aged men: how to control the belly fat that comes with aging? From Science Daily:

Weight training appears key to controlling belly fat

Healthy men who did 20 minutes of daily weight training had less of an increase in age-related abdominal fat compared with men who spent the same amount of time doing aerobic activities, according to a new study. Combining weight training and aerobic activity led to the most optimal results. Aerobic exercise by itself was associated with less weight gain compared with weight training.

"Because aging is associated with sarcopenia, the loss of skeletal muscle mass, relying on body weight alone is insufficient for the study of healthy aging," said lead author Rania Mekary, a researcher in HSPH's Department of Nutrition. "Measuring waist circumference is a better indicator of healthy body composition among older adults. Engaging in resistance training or, ideally, combining it with aerobic exercise could help older adults lessen abdominal fat while increasing or preserving muscle mass."

The new study was long-term with a large sample of healthy men with a wide range of BMI (body mass index). Mekary and colleagues studied the physical activity, waist circumference (in centimeters (cm)), and body weight of 10,500 healthy U.S. men aged 40 and over participating in the Health Professionals Follow-up Study between 1996 and 2008.

Their analysis included a comparison of changes in participants' activity levels over the 12-year period to see which activities had the most effect on the men's waistlines. Those who increased the amount of time spent in weight training by 20 minutes a day had less gain in their waistline (-0.67 cm) compared with men who similarly increased the amount of time they spent on moderate-to-vigorous aerobic exercise (-0.33 cm), and yard work or stair climbing (-0.16 cm). Those who increased their sedentary behaviors, such as TV watching, had a larger gain in their waistline.

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The bottom line: for better health be physically active at least is 2.5 hours of week. Note that HbA1c is a measure of glycated hemoglobin which identifies average plasma glucose concentration (and lower is better). From Medscape:

Exercise Tied to Cardiometabolic Markers in Clinic Patients 

Healthy, middle-aged outpatients who were physically active for at least 2.5 hours a week had better blood pressure and blood glucose levels than their sedentary peers in a large cross-sectional study in California. The differences were especially notable in women, in this study published online December 18, 2014 in Preventing Chronic Disease.

Men and women who were consistently physically active—defined as performing moderate to vigorous activity such as brisk walking for at least 150 minutes a week, as self-reported at all three outpatient visits in a 33-month period—had lower diastolic blood pressure, glucose, and HbA1c levels than patients not reporting exercise at that level.

Moreover, on a population level, the observed associations "were comparable to those needed to reduce the risk of coronary heart disease, stroke, and diabetes," they continue. "If healthcare providers would routinely assess the physical activity of their patients and refer those who are physically inactive to effective physical-activity programs, it may reduce the burden of future chronic diseases."

They analyzed electronic records from over 622,000 adults covered by Kaiser Permanente Southern California healthcare insurance who made at least three clinic visits between April 2010 and December 2012 and were not being treated for diabetes or hypertension.

The consistently active women had systolic and diastolic blood pressures that were 4.60-mm-Hg lower and 3.28-mm-Hg lower, respectively, than inactive women. Perhaps surprisingly, somewhat active women had slightly better blood-pressure values than the more active group.

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Try standing on one leg with your eyes open, Can you do it for longer than 20 seconds? From Science Daily:

Ability to balance on one leg may reflect brain health, stroke risk

Struggling to stand on one leg for less than 20 seconds was linked to an increased risk for stroke, small blood vessel damage in the brain, and reduced cognitive function in otherwise healthy people, a study has shown. One-legged standing time may be a simple test used to measure early signs of abnormalities in the brain associated with cognitive decline, cerebral small vessel disease and stroke.

The study consisted of 841 women and 546 men, average age of 67. To measure one-leg standing time, participants stood with their eyes open and raised one leg. The maximum time for keeping the leg raised was 60 seconds. Participants performed this examination twice and the better of the two times was used in the study analysis. Cerebral small vessel disease was evaluated using brain magnetic resonance imaging.

Researchers found that the inability to balance on one leg for longer than 20 seconds was associated with cerebral small vessel disease, namely small infarctions without symptoms such as lacunar infarction and microbleeds. They noted that: 34.5 percent of those with more than two lacunar infarction lesions had trouble balancing, 16 percent of those with one lacunar infarction lesion had trouble balancing, 30 percent of those with more than two microbleed lesions had trouble balancing, 15.3 percent one microbleed lesion had trouble balancing.

Overall, those with cerebral diseases were older, had high blood pressure and had thicker carotid arteries than those who did not have cerebral small vessel disease. However, after adjustment for these covariates, people with more microbleeds and lacunar infarctions in the brain had shorter one-legged standing times. Short one-legged standing times were also independently linked with lower cognitive scores.

Small vessel disease occurs due to microangiopathy of arterioles in the brain, making these arteries less flexible, which can interfere with blood flow. Small vessel disease typically increases with age. Loss of motor coordination, including balance, as well as cognitive impairment has been suggested to represent subclinical brain damage. Tabara and colleagues also found a strong link between struggling to stand on one leg and increased age, with marked shorter one-leg standing time in patients age 60 and over.

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Feeling younger than your chronological age is good! From Science Daily:

Feeling younger than actual age meant lower early death rate for older people, study finds

Turns out, feeling younger than your actual age might be good for you. Older people who felt three or more years younger than their chronological age had a lower death rate compared with those who felt their age or who felt more than one year older than their actual age, researchers found.

Self-perceived age can reflect assessments of health, physical limitation and well-being in later life, and many older people feel younger than their actual age, according background information in the report. Authors Isla Rippon, M.Sc., and Andrew Steptoe, D.Sc., of the University College London, examined the relationship between self-perceived age and mortality.

The authors used data from a study on aging and included 6,489 individuals, whose average chronological age was 65.8 years but whose average self-perceived age was 56.8 years. Most of the adults (69.6 percent) felt three or more years younger than their actual age, while 25.6 percent had a self-perceived age close to their real age and 4.8 percent felt more than a year older than their chronological age.

Mortality rates during an average follow-up of 99 months were 14.3 percent in adults who felt younger, 18.5 percent in those who felt about their actual age and 24.6 percent in those adults who felt older, according to the study results. The relationship between self-perceived age and cardiovascular death was strong but there was no association between self-perceived age and cancer death.