Want to Prevent Dementia? Follow these WHO New Guidelines

If you want to save your brain, focus on keeping the rest of your body well with exercise and healthy habits rather than popping vitamin pills, new guidelines for preventing dementia advise. About 50 million people currently have dementia, and Alzheimer’s disease is the most common type.

Each year brings 10 million new cases, says the report released Tuesday by the World Health Organization. Although age is the top risk factor, “dementia is not a natural or inevitable consequence of aging,” it says.

Many health conditions and behaviors affect the odds of developing it, and research suggests that a third of cases are preventable, said Maria Carrillo, chief science officer of the Alzheimer’s Association, which has published similar advice.

Since dementia is currently incurable and so many experimental therapies have failed, focusing on prevention may “give us more benefit in the shorter term,” Carrillo said.

Much of the WHO’s advice is common sense, and echoes what the U.S. National Institute on Aging says.

That includes getting enough exercise; treating other health conditions such as diabetes, high blood pressure and high cholesterol; having an active social life, and avoiding or curbing harmful habits such as smoking, overeating and drinking too much alcohol. Evidence is weak that some of these help preserve thinking skills, but they’re known to aid general health, the WHO says.

Eating well, and possibly following a Mediterranean-style diet, may help prevent dementia, the guidelines say. But they take a firm stance against vitamin B or E pills, fish oil or multi-complex supplements that are promoted for brain health because there’s strong research showing they don’t work.

“There is currently no evidence to show that taking these supplements actually reduces the risk of cognitive decline and dementia, and in fact, we know that in high doses these can be harmful,” said the WHO’s Dr. Neerja Chowdhary.

“People should be looking for these nutrients through food … not through supplements,” Carrillo agreed.

The WHO also did not endorse games and other activities aimed at boosting thinking skills. These can be considered for people with normal capacities or mild impairment, but there’s low to very low evidence of benefit.

There’s not enough evidence to recommend antidepressants to reduce dementia risk although they may be used to treat depression, the report says. Hearing aids also may not reduce dementia risk, but older people should be screened for hearing loss and treated accordingly.
Source: CBS


Read the WHO Guidelines Publication:

RISK REDUCTION OF COGNITIVE DECLINE AND DEMENTIA . . . . .


Today’s Comic

Guidance for Preventing Heart Disease, Stroke Released

According to the guideline released by ACC/AHA, any effort to prevent a first instance of cardiovascular disease (called primary prevention) should ideally start with a thorough assessment of one’s risk—that is, estimating how likely someone is to develop blockages in their arteries and have a heart attack or stroke or die as a result. All patients should openly talk with their care team about their current health habits and personal risk for cardiovascular disease and, together, determine the best way to prevent it based on current evidence and personal preferences.

“We have good evidence now for how to identify these very high risk individuals with a physical exam and a good history, and for those at borderline risk there are additional factors that can help us determine who is at greater risk and should, for example, be on a medication like a statin earlier to prevent a cardiovascular event,” Blumenthal said. “In the past, a lot of people may have had a fatalistic attitude that they were going to develop heart problems sooner or later but, in reality, most cardiovascular events can be prevented.”

The document synthesizes the best data and proven interventions for improving diet and exercise, tobacco cessation and optimally controlling other factors that affect one’s likelihood of heart problems and stroke (e.g., obesity, diabetes, high cholesterol and high blood pressure). The document also discusses the challenges that may interfere with individuals being able to integrate better lifestyle habits.

Lifestyle Change Recommendations

The guideline underscores healthy lifestyle changes as the cornerstone of preventing heart disease and goes a step further by providing practical advice based on the latest research.

“We can all do better with our dietary and exercise habits, and that’s so important when we think about wanting to live longer and healthier lives, whether it’s to see our grandchildren grow up or to stay as active as possible in older age,” Blumenthal said.

Some of the key lifestyle recommendations include:

  • Eating heart healthier – choosing more vegetables, fruits, legumes, nuts, whole grains, and fish, and limiting salt, saturated fats, fried foods, processed meats, and sweetened beverages; specific eating plans like the Mediterranean, DASH and vegetarian diets are reviewed.
  • Engaging in regular exercise – experts advise aiming for at least 150 minutes of moderate-intensity exercises such as brisk walking, swimming, dancing or cycling each week. For people who are inactive, some activity is better than none and small 10-minute bursts of activity throughout the day can add up for those with hectic schedules. Currently, only half of American adults are getting enough exercise and prolonged periods of sitting can counteract the benefits of exercise.
  • Aiming for and keeping a healthy weight – for people who are overweight or obese, losing just 5 to 10 percent of their body weight (that would be 10-20 pounds for someone who weighs 200 pounds) can markedly cut their risk of heart disease, stroke and other health issues.
  • Avoiding tobacco by not smoking, vaping or breathing in smoke – 1 in 3 deaths from heart disease is attributable to smoking or exposure to secondhand smoke, so every effort to try to quit through counseling and/or approved cessation medications should be supported and tailored to each individual.

Aspirin Use

For people who’ve had a heart attack, stroke, open heart surgery or stents placed to open clogged arteries, aspirin can be lifesaving. But regular use of aspirin to prevent heart attacks and stroke in healthy people isn’t as clear-cut.

In this guideline, ACC/ AHA experts offer science-based guidance that aspirin should only rarely be used to help prevent heart attacks and stroke in people without known cardiovascular disease. Recent research suggests that the chance of bleeding, given the blood-thinning effect of aspirin, may be too high and the evidence of benefit—the number of heart attacks or strokes that are actually prevented—is not sufficient enough to make a daily aspirin worth taking for most adults in this setting.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” Blumenthal said. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin. Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”

Based on a simplified synopsis of the latest ACC/AHA cholesterol guideline, for primary prevention, statins should be commonly recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low density lipoprotein (LDL) cholesterol levels (≥ 190 mg/dl), Type 2 diabetes, and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors and having a detailed discussion with their clinician.

Diabetes

For people with Type 2 diabetes, which is one of the strongest risk factors for cardiovascular disease, there are new data that two classes of diabetes medications, which work to lower blood sugar levels, can also cut the risk of heart attack, stroke and related deaths.

Source: American Heart Association

Medicare Claims Show Long-term Prostate Cancer Prevention Benefits of the Medication Finasteride

Men who take the medication finasteride get a prostate cancer prevention benefit that can last 16 years – twice as long as previously recorded, according to SWOG clinical trial analysis published in the Journal of the National Cancer Institute.

This finding was made possible by a new research strategy – linking Medicare claims data to clinical trial data, in this case from a landmark study run by SWOG, the federally funded cancer clinical trial network. The SWOG study, known as the Prostate Cancer Prevention Trial, or PCPT, set out to see whether finasteride, a drug used to treat symptoms of prostate enlargement as well as male pattern baldness, would prevent prostate cancer in men over the age of 55. The study enrolled 18,882 men from 1993-1997. It was stopped in 2003 when investigators learned that finasteride reduced prostate cancer risk by 25 percent when compared with a placebo. SWOG leader Ian Thompson, Jr., MD, of CHRISTUS Santa Rosa Hospital Health System, was the study chair of PCPT.

Joseph Unger, PhD, a SWOG biostatistician and health services researcher from Fred Hutchinson Cancer Research Center, has a track record of using new research methods to answer bigger, bolder questions about cancer prevention and treatment. Along with SWOG colleague Dr. Dawn Hershman, Unger has pioneered for a decade the use of secondary sources of data, such as Medicare claims, U.S. Census Bureau data, and public health statistics from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, to examine new hypotheses.

For this study, Unger wanted to know if the protective effects of finasteride lasted longer than seven years – the amount of follow-up evaluated in the PCPT. Answering this question would typically require reopening the old study, reconnecting with patients, and conducting extensive follow-up – an expensive and time-consuming proposition. But Unger took another tack, requesting and obtaining a data use agreement from the federal Centers for Medicare & Medicaid Services to access to records from Medicare, the health insurance program for people over 65.

Using patient information from the PCPT, Unger linked patients enrolled in the PCPT to their Medicare claims from 1999 through 2011. The team was surprised to find they were able to successfully link 75 percent of PCPT trial participants. Unger and colleagues at Fred Hutch created an algorithm to flag a prostate cancer diagnosis in the Medicare data, and examined the diagnoses over time. The team identified 3,244 PCPT participants who were later diagnosed with prostate cancer over a median follow-up of 16 years, and found that participants on the PCPT that took finasteride had a 21 percent decreased risk of getting prostate cancer, compared to those who took a placebo drug, over the course of those 16 years.

“These findings raise the intriguing possibility that seven years of finasteride can reduce prostate cancer diagnoses over a much longer period than was previously shown,” Unger said. “It’s a low-cost generic drug, with minimal side effects, that can have a benefit that lasts long after men stop taking it.”

At the same time, Unger said, the SWOG study shows the value of using Medicare claims to extend follow-up for trial participants and answer new questions about cancer care and prevention. “These secondary data sources are emerging as a new paradigm for long-term follow up for cancer clinical trials,” he said. “It’s an exciting new avenue of research.”

Source: SWOG


Today’s Comic

Should You Take Daily Aspirin for Your Heart?

Lindsey Konkel wrote . . . . . . .

About 30 percent of adults in the U.S. age 65 and older report taking  aspirin daily to prevent a heart attack or stroke. This over-the-counter (OTC) pain reliever can be a lifesaver, but regular use may cause serious side effects, notably internal bleeding.

Here’s expert advice on who should and shouldn’t take daily aspirin, and if you do, how to take it safely.

Risks and Benefits of Daily Aspirin

Cardiovascular disease, or CVD, is often caused by narrowed arteries. Aspirin is an antiplatelet medication. That means it prevents platelets (a type of blood cell) from clumping together and forming blood clots in those arteries.

For people with established CVD, especially those who have already had a heart attack or stroke, there’s strong evidence that taking a daily aspirin significantly lowers the risk of a second cardiovascular event, says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser.

The net benefits of daily aspirin use are less clear-cut for older adults who are only at moderate risk of CVD.

Here’s why: Although age can boost the likelihood of cardiac events that may be prevented by daily aspirin use, it can also raise the risk of internal bleeding. A study published in The Lancet in June 2017, for instance, showed that the risk of serious, potentially fatal gastrointestinal (GI) bleeding was highest in people age 75 and older.

However, the U.S. Preventive Services Task Force, an independent group that develops recommendations on preventive healthcare, says there is currently insufficient evidence to assess the benefits and harm of aspirin in adults age 70 and older.­­

“The best approach is to have a discussion with your healthcare provider about the potential risks and benefits of aspirin therapy for you specifically,” says Samia Mora, M.D., a cardiologist at Brigham and Women’s Hospital in Boston.

Online calculators for GI bleeding risk and heart risk, such as Aspirin-Guide and Heart Risk Calculator, can help facilitate shared decision-making between you and your provider, she adds.

Using Daily Aspirin Safely

If you and your doctor determine that daily aspirin is appropriate for you, take smart steps. Because the risk of bleeding rises with dosage, take the lowest possible amount. “For most people, that’s an 81 mg ‘baby aspirin,’ ” Mora says.

Your doctor may also recommend the use of a medication known as a proton pump inhibitor (PPI), such as lansoprazole (Prevacid and generic) and omeprazole (Prilosec and generic), or an antacid—especially if you’re at higher risk for internal bleeding (this includes those with a history of ulcers, clotting disorder, or heavy alcohol use) but need daily aspirin for the protection of your heart.

PPIs help safeguard against gastrointestinal bleeding. But regular use has been linked to increased susceptibility to hip fracture and serious bacterial infections, such as Clostridium difficile, and pneumonia.

Some OTC painkillers, such as ibuprofen (Advil and generic), can interfere with aspirin’s heart-protecting action. So for pain relief, use acetaminophen (Tylenol and generic) instead. If you must use ibuprofen, the Food and Drug Administration says it’s best to wait 30 minutes or more after taking aspirin.

If you’re thinking about stopping your daily aspirin regimen, be sure to discuss it with your doctor first. Quitting suddenly may be risky for long-time users. A Swedish study published in September 2017 in the journal Circulation found that those who did faced a 37 percent increased risk of heart attack or stroke.

What About Cancer Protection?

The long-term use of daily low-dose aspirin appears to lower the risk of colorectal cancer. But the task force doesn’t recommend it solely for cancer prevention.

It recommends low-dose daily aspirin for the prevention of CVD and colorectal cancer only for people age 50 to 59 who also are at risk for CVD in the next 10 years and meet other criteria.

Other ways to cut your risk of colorectal cancer include regular exercise, quitting smoking, and upping your intake of fruits and vegetables while cutting red and processed meats from your diet, says Mora.

If you have a strong family history of colorectal cancer, Mora suggests that you talk to your doctor about appropriate strategies.

Source: Consumer Report


Read also:

The Aspirin-Guide app from researchers at Brigham and Women’s Hospital, Harvard Medical School . . . . .

Heart Risk Calculator . . . . .