Daily Archives: 25 August 2024

The Outbreak Worsened Depression Among Elderly Diabetics

A recent investigation involving over 2,700 senior Canadians revealed that older adults with diabetes encountered an increased risk of depression amid the COVID-19 pandemic. Within this group, nearly half of those previously diagnosed with depression reported depressive episodes during the pandemic. Loneliness emerged as a significant factor exacerbating the situation. ZhiDi Deng, a clinical pharmacist and the study’s lead author, observed, “The pandemic considerably amplified the risk of depression among elderly individuals with diabetes due to loneliness. This not only underscores the mental health challenges imposed by quarantines and lockdowns but also points to the necessity for enhancing service delivery to this demographic in future public health emergencies.”

While those without a prior history of depression were less affected, one in eight still suffered from depression in late 2020. Grace Li, a co-author and research assistant at the University of Toronto’s Institute for Life Course and Aging, emphasized, “The pandemic has profoundly affected the mental well-being of all, particularly those older adults with chronic diseases like diabetes. It’s crucial for primary health caregivers to stay alert for depression signs in their elderly patients, even those who previously coped well.” The study also pinpointed additional risk factors for depression among diabetic patients, including gender, physical limitations, chronic pain, and family conflicts.

Some findings were contrary to expectations. It was noted that individuals who were separated, divorced, or widowed had lower rates of recurring depression during the pandemic compared to those married or in common-law relationships. Dorina Cadar, co-author and Senior Lecturer in Neuroepidemiology and Dementia at the Brighton and Sussex Medical School suggested, “Contrary to pre-pandemic data which showed married people as generally less depressed, our study found that marital status might have negatively impacted mental health during the pandemic due to prolonged close proximity and potential exacerbation of relational conflicts.”

Another surprising result was the higher depression risk among wealthier individuals compared to their less affluent counterparts during the pandemic—a reversal of pre-pandemic trends. Maria Rowsell, another co-author, theorized, “This could be influenced by the Canadian Emergency Response Benefit, which provided a $2000 monthly income to those who lost jobs, potentially alleviating financial stress among lower-income Canadians and inadvertently impacting their mental health more positively.” The study utilized data from the Canadian Longitudinal Study on Aging and involved individuals with diabetes, including 1,757 without and 973 with a history of depression before the pandemic. These findings were recently published in Archives of Gerontology and Geriatrics Plus.

Professor Esme Fuller-Thomson, the senior author and Director at the Institute for Life Course and Aging, concluded, “The pandemic’s impact extends well beyond physical health, highlighting the urgent need to enhance mental health services accessibility for those with diabetes, particularly during stressful periods. Effective interventions such as cognitive behavioural therapy and psychoeducation should be more accessible to support the mental health of those with coexisting depression and diabetes.” This study not only sheds light on the direct impacts of the pandemic on vulnerable populations but also offers insights into how health policy and support systems can adapt to better address the complex interplay of chronic illness and mental health in crises.

More information: ZhiDi Deng et al, Exploring the Impact of the COVID-19 Pandemic on Depression in middle-aged and older Canadians with Diabetes: Insights on Incidence, Recurrence, and Risk Factors from the Canadian Longitudinal Study on Aging, Archives of Gerontology and Geriatrics Plus. DOI: 10.1016/j.aggp.2024.100065

Journal information: Archives of Gerontology and Geriatrics Plus Provided by University of Toronto

Declines in Heart Attack and Stroke Risk Over Three Decades Exclude Lower Income US Adults

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Over the past three decades, while heart disease mortality has sharply decreased across the United States, a recent study highlights that these cardiovascular benefits have predominantly benefited higher-income groups. Among lower-income communities, there has been little to no improvement in heart attack rates, with some instances worsening over the 30 years.

Adam Richards, an associate professor of global health and medicine at George Washington University, pointed out that the improvements in cardiovascular health have not been uniformly distributed. “The past thirty years have shown an unequal decline in cardiovascular health, necessitating a closer examination of healthcare accessibility and other social determinants of health that disproportionately impact cardiovascular risks in low-income families,” Richards explained.

Richards and his team analysed data from national surveys involving nearly 27,000 individuals aged between 40 and 75 who had no history of heart attacks or strokes. They assessed the estimated 10-year risk of cardiovascular disease for each six-year study segment. Initially disregarding income, the overall national data from 1988 to 2018 indicated improvements in cardiovascular disease rates.

However, when income was considered, disparities became evident. While the wealthiest portion of the population saw their 10-year cardiovascular risk decrease from 7.7% to 5.1%, and the second wealthiest group experienced a reduction from 7.6% to 6.1%, the risk for the lowest income group remained consistently high, above 8%.

The scope of the study should have included investigating the root causes of these disparities. Nonetheless, other studies suggest that about half of the reduction in cardiovascular mortality can be attributed to better treatments and risk factor management, with disparities in treatment accessibility and risk factor prevalence likely contributing to the growing socioeconomic inequalities in health.

Richards also noted that the U.S., unique among high-income nations, lacks a universal health insurance system, placing significant obstacles in the path of low-income individuals, even those insured. These barriers include financial constraints and difficulties related to transportation. He highlighted the broader socioeconomic influences, such as income and social status, significantly shaping health outcomes. In the U.S., issues like tobacco use, obesity, and diabetes are increasingly concentrated among low-income populations. Compared to other developed nations, the U.S. invests less in social health determinants, such as paid childcare, medical leave, and nutritional support, which can mitigate the health impacts of poverty.

This comes in a context where, according to the American Heart Association, heart attacks and strokes have been the leading causes of death in the U.S. for over a century.

More information: Nicholas K. Brownell et al, Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988–2018, Circulation Cardiovascular Quality and Outcomes. DOI: 10.1161/CIRCOUTCOMES.123.010111

Journal information: Circulation Cardiovascular Quality and Outcomes Provided by The George Washington University

Research reveals links between obesity and heart failure

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A recent study conducted by researchers from Johns Hopkins Medicine, published on July 25th in Nature Cardiovascular Research, has unveiled the effects of obesity on the muscle structure in patients with heart failure with preserved ejection fraction (HFpEF).

The Journal of Cardiac Failure notes that HFpEF accounts for more than half of all heart failure cases globally. In the U.S., it represents over 3.5 million cases. Historically, HFpEF was linked to high blood pressure, causing excess muscle growth (hypertrophy) to manage the increased pressures. However, in the last two decades, the prevalence of HFpEF has risen among patients with severe obesity and diabetes, as reported by the Journal of the American College of Cardiology. Despite this, there remains a scarcity of effective treatments for HFpEF, partly due to a shortage of studies on human heart tissue that pinpoint the exact abnormalities. Given the high hospitalization and mortality rates associated with HFpEF—30-40% within five years—gaining a deeper understanding of its root causes is crucial.

David Kass, M.D., Professor of Medicine at the Johns Hopkins University School of Medicine and lead investigator of the study, explains, “HFpEF is a complex syndrome that involves abnormalities across several organs. Although it’s termed heart failure due to symptom similarities with other forms of heart failure where the heart muscle is weak, in HFpEF, the heart’s pumping action is normal yet symptoms of heart failure persist. Previous standard heart failure medications have been ineffective in treating HFpEF, but recent successes have been seen with drugs originally designed for diabetes and obesity.”

Specifically, an SGLT2 inhibitor (sodium glucose transporter two inhibitor), a drug for diabetes, is the only evidence-based medication for HFpEF that has shown improvements in symptoms and significant reductions in long-term hospital readmissions and mortality rates. Additionally, the GLP1-receptor agonist, a weight loss medication, has shown promise in alleviating HFpEF symptoms, with ongoing studies investigating potential impacts on mortality and hospital admissions. These drugs, originally developed for diabetes, have also proven beneficial for HFpEF.

In their research, the Johns Hopkins team collected a small sample of muscle tissue from 25 patients diagnosed with varying degrees of HFpEF due to diabetes and obesity. They compared this with heart tissue from 14 organ donors with normal hearts. The tissue was examined under an electron microscope, which provides a high-magnification view of muscle structure.

Mariam Meddeb, M.D., MS, a cardiovascular disease specialist at Johns Hopkins involved in the study, said, “Using an electron microscope allows us to magnify images up to 40,000 times, offering an exceptionally detailed view of the muscle cell’s ultrastructure, such as mitochondria, the energy powerhouses, and sarcomeres, the muscle fiber units.”

The study identified significant ultrastructural abnormalities, especially in the tissue of the most obese patients with HFpEF. These included swollen, pale, disrupted mitochondria, abundant fat droplets, and frayed sarcomeres. Interestingly, these abnormalities were independent of diabetes and were less pronounced in less obese patients.

“These findings are pivotal for those developing animal models of HFpEF, as they clarify the specific microscopic changes one aims to replicate,” notes Dr. Kass. “It also poses an important question: can reducing obesity, which is currently being targeted with various drug therapies, reverse these ultrastructural changes and thereby improve outcomes for HFpEF patients?”

This study advances our understanding of HFpEF and elucidates the significant impact of obesity on heart disease, offering a new target for therapeutic interventions to benefit the vast number of patients suffering from HFpEF.

More information: Biykem Bozkurt et al, Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America, Journal of Cardiac Failure. DOI: 10.1016/j.cardfail.2023.07.006

Journal information: Journal of Cardiac Failure Provided by Johns Hopkins Medicine

University of Hawaii Study Reveals Faster Biological Aging Among Native Hawaiians

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In a study from the University of Hawaiʻi at Mānoa, researchers have uncovered that Native Hawaiians exhibit a higher rate of accelerated biological ageing compared to White and Japanese American residents. The study also highlights the impact of living in adverse environments, such as neighbourhoods with low socioeconomic status, contributing to accelerated biological ageing regardless of ethnic background. However, life experiences might provide a buffer against this acceleration.

The research led by Alika Maunakea, a Native Hawaiian professor of epigenetics and a researcher in health disparities at the John A. Burns School of Medicine, indicates that individuals residing in socioeconomically disadvantaged areas can mitigate some of the effects of accelerated ageing. Those who participate in regular physical activity, achieve higher educational levels, and maintain healthier diets appear to experience biological ageing rates more aligned with their chronological age. These factors were associated with a lower BMI and a reduced risk of diabetes.

The study delved into cancer research data to establish these findings. Maunakea and his team analyzed DNA samples from 376 participants in the UH Cancer Center’s ongoing multiethnic cohort. Biological ageing is considered the progressive decline in cellular and physiological functions, reflecting the body’s actual age on a molecular and cellular level, which can differ from chronological age. This type of ageing is assessed through DNA methylation, an epigenetic process that influences gene activity and indicates biological age. This process allows scientists to determine whether an individual is ageing faster or slower than their chronological age.

While previous research on DNA methylation and biological age has primarily focused on populations of European ancestry, studies on ethnically diverse populations have been limited. This gap is significant as these populations often experience higher incidences and earlier onsets of diseases such as diabetes, heart disease, and certain cancers, particularly evident in Native Hawaiians. This group also suffers from the highest all-cause mortality rates compared to other major ethnic groups in Hawaiʻi. Through this study, Maunakea hopes to illuminate the biological mechanisms underlying health disparities in Native Hawaiians to address these issues better.

Maunakea emphasizes these findings’ substantial public health implications, suggesting that they could inform health policy. While it may be challenging to change certain neighbourhood-level factors affecting health, such as residential location and environmental conditions, individual lifestyle choices related to education, physical activity, and diet can be enhanced through federal, state, and community initiatives. One such example is MAʻO Organic Farms in Waiʻanae, which combats health and socioeconomic disparities in the region.

Reflecting on the personal significance of the study’s outcomes, Maunakea, born and raised in Waiʻanae, views the results as confirmation that lifestyle plays a crucial role in health. He argues that being Native Hawaiian does not predetermine one’s health trajectory, even in economically challenged areas. The molecular data from the study demonstrates that adopting healthier lifestyles reduces disease risk and likely enhances longevity. This insight gives Maunakea hope for significant improvements in health and well-being for Native Hawaiians within his lifetime.

More information: Alika K. Maunakea et al, Socioeconomic Status, Lifestyle, and DNA Methylation Age Among Racially and Ethnically Diverse Adults, JAMA. DOI: 10.1001/jamanetworkopen.2024.21889

Journal information: JAMA Provided by University of Hawaiʻi at Mānoa