Broken Heart Syndrome Is on the Rise, Especially Among Older Women

Thor Christensen wrote . . . . . . . . .

Broken heart syndrome, a life-threatening condition whose symptoms mimic a heart attack, is on the upswing, according to new research that shows the sharpest increases among women 50 and older.

Published Wednesday in the Journal of the American Heart Association, the study examined 135,463 cases of broken heart syndrome in U.S. hospitals from 2006 to 2017. It found a steady annual increase among both women and men, with women making up 88.3% of the cases.

The overall increase wasn’t unexpected as the condition has become increasingly recognized among medical professionals, said Dr. Susan Cheng, the study’s senior author. But researchers were taken aback to find the rate of the condition was at least six to 12 times higher in women ages 50 to 74 than it was in men or in younger women.

“These skyrocketing rates are both intriguing and concerning,” said Cheng, director of the Institute for Research on Healthy Aging in the department of cardiology at the Smidt Heart Institute at Cedars-Sinai in Los Angeles.

The condition, also known as Takotsubo cardiomyopathy, has been studied for decades in Japan and elsewhere. But it wasn’t well known internationally until 2005, when the New England Journal of Medicine published research on it.

Triggered by physical or emotional stress, broken heart syndrome causes the heart’s main pumping chamber to temporarily enlarge and pump poorly. Patients experience chest pain and shortness of breath, symptoms similar to those of a heart attack.

If they survive the initial phase of the disease, people often can recover in days or weeks. However, the longer-term effects are still being studied. Despite apparent recovery of heart muscle function, some studies show people who have had broken heart syndrome are at heightened risk for future cardiovascular events.

Cheng said more research is needed to understand the risks and reasons why broken heart syndrome seems to disproportionately affect middle-aged to older women.

The end of menopause may play a role, she said, but so might an uptick in overall stress.

“As we advance in age and take on more life and work responsibilities, we experience higher stress levels,” she said. “And with increasing digitization around every aspect of our lives, environmental stressors have also intensified.”

The study arrives at a time when public health organizations have been delving deeper into the mind-heart-body connection. In January, the American Heart Association published a scientific statement on the connection, saying there were “clear associations” between psychological health and cardiovascular disease risk.

While the study was done before the rise of COVID-19, Cheng said the stress of the pandemic has likely led to a rise in the number of recent cases of broken heart syndrome, many of them undiagnosed.

“We know there have been profound effects on the heart-brain connection during the pandemic. We are at the tip of the iceberg in terms of measuring what those are,” she said.

Dr. Erin Michos, who helped write the AHA’s scientific statement but was not involved in the new research, said the findings underscore how important it is for doctors to screen patients for mental health conditions.

She also called for more research to understand a disease about which little is known.

“We should all be worried about why its incidence is on the rise,” said Michos, an associate professor of medicine and director of Women’s Cardiovascular Health at Johns Hopkins School of Medicine in Baltimore.

The study, she said, serves as a potent reminder that everyone needs be proactive about their mental health, especially those with cardiovascular risks.

“We can’t avoid all stress in life, but it is important for patients to develop healthy coping mechanisms. Some strategies include mindfulness meditation, yoga, exercise, eating healthy, getting adequate sleep and cultivating social relationships for support systems,” Michos said. “For patients with significant psychological stress, a referral to a clinical psychologist or other clinician with expertise in mental health is recommended.”

Source: American Heart Association

Carrying a Tune Could Lead to Better Health

Thor Christensen wrote . . . . . . . . .

Not everyone can sing like a nightingale. When some of us try to carry a tune, we sound like Bob Dylan imitating Elmer Fudd.

Still, no matter the sound, experts say we should limber up our larynxes more often. According to a growing body of research, bursting into song is good for both your body and your brain.

“Singing a song that we know by ourself or with others triggers the reward system in the brain and releases dopamine that makes us feel better,” said Dr. Gottfried Schlaug, who studies brain imaging and music at the University of Massachusetts Amherst.

One great thing about singing is you can reap the benefits anytime, anywhere. When COVID-19 sent society into lockdown mode last year, people around the globe belted out songs from their balconies to relieve stress and anxiety.

“It doesn’t matter if you’re singing in a public group or you’re alone in the car singing (along) with Michael Jackson. It’s all beneficial,” said Kay Norton, a professor of musicology at Arizona State University who studies the healing power of music.

Nobody knows exactly when humans first started singing on a regular basis. But in recent decades, scientists have studied its benefits in a range of areas, from relieving pain to minimizing snoring and helping improve posture and muscle tension.

Singing seems to have a particularly strong impact on lung function. Hitting all the notes in a song requires deep breathing, which improves oxygen intake and may help people with asthma or chronic obstructive pulmonary disease.

But as good as singing may be for your body, it might be even better for your brain.

In addition to flicking on the dopamine switch, singing releases other feel-good hormones like oxytocin. It also may lower cortisol levels, reducing stress. A June 2019 study in BMJ Supportive and Palliative Care showed it helps people who’ve lost a loved one cope with grief. Other research published in 2016 in Evolution and Human Behavior shows singing in a choir improves feelings of social connectedness.

A metanalysis of several studies published this past May in the Journal of the American Geriatrics Society shows singing can trigger otherwise inaccessible memories for people with Alzheimer’s and other forms of dementia.

“When dementia comes along and robs somebody of some of their normal brain capability, singing can still activate the brain locations where musical memories were stored long ago. You see people light up when they hear something that’s familiar break through the fog of dementia,” said Norton, who has written a book about singing and well-being. She suggests people share a playlist of their favorite songs in case loved ones need it one day.

Some people who’ve suffered brain damage from a stroke can actually sing words or phrases even if they’re unable to say the same words or phrases, said Schlaug, who regularly sings with his stroke patients to determine if an intense program of singing helps their recovery.

While neuroscientists are still trying to figure out exactly why singing therapy helps some people who have had a stroke, one theory is it fires up brain activity and connects networks in different regions of the brain, particularly on the right side of the brain.

“A stroke on the left side of the brain is typically the cause for communication problems,” said Schlaug, director of the Human Magnetic Resonance Center at UMass and a professor of neurology at UMass Chan Medical School-Baystate in Springfield. The right side of the brain has to compensate for this impairment. “Singing words and phrases is the software that runs on the hardware on the right side of the brain to make it run efficiently.”

Interest in singing therapy and other types of music therapy have significantly increased in recent years, with thousands of board-certified practitioners now working with patients in schools, doctor’s offices and nursing homes.

But even if you’re just singing in the shower, everyone should do it regularly, Schlaug said. After all, it’s one of the easiest activities to do and may have therapeutic potential.

“It doesn’t cost anything,” he said. “We don’t even need an instrument: We are the instrument ourselves.”

Source: American Heart Association

Twofer Vaccine in the Making Works Against ‘Twindemic’ of Flu, COVID-19

Kenneth Bender wrote . . . . . . . . .

A one-and-done vaccine that prevents both influenza and COVID-19 might help alleviate vaccine hesitancy for both conditions.

The first clinical trial to assess concomitant administration of any vaccine with either an adenoviral vector or mRNA COVID-19 vaccine found the combination with influenza vaccine is safe, produces immunogenicity associated with separate vaccination, and supports the combination as an efficient intervention against the possible “twindemic.”

Validation of a more efficient means to vaccinate against these viral infections is particularly welcome as flu season has commenced in the US and northern hemisphere countries, and a recent survey from the National Foundation for Infectious Diseases (NFID) shows that 44% of the US population are unsure or do not plan to get vaccinated against influenza.

Rajeka Lazarus, DPhil, Department of Microbiology, University Hospitals Bristol and Weston, NHS Foundation Trust, Bristol, UK, and colleagues of the ComFluCOV Trial Group anticipate that concomitant administration would reduce burden on health care systems, and report, “concomitant vaccination raises no safety concerns and preserves the immune response to both vaccines.”

The investigators recruited 679 participants who had received the first dose of either the adenoviral vector SARS-CoV-2 vaccine ChAd0x1 (AstraZeneca) or the mRNA vaccine BNT162b2 (Pfizer/BioNTech) and randomized 1:1 to receive either placebo or an age-appropriate dosed influenza vaccine (adjuvanted trivalent or cellular or recombinant quadrivalent) with their second COVID-19 vaccine dose. Follow-up monitoring was available for 665 participants.

The study monitored for adverse effects and assessed laboratory indicators of immunogenicity from April 1 through June 26, 2021, outside influenza season. The study was interrupted April 8 when notice was received of thomboembolic events associated with ChAd0x1, and resumed April 9 with exclusion of participants with risk factors for thrombotic events.

The primary outcome was one or more solicited reports of systemic reaction within 7 days after vaccination such as fever, chills, or joint pains. Secondary outcomes involving safety and adverse response included solicited local reactions such as pain or tenderness and unsolicited adverse events, including medically-attended adverse events.

The secondary outcome of immune response was determined from measures including SARS-CoV-2 S-protein immunoglobulin G (anti-S IgG) concentration in serum collected on day of vaccination (D0) and day 21; and hemagglutinin antibody inhibition (HAI) against the 4 strains of influenza contained in the 2020/21 formulations, on D0, day 21 and day 42. Other immunological measures that will be in a subsequent report include neutralizing antibodies against SARS-CoV-2 on D0 and day 21 and mucosal immune responses to COVID-19 vaccines in saliva.

Lazarus and colleagues reported that, overall, 555/665 (83.5%) of participants had at least one solicited local adverse reaction after vaccination on DO; in 85.2% of those receiving concomitant vaccinations and 81.7% with placebo in lieu of influenza. The numbers with local reactions 7 days after injection were similar in both groups, although higher among those receiving the active combination at day 21. Rates of medically assisted adverse events were similar between groups following both D0 and day 21.

The Anti-S IgG geometric mean units (GMU) at day 21 were similar between those who received either SARS-CoV-2 vaccine alone or with concomitant influenza vaccine. Seroconversion rates (SCR) ranged from 89-100% and 79-93% 21 days after either BNT162b2 or CHAd0x1, respectively, whether administered alone or in combination with influenza vaccine. There were no significant differences in the HAI GMR for any influenza strain 21 days after influenza concomitant vaccination with SARS-CoV-2 vaccine compared to previously studied cohorts receiving influenza vaccination alone.

“By performing the trial in relation to the second rather than the first dose of COVID-19 vaccine, we have evaluated safety and immunogenicity in primed individuals,” Lazarus and colleagues point out. “Therefore, the findings are also likely to be more relevant to the question of concomitant administration of booster doses and seasonal influenza vaccines, which over time may become the ‘norm’ in many parts of the world.”

Source: Infection Control Today

Anti-Nausea Drug May Boost Survival for Some Cancer Patients

Patients who undergo surgery for certain types of cancer may have better short-term survival if they receive a particular anti-nausea drug, a preliminary study suggests.

Among more than 74,000 patients who had cancer surgery, researchers found that those who received the drug — called dexamethasone — were less likely to die in the next 90 days.

The vast majority of all patients survived that long. But those given dexamethasone during surgery were about one-third less likely to die, the study found.

Dexamethasone has gained attention during the pandemic because it was shown to help some patients seriously ill with COVID-19. But the medication, an anti-inflammatory corticosteroid, has a long history of use.

When given during surgery, it helps control postoperative nausea and vomiting.

The new findings suggest dexamethasone might improve short-term survival after some cancer surgeries, said senior researcher Dr. Maximilian Schaefer, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

But to prove that, he said, there would need to be a clinical trial where patients with these cancers were randomly assigned to either receive dexamethasone during surgery or not.

“I think these findings lay the groundwork for clinical trials,” Schaefer said.

He reported the findings Saturday at the annual meeting of the American Society of Anesthesiologists (ASA), in San Diego. Studies presented at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

This study is not the first to look at whether giving dexamethasone during cancer surgery is associated with patients’ short-term survival. Several have investigated the question and have come to mixed conclusions depending on the type of cancer — suggesting no effect, a survival benefit, or a higher risk of death.

In theory, dexamethasone could have both positive and negative effects on survival. The drug, Schaefer said, has been shown to inhibit tumor growth in the lab, but it also suppresses the immune system.

In their study, Schaefer’s team found a survival benefit specifically among patients with cancers considered “non-immunogenic.” That means the cancer does not elicit a strong immune response, and the immune system does not play a major role in controlling its growth.

Those cancers include tumors of the breast, uterus, ovaries, esophagus, pancreas, thyroid, bones and joints.

Among patients who had surgery for those cancers, the study found, about 0.8% of those given dexamethasone died within 90 days. That compared with just over 3% of those who did not receive the anti-nausea drug.

Still, it’s not clear that dexamethasone is responsible for the benefit, said Dr. Juan Cata, a member of the ASA’s Committee on Research, and an associate professor of anesthesiology at MD Anderson Cancer Center in Houston.

“This is a very well-done study,” said Cata, who was not involved in the research.

But, he said, the study was observational: It looked at records from 74,058 patients who had cancer surgery between 2005 and 2020. And in any observational study, Cata said, it’s difficult to account for all the differences between patients who receive a treatment and those who do not.

Schaefer and his team weighed the variables they could, such as patients’ age (dexamethasone is often given to younger patients), sex, indicators of their overall health and whether they’d had chemotherapy before surgery. And patients who received dexamethasone were still one-third less likely to die within 90 days of surgery.

There could, though, be other differences at work, too, according to Cata. He noted that dexamethasone patients were, on average, in surgery significantly longer — and the question is why.

There’s also the question of what caused patients’ deaths. Cata said that deaths within 90 days of surgery are often related to postoperative complications rather the cancer itself.

While the findings do not prove cause and effect, Schaefer said they do have implications for medical practice. They can give anesthesiologists “more confidence,” he said, in giving dexamethasone to patients undergoing surgery for non-immunogenic cancers.

Cata said the drug is an effective and low-cost way to help prevent post-surgery nausea and vomiting — and that alone is meaningful to patients.

Source: HealthDay

What the Latest Research Says about Adding Healthy Years to Your Life

Matt Fuchs wrote . . . . . . . . .

Death comes for us all. But recent research points to interventions in diet, exercise and mental outlook that could slow down aging and age-related diseases – without risky biohacks such as unproven gene therapies. A multidisciplinary approach involving these evidence-based strategies “could get it all right,” said Valter Longo, a biochemist who runs the Longevity Institute at the University of Southern California’s Leonard Davis School of Gerontology.

There’s a debate, however, about how much we can increase our longevity. All humans share 99.9 percent of their genes. This explains why even “super-agers,” born with tiny genetic differences that promote longevity, almost never surpass 110. (Jeanne Louise Calment of France was an outlier, living until the age of 122, the current record.) Some animals make it well beyond that mark, according to Jan Vijg, a molecular geneticist at the Albert Einstein College of Medicine. Scientists know just one way for humans to live 170 years like a giant tortoise: become a giant tortoise.

Some experts do find it likely that someone will set a record for our species by the end of this century. Statisticians have observed a “mortality plateau” for very old people; although the chance of dying in a given year goes up with age, the odds seem to stop increasing after 105. Beyond this plateau, it’s basically a coin toss every year: Heads you’ll see your next birthday, tails you won’t.

But the mortality plateau is often debated. Even if it’s true that the risk of death levels off, this won’t necessarily result in super-agers living longer than before. Susan Alberts, a Duke University primatologist, published a paper that compared the human rate of aging with other primates. The maximum human life expectancy has increased by about three months per year since the mid-1800s, but that can be explained by fewer early and midlife deaths. Alberts found that the rate of decline during old age has stayed the same, mirroring other species. She believes that maximum human life span could be extended by continuing to “avert early and midlife deaths,” which simply increases the pool of people who could live a really long time.

Time will tell who’s right regarding the life span of our species. What’s clear is that certain lifestyles help individuals live longer than they otherwise would – including the genetically blessed. Harvard researchers found that healthy habits add nearly 15 years of life expectancy. “That’s over $100 trillion in health-care savings,” said Harvard biologist David Sinclair.

Not enough Americans can access healthy lifestyles, however, and we’re getting sick and dying earlier across economic levels compared with other countries. People under 65 in the richest areas of the United States have higher mortality than those in the poorest areas of Europe, according to a study published in September. “We’re going to pay if we don’t do something about this rising tide of disabled people,” said Judith Campisi, a biochemist at the Buck Institute for Research on Aging.

Findings from longevity research could support better health in old age, with fewer age-related diseases and disabilities. And interestingly, many scientists believe that a certain amount and type of stress can help, thanks to evolution. As Sinclair wrote in his 2019 book, “Lifespan”: “Our genes didn’t evolve for a life of pampered comfort. A little stress to induce hormesis once in a while likely goes a long way.”

“Hormesis” is a process in which various stressors — such as those related to diet and exercise — seem to activate genes that slow down cell growth and aging.

Using food to trick yourself

Stress that’s good for longevity can be caused by nutrition. Ideally, our ancestors enjoyed protein-rich red meat for peak energy and performance. But when hunting expeditions failed, people resorted to eating hardy plants. Today, our bodies still infer a state of scarcity if we consume lots of vegetables, switching on the longevity genes. Indeed, such a diet is associated with longer lives, according to the Harvard study. Becoming a full-fledged vegetarian probably isn’t necessary, but, to maximize what longevity experts call “healthspan,” at least 50 percent of protein should come from vegetable sources, Longo said.

He advises getting other proteins mostly from fatty fish while moderating your intake of starchy carbohydrates, such as pasta and potatoes. Research has shown that older people who routinely devour such carbs may be more likely to become cognitively impaired. Try to replace them sometimes with foods such as lentils or extra vegetables, which have more fiber and minerals than refined carbs, said Kris Verburgh, a nutrigerontologist and author of “The Longevity Code.”

Another signal of scarcity that seems to switch on longevity genes is the restriction of all foods, which has been shown by decades of animal studies to lengthen life span. Although water-only fasting over several days can be dangerous, “fasting mimicking” diets — very low-calorie five-day eating plans that trick the body into thinking it’s fasting while allowing some foods and nutrients — have been shown to be safer. Longo believes such diets “will play a major part in maximizing longevity.”

Research continues on various fasting regimens. In a preprint review, Matt Kaeberlein, a biogerontologist at the University of Washington, found limited evidence that avoiding food during specific windows of the day, without dropping overall calorie intake, increases life span in mice. When calories are reduced, some genetic strains of mice seem to benefit, but others actually die faster. Calorie restriction “could enhance longevity in some people while shortening lifespan in others,” Kaeberlein wrote.

“We’re beginning to find faults with some extreme diets,” Campisi said. The best approach, she said, “is dietary restriction without malnutrition.” The real benefit of fasting, she added, might simply come from losing weight. “Obesity is a risk factor for inflammation,” and chronic, low-grade inflammation can accelerate aging in a process known as inflammaging.

Sinclair eats just once per day, at dinnertime. “When you eat is perhaps more important than what you eat,” he said, referring to animal studies. “It’s easy to say mice aren’t humans, but there are some broad lessons.”

Exercising, but in moderation

Exercise can further simulate our ancestors’ stressful environments, some experts say, which can dupe your genes into extending your span of health. Just don’t do too much.

In August, the Mayo Clinic published research suggesting an optimal amount of exercise: People who played sports for 2.6 to 4.5 hours per week since the 1990s were about 40 percent less likely to have died than those who exercised less often. Cardio workouts may extend longevity by multiplying mitochondria, the “powerhouses” within cells. When scientists damage mitochondria in mice, the animals die faster, and mitochondrial dysfunction results in inflammaging in humans, Campisi said.

High-intensity interval training, or HIIT, may be particularly effective in adding to longevity. K. Sreekumaran Nair, a Mayo endocrinologist, found that 12 weeks of HIIT reversed many age-related differences in how older people synthesize proteins, buffering their mitochondria. Strength training may also partially reverse aspects of aging.

As with fasting, just don’t go overboard. “Some young guys want to do too much of everything,” Nair said. “There’s no data that working out beyond a certain level gives you better mitochondria.” Being very aerobically fit may reduce mortality risk, but the August paper suggests a Goldilocks sweet spot; exercising more than 10 hours per week was linked to shorter life spans. Previous research has shown an association between extreme exercise and health problems, such as premature aging of the heart.

Nair suggests doing 35 minutes of HIIT three days per week; doing two nonconsecutive days of strength training, focusing on core muscles, arms and legs, with three sets for each muscle group; and taking walks of 7,000 to 10,000 steps on the other two days. He also recommends trying to get at least three minutes of movement after every hour of sitting.

But keep in mind that these diet and exercise regimens can’t magically undo a lifetime of mistakes. A young person’s lifestyle “will echo for decades,” Sinclair warned.

Beyond diet and exercise

Sinclair noted another driver of longevity: long-term, loving relationships. In a nearly 80-year study, researchers found that the most important factor in a long, healthy life was having a close partner. Lynne Charnay, a 96-year-old actress who still performs onstage, attributes her longevity to marital bliss — a double dose of it. “I’ve had not one fabulous husband, but two!” Boxing regularly with her personal trainer in New York doesn’t hurt, either.

Another protective factor: optimism. In 2019, Boston University psychologist Lewina Lee found that optimism was associated with exceptional longevity. Take heart, Debbie Downers: Optimism can be cultivated through interventions. “While optimism is about 25 percent heritable,” Lee told me, “the rest is attributable to environmental influences.” That may partly explain why people entrenched in poverty, with little reason for optimism, die at much younger ages.

But residents of lower-income areas also have limited access to the heathy foods and opportunities cited above. That’s why experts on aging have called for policies that improve access to healthy lifestyles, especially as findings about exercise, nutrition and other anti-aging interventions continue to evolve, promising more years of health to those who can afford them.

“We’re still in the Wright brothers’ days of flight when it comes to longevity,” Sinclair said. “We still have a 747 and a Concorde to come, I hope, within our lifetimes.”

Source: Anchorage Daily News