Daily Archives: 18 August 2024

Urban Parks and Waterways Associated with Reduced Coronary Artery Calcification

Access to urban green and blue spaces significantly reduces the likelihood of coronary artery calcification among middle-aged individuals, serving as an early indicator of cardiovascular diseases. This correlation is robust in Black individuals and those from lower socio-economic backgrounds, with the most pronounced effects observed among Black residents in economically disadvantaged areas. Black participants with substantial access to river areas showed a 32% decrease in the likelihood of coronary artery calcification compared to those with minimal access, while increased exposure to green spaces correlated with up to a 35% reduction in calcification odds for Black participants. Additionally, a 10% increase in green space exposure correlated with an average 15% reduction in calcification odds.

These findings were recently published in the journal Circulation on June 27. Coronary artery calcification involves the buildup of calcium within the plaque on the walls of the coronary arteries, an early sign of coronary artery disease that could lead to a heart attack. Dr. Lifang Hou, the corresponding author and a professor of preventive medicine at Northwestern University Feinberg School of Medicine, highlighted the protective role of urban green and blue spaces against coronary artery calcification. Dr Hou pointed out that these environments are especially beneficial for underprivileged groups at increased risk of cardiovascular diseases, advocating for environmental policies that enhance access and the quality of urban natural spaces to promote public health and address disparities related to race and neighbourhood.

The health benefits associated with green and blue spaces are numerous, including increased opportunities for physical activity, social interactions, stress relief, and environmental restoration. Such exposures also boost immune function, reduce chronic inflammation, and slow down the biological ageing process—all crucial factors in improving overall and cardiovascular health. Dr. Hou noted the importance of further research to comprehend how urban natural settings can fully influence health pathways.

However, the study also indicated that proximity to parks could adversely affect specific neighbourhoods. Individuals residing closer to parks in these areas faced a 29% higher chance of developing coronary artery calcification compared to those with lesser access. The poor condition of these parks or related safety concerns might deter their use, preventing residents from fully benefiting from these spaces. Kyeezu Kim, the study’s first author and adjunct assistant professor of preventive medicine at Feinberg, as well as an associate professor at Sungkyunkwan University School of Medicine in South Korea, emphasised the need for improved management and quality control of park environments in socio-economically challenged neighbourhoods. This approach is crucial for maximising the public health benefits of urban spaces, and further data is warranted to explain these observations fully.

Dr Hou and the research team’s findings underscore the potential public health benefits of improving access to and quality residential blue and green spaces. Such measures can promote health benefits and address racial and neighbourhood-related health disparities, providing quantitative evidence supporting environmental policies to enhance urban natural environments for the well-being of all residents, especially those in underserved communities.

More information: Kyeezu Kim et al, Associations of Urban Blue and Green Spaces With Coronary Artery Calcification in Black Individuals and Disadvantaged Neighborhoods, Circulation. DOI: 10.1161/CIRCULATIONAHA.123.067992

Journal information: Circulation Provided by Northwestern University

Mediterranean Diet Linked to a 20% Decreased Mortality Risk in Women

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Researchers at Brigham and Women’s Hospital have explored potential mechanisms behind the 23 per cent reduction in mortality risk among American women adhering to the Mediterranean diet. This diet’s health benefits are well-documented, yet there has been a lack of long-term data on its effects in U.S. women and a limited understanding of the mechanisms driving its efficacy. In a landmark study, over 25,000 initially healthy U.S. women were monitored for up to 25 years. The study, led by Brigham and Women’s Hospital, part of the Mass General Brigham healthcare system, found significant reductions in all-cause mortality, particularly from cancer and cardiovascular diseases. Researchers noted biological changes in metabolism, inflammation, and insulin resistance, which might explain the observed benefits.

Dr. Samia Mora, MD, the senior author of the study and director of the Center for Lipid Metabolomics at Brigham, played a pivotal role in the research. She underscored the impact of dietary habits on longevity, highlighting that adhering to a Mediterranean diet could reduce the risk of death by approximately a quarter over more than 25 years. The Mediterranean diet, primarily plant-based, includes a large variety of nuts, seeds, fruits, vegetables, whole grains, and legumes, with olive oil as the main source of fat. It also allows for moderate consumption of fish, poultry, dairy, and eggs, with minimal intake of red meats, sweets, and processed foods.

The study tracked the long-term health benefits of the Mediterranean diet and investigated the biological pathways that might explain these benefits. About 40 biomarkers were evaluated, covering different biological pathways and clinical risk factors. Key findings pointed to metabolism and inflammation as significant contributors, supplemented by other factors like triglyceride-rich lipoproteins and insulin resistance. Smaller contributions came from pathways related to branched-chain amino acids, various lipoproteins, glycemic measures, and hypertension.

Dr. Shafqat Ahmad, PhD, the lead author of the study and an associate professor of Epidemiology at Uppsala University in Sweden, highlighted the potential public health implications of these findings. He noted that modest changes in risk factors for metabolic diseases could yield substantial long-term benefits, advocating for dietary adjustments to reduce overall mortality risks. The study’s results, published in JAMA, are promising but come with caveats due to the demographic specificity of the participants—primarily middle-aged, well-educated, non-Hispanic white female health professionals—and the reliance on self-reported data such as food-frequency questionnaires and measurements of height, weight, and blood pressure.

Despite these limitations, the extensive scale and lengthy follow-up period are significant to the study’s conclusions. As the Mediterranean diet gains popularity worldwide, variations have emerged, adapting to different cultural and dietary traditions. Dr. Mora calls for public health policies to promote the Mediterranean diet’s healthful attributes and discourage less beneficial adaptations. The study highlights the health benefits of the Mediterranean diet and provides valuable insights into why it may be so effective at improving longevity and reducing mortality from major diseases.

More information: Shafqat Ahmad et al, Mediterranean Diet Adherence and Risk of All-Cause Mortality in Women, JAMA. DOI: 10.1001/jamanetworkopen.2024.14322

Journal information: JAMA Provided by Brigham and Women’s Hospital

A Groundbreaking Study by HKUMed and Harvard Reveals Statins Lower Cardiovascular Disease Risk by Over 20% in Hong Kong Seniors with High Cholesterol

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Researchers from HKUMed’s LKS Faculty of Medicine and Harvard’s TH Chan School of Public Health have unveiled the first comprehensive evidence supporting the efficacy of statins in elderly patients, dispelling long-standing uncertainties. This compelling evidence underscores that consistent statin therapy significantly reduces the relative risk of cardiovascular diseases by 21% in individuals aged 75–84 and 35% in those aged 85 and above, with no significant increase in safety concerns.

This groundbreaking study is a significant contribution to the field of geriatric medicine, providing robust, real-world evidence of the benefits of statin usage in older populations through sophisticated analytical techniques. These findings, which have been published in the prestigious ‘Annals of Internal Medicine’, mark a significant step forward in our understanding of cardiovascular disease prevention in the elderly.

Cardiovascular disease remains a primary health concern globally, particularly within ageing populations. Managing high cholesterol effectively is vital for preventing these diseases. Recent data from Hong Kong’s ‘Population Health Survey’ show that 65.6% of people aged 65–84 suffer from high cholesterol. While statins have long been utilised to enhance lipid profiles and mitigate cardiovascular disease risks, there’s been a lack of consensus regarding their use for primary prevention in those over 75. This uncertainty often stems from the inadequate representation of older adults in randomised controlled trials, which leaves significant clinical questions unanswered in everyday healthcare settings. This study leverages real-world data to explore statin therapy’s long-term advantages and potential risks in older adults, aiding in informed decision-making about initiating statin treatment in this expanding demographic.

The study’s research team, led by Professor Eric Wan Yuk-fai from the Department of Family Medicine and Primary Care and the Department of Pharmacology and Pharmacy at HKUMed, analysed public electronic medical records from Hong Kong’s Hospital Authority covering January 2008 to December 2018. This involved over 80,000 older individuals with suboptimal lipid levels and conditions that heightened their risk of cardiovascular diseases, such as diabetes. They employed a novel method known as target trial emulation, which mimics the characteristics of randomised controlled trials within the framework of an observational study, greatly diminishing the typical biases associated with observational research.

The results revealed that continuous statin use correlated with a 21% reduction in relative risk and a 5% absolute risk reduction over five years in cardiovascular diseases among individuals aged 75–84. For those aged 85 and older, the relative risk reduction reached an even more impressive 35%, with an absolute risk reduction of 12.5% over five years. Furthermore, the study identified no significant increase in the risk of major adverse events such as liver dysfunction or myopathies in this demographic.

The study’s findings have global relevance, affirming the safety and efficacy of statins for the primary prevention of cardiovascular diseases in older adults. It indicates that advanced age alone should not preclude high-risk patients from the benefits of statin therapy. With the global burden of cardiovascular diseases in ageing populations on the rise, this research provides crucial evidence supporting the prescription of statins for primary prevention in these vulnerable groups, regardless of geographical location.

Professor Cindy Lam Lo-kuen, from HKUMed’s Department of Family Medicine and Primary Care, highlighted the implications of these findings for clinical decision-making regarding statin therapy initiation in this growing population segment. The study’s innovative approach, particularly the use of target trial emulation, not only paves the way for future research in geriatric medicine but also has the potential to significantly improve healthcare outcomes for older populations globally. This method can produce valuable insights into the care of the elderly, thus enhancing healthcare outcomes for older populations globally.

More information: Wanchun Xu et al, Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study, Annals of Internal Medicine. DOI: 10.7326/M24-0004

Journal information: Annals of Internal Medicine Provided by The University of Hong Kong

Significant Biomolecular Changes Detected in Our 40s and 60s, Reveals Stanford Medicine Study

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If you’ve ever felt like your entire body is breaking down simultaneously, it might not just be in your head. A new study from Stanford Medicine has revealed that significant molecular and microbial shifts occur during our 40s and 60s. Researchers examined thousands of molecules in people aged 25 to 75 and their microbiomes—bacteria, viruses, and fungi- within and on our bodies. Contrary to gradual changes, the study found two significant periods of rapid transformation around the ages of 44 and 60. These findings, detailed in an upcoming paper in Nature Aging, highlight gradual biological changes and pronounced shifts at specific intervals, according to Michael Snyder, PhD, chair of genetics at Stanford and the study’s senior author.

The research, led by Xiaotao Shen, PhD, a former Stanford Medicine postdoctoral scholar now at Nanyang Technological University Singapore, suggests these shifts significantly impact our health. For example, the abundance of molecules related to cardiovascular health and immune function shows marked changes at these age milestones. This research initiative stemmed from the observation that the risk of age-related diseases such as Alzheimer’s and cardiovascular disease doesn’t increase linearly but spikes in older age, prompting an investigation into the molecular and microbial change rate across ages.

Snyder’s team worked with data from 108 individuals, monitoring them over several years through regular blood donations and other biological samples. This enabled the tracking of a diverse range of molecules, including RNA, proteins, and metabolites, as well as microbiome changes. From this vast data collection—encompassing more than 135,000 different molecules and microbes totalling nearly 250 billion data points—they discovered that about 81% of all molecules exhibited non-linear changes, fluctuating more significantly around the mid-40s and early 60s.

While much of the existing research on ageing focuses on how molecular levels typically increase or decrease over time, this study is one of the few to explore the rate at which these biological changes occur. Snyder commented on the abundance of dramatic changes particularly noted in the early 60s, aligning with the age-related increase in disease risks and other ageing phenomena. The team was initially surprised to find significant molecular changes in the mid-40s as well, which they first thought might be influenced by menopause or perimenopause in women. However, further analysis indicated that similar shifts were occurring in men, suggesting that other significant factors affect these changes in both genders.

Shen emphasized the need for further research to identify and understand these factors, which appear crucial in men and women during their mid-40s. The study’s findings suggest that these age-related changes could be linked to lifestyle or behavioural factors prevalent in these age groups rather than purely biological causes. For instance, dysfunction in alcohol metabolism might emerge from increased consumption during the mid-40s, often a stressful period.

As the research team plans to explore the underlying causes of these clusters of changes, the implications of their findings are clear. These age-specific shifts necessitate a greater focus on health management during critical life stages. Practical steps include boosting physical activity to protect heart health and muscle mass and moderating alcohol consumption as the body’s processing ability wanes. Snyder advocates for proactive lifestyle adjustments to maintain health and vitality, emphasizing, “I firmly believe that we should try to adjust our lifestyles while we’re still healthy.” This study sheds light on when and how biological changes occur and underscores the importance of anticipating and adapting to these changes to enhance health outcomes as we age.

More information: Xiaotao Shen et al, Nonlinear dynamics of multi-omics profiles during human aging, Nature Aging. DOI: 10.1038/s43587-024-00692-2

Journal information: Nature Aging Provided by Stanford Medicine