After a Stroke, Diabetes Could Worsen Brain Function

Having Type 2 diabetes could cause cognitive impairment in stroke survivors, according to new research that points out the need to aggressively treat prediabetes.

A new analysis of seven international studies found that three to six months after a stroke, the participants with diabetes functioned worse than those without diabetes on measures for memory, attention, mental flexibility, processing speed, language and other examples of cognitive function.

“That’s why Type 2 diabetes is another important target in the prevention of dementia, and the focus should be on early treatment for prediabetes to delay or prevent the progression to Type 2 diabetes,” Dr. Perminder Sachdev said in a news release. She is the study’s senior author and scientia professor at UNSW Sydney’s Centre for Healthy Brain Ageing in Kensington, Australia.

Previous research by Sachdev and colleagues determined that stroke patients with a diabetes history had worse brain function than those without the condition. But this new work, published Thursday in the American Heart Association’s journal Stroke, looked at whether that held true for people with prediabetes.

“This is important because prediabetes is very common, and individuals can have prediabetes for several years before progressing to Type 2 diabetes,” Sachdev said. “Early and aggressive treatment of prediabetes can delay or prevent Type 2 diabetes. If we target the treatment of prediabetes, could this prevent the development of dementia in some individuals?”

The analysis included data from 1,601 stroke patients in Australia, France, Korea, the Netherlands, Singapore and the United States. Their average age was 66 and almost all had clot-caused strokes. Overall, 70% were Asian, 26% white and 2.6% African American.

Fasting blood sugar levels measured at hospital admission and medical history were used to define Type 2 diabetes and prediabetes. But the study was limited by not having information about the duration and severity of diabetes and having only one blood sugar measurement.

After adjusting for age, sex and education, researchers found “significantly poorer” function in stroke survivors with diabetes – but not in those with prediabetes. The findings held up even after researchers adjusted for additional factors such as ethnicity, high blood pressure, smoking, body mass index, abnormal heart rhythm and previous stroke.

“The deficits we found in all areas of cognitive function highlight the importance of assessing the capacity for self-care in patients with Type 2 diabetes following a stroke,” Jess Lo, lead author of the study, said in a news release. She is a research associate at UNSW Sydney’s Centre for Healthy Brain Ageing.

Health care providers should ensure stroke survivors have the mental competency to fulfill the complex tasks needed to manage diabetes, Lo said.

That “can include measuring glucose levels multiple times a day, managing glucose monitoring devices, adjusting medication doses, self-administering insulin or other medications, and understanding food labels and portion sizes to adjust what is eaten at each meal or snack.”

Source: American Heart Association


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Even 1 Sugary Drink a Day Could Boost Heart Disease, Stroke Risk in Women

Women who drink one or more sugar-laden beverages – such as soda, sweetened water and teas, and fruit drinks – every day could boost their risk of cardiovascular disease by 20% compared to women who rarely or never drink them, according to new research.

The daily drinks also were associated with a 26% higher likelihood of needing a procedure to open clogged arteries, such as angioplasty, and a 21% higher chance of having a stroke.

“Although the study is observational and does not prove cause and effect, we hypothesize that sugar may increase the risk of cardiovascular diseases in several ways,” senior study author Cheryl Anderson said in a news release. She is professor and interim chair of family and public health at the University of California San Diego. “It raises glucose levels and insulin concentrations in the blood, which may increase appetite and lead to obesity, a major risk factor for cardiovascular disease.”

The research, part of the ongoing California Teacher’s Study that began in 1995, included more than 106,000 women who reported how much and what they drank via a food questionnaire. Participants, whose average age was 52, had not been diagnosed with heart disease, stroke or diabetes when they enrolled in the study. The work was published Wednesday in the Journal of the American Heart Association.

Anderson, chair of the AHA’s nutrition committee, said too much sugar in the blood also is linked to “oxidative stress and inflammation, insulin resistance, unhealthy cholesterol profiles and Type 2 diabetes, conditions that are strongly linked to the development of atherosclerosis, the slow narrowing of the arteries that underlies most cardiovascular disease.”

Women who drank the most sugar-sweetened beverages were younger, more likely to be current smokers, obese and less likely to eat healthy foods.

The new study defined sugary beverages as caloric soft drinks, sweetened bottled waters or teas and sugar-added fruit drinks, not 100% fruit juices.

The kind of sugary drinks women chose made a difference. One or more sugar-added fruit drinks a day was associated with a 42% greater likelihood of developing cardiovascular disease compared to women who rarely or never drank them. With soft drinks, that likelihood was 23%.

The study was limited by having only one measurement of sugar-sweetened beverage intake, and it also was unable to evaluate consumption of artificially sweetened beverages and/or sweetened hot beverages.

Sugar-sweetened beverages are the biggest source of added sugars in the American diet; a typical 12-ounce can of regular soda has 130 calories and 8 teaspoons (34 grams) of sugar.

The AHA recommends limiting added sugar to no more than 100 calories a day, which is about 6 teaspoons, or 25 grams, for most women. For men, the recommendation is no more than 150 calories a day, which is about 9 teaspoons of sugar or 38 grams.

Source: American Heart Association

Heavy Drinking Could Lead to Stroke, Peripheral Artery Disease

Drinking high amounts of alcohol may be linked to increased risk of stroke or peripheral artery disease – the narrowing of arteries in the legs, according to new genetic research.

The study, published Tuesday in Circulation: Genomic and Precision Medicine, used a technique called Mendelian randomization that identifies genetic variants. While observational studies have shown similar results, this new work provides insights through a different lens.

“Since genetic variants are determined at conception and cannot be affected by subsequent environmental factors, this technique allows us to better determine whether a risk factor – in this case, heavy alcohol consumption – is the cause of a disease, or if it is simply associated,” the study’s lead author, Susanna Larsson, said in a news release. Larsson is senior researcher and associate professor of cardiovascular and nutritional epidemiology at Karolinska Institutet in Stockholm, Sweden. “To our knowledge, this is the first study of its kind on alcohol consumption and several cardiovascular diseases.”

Genetic data from more than 500,000 United Kingdom residents showed higher alcohol intake contributed to a threefold increase of peripheral artery disease, a 27% increase in stroke risk, and a potential link to coronary artery disease, atrial fibrillation and aortic aneurysm.

“Higher alcohol consumption is a known cause of death and disability, yet it was previously unclear if alcohol consumption is also a cause of cardiovascular disease,” Larsson said. “Considering that many people consume alcohol regularly, it is important to disentangle any risks or benefits.”

Researchers suggest the heightened risk of stroke and PAD could be caused by higher blood pressure.

The American Heart Association’s statement on dietary health suggests alcohol intake can be part of a healthy diet if consumed in moderation – that is, no more than one drink a day for non-pregnant women and two drinks a day for men. The statement notes potential risks of alcohol on existing health conditions, medication-alcohol interaction or personal safety and work situations.

The prevalence of heavy drinking among participants was low, which researchers say is a limitation of the study.

Source: American Heart Association

Women’s Lifestyle Changes, Even in Middle Age, May Reduce Future Stroke Risk

Middle age may not be too late for women to substantially reduce their stroke risk by not smoking, exercising, maintaining a healthy weight and making healthy food choices, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

In general, women are more likely than men to have a stroke, die from stroke and have poorer health and physical function after a stroke. The average age of first stroke in women is 75 years. Based on this information, researchers theorized that making mid-life lifestyle changes might help reduce stroke’s burden among women.

“We found that changing to a healthy lifestyle, even in your 50s, still has the potential to prevent strokes,” said Goodarz Danaei, Sc.D., lead study author and Bernard Lown Associate Professor of Cardiovascular Health at Harvard T.H. Chan School of Public Health in Boston. “Women who made lifestyle modifications in middle age reduced their long-term risk of total stroke by nearly a quarter and ischemic stroke, the most common type of stroke, by more than one-third.”

Researchers analyzed the Nurses’ Health Study, which includes health information on nearly 60,000 women who enrolled at average age of 52 and continued in the study for an average of 26 years. Researchers studied the impact on stroke risk from smoking cessation, exercising 30 minutes or more daily and gradual weight loss if women were overweight. The researchers also studied the impact of making recommended dietary modifications that emphasize eating more fish, nuts, whole grains, fruits and vegetables and less red meat, no processed meat and less alcohol.

During the 26-year follow-up, researchers found:

  • 4.7% of women with no lifestyle interventions had a stroke of any type; 2.4% had ischemic stroke; and 0.7% had hemorrhagic stroke.
  • Engaging in the three non-dietary interventions — smoking cessation, daily exercise and weight loss — was estimated to reduce the risk of total stroke by 25% and ischemic stroke by 36%.
  • Sustained dietary modifications were estimated to reduce the risk of total stroke by 23%.

Researchers also found that increasing fish and nut consumption and reducing unprocessed red meat consumption appeared to have positive impacts on reducing stroke risk, although the degree of impact from these dietary changes was not as big as those achieved through increased physical activity, smoking cessation and maintaining a healthy weight.

While this was an observational study that included mostly white, middle-aged women, Danaei said, “there are other studies to support that the proportional changes in stroke risk from lifestyle and dietary modifications may be generalizable to men. We also estimate that exercising 30 minutes or more daily may reduce the risk of stroke by 20%.”

Source: American Heart Association


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Could this Toothpaste Prevent a Heart Attack or Stroke?

Gisele Galoustian wrote . . . . . . . . .

For decades, researchers have suggested a link between oral health and inflammatory diseases affecting the entire body — in particular, heart attacks and strokes. Inflammation is intimately involved in the pathogenesis of atherosclerosis and is accurately measured by high sensitivity C-reactive protein (hs-CRP), a sensitive marker for future risks of heart attacks and strokes.

Researchers from Florida Atlantic University’s Schmidt College of Medicine, Marshfield Clinic Research Institute, and the University of Wisconsin School of Medicine and Public Health, collaborated on a randomized trial titled, “Correlation between Oral Health and Systemic Inflammation” (COHESION), to further explore whether Plaque HD®, a plaque identifying toothpaste, reduces hs-CRP.

Results of the randomized pilot trial, published online ahead of print in the American Journal of Medicine , showed that Plaque HD® produced a statistically significant reduction in hs-CRP among those with elevations at baseline. Plaque HD® is the first toothpaste that identifies plaque so that it can be removed with directed brushing. In addition, the product’s proprietary formulation contains unique combinations and concentrations of cleaning agents that weaken the core of the plaque structure to help the subject visualize and more effectively remove the plaque.

In this trial, all randomized subjects were given the same brushing protocol and received a 30-day supply of toothpaste containing either Plaque HD® or an identical non-plaque identifying placebo toothpaste. To assess hs-CRP, levels were measured by Quest Diagnostics using an enzyme linked immunosorbent assay.

“The current findings are similar to those from our previous pilot trial,” said Charles H. Hennekens, M.D., Dr.P.H., senior author, first Sir Richard Doll Professor, and senior academic advisor in FAU’s Schmidt College of Medicine. “Whether this plaque-identifying toothpaste decreases heart attacks or strokes requires a large-scale randomized trial of sufficient size and duration. These results provide a stronger rationale to conduct such trials. If positive, the results of these trials would have significant potential clinical and public health implications.”

Based on these findings, Hennekens and colleagues at FAU and the University of Wisconsin School of Medicine and Public Health are drafting an investigator-initiated research grant proposal to the National Institutes of Health (NIH). Their proposed randomized trial will test whether Plaque HD® reduces progression of atherosclerosis in the coronary and carotid arteries, for which systemic inflammation is an important precursor.

A report from the United States Centers for Disease Control and Prevention found that 47.2 percent of American adults aged 30 years and older have some form of periodontal disease, a pathological inflammatory condition of the gums and tissues surrounding the teeth. Periodontal disease increases with age affecting more than 70 percent of adults 65 years and older. Prior research has suggested that periodontal disease may be connected to a variety of other diseases, including heart disease and stroke and other inflammatory diseases such as rheumatoid arthritis. Inflammation throughout the body may be a crucial link between periodontal and other systemic diseases.

Further, two years ago, the prestigious New England Journal of Medicine ranked the original manuscript published in 1997 by Hennekens and colleagues on aspirin, inflammation and cardiovascular disease, as their most influential original report of the last 20 years. Those randomized data derived from the landmark Physician’s Health Study, in which Hennekens was the founding principal investigator, and suggested that hs-CRP predicted future heart attacks and strokes.

Source: Florida Atlantic University


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