Screening Saves Lives

Despite advances in screening and treatment, breast cancer remains the second-leading cause of cancer deaths in women, just behind lung cancer, according to the American Cancer Society. The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 50 and over undergo mammograms every other year for breast cancer screening. The guidelines emphasize the importance of regular screenings to detect breast cancer early when it is most treatable. For women ages 75 and older, the USPSTF notes that there is insufficient evidence to make a definitive recommendation, so the decision should be based on a woman’s health status and personal preferences.

While the USPSTF’s recommendations apply to women who have factors associated with an increased risk of breast cancer, such as having a first-degree relative with the disease, or having dense breasts, they do not apply to women who have a genetic marker or syndrome associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 genetic variation, a history of high-dose radiation therapy to the chest at a young age, previous breast cancer, or a high-risk breast lesion on previous biopsies. “Women should be aware that screening recommendations differ among the various groups such as the USPSTF, the American Cancer Society, the American College of Radiology (ACR) and Society of Breast

Imaging (SBI), among others,” says Dr. Alan Astrow, Chief of Hematology and Medical Oncology in the Department of Medicine at New York-Presbyterian Brooklyn Methodist Hospital, an affiliate of Weill Cornell Medicine. “While the recommendations differ, the most important thing to know is that screening for breast cancer detects cancer at an earlier stage than it would be detected without screening. This leads to the need for less extensive treatment because the cancers are picked up at a less advanced stage and ultimately saves lives,” says Dr. Astrow.

Dense Breast Update

Approximately 50 percent of women have dense breasts, 10 percent have extremely dense breasts, and 40 percent have heterogeneously dense breast tissue. “Both groups are considered to be at slightly increased risk of breast cancer, and both groups are recommended to consider supplemental screening exams,” says Michele Drotman, MD, Chief of Breast Imaging, Weill Cornell Medical Center-New York Presbyterian Hospital. “The choices for supplemental screening are ultrasound, contrast-enhanced mammography (CEM), and MRI. Insurance does not always cover the costs of the additional exams.” Each of the screening options has pros and cons. “Ultrasound is easy to undergo, but has lower sensitivity and a high false positive rate; CEM and MRI have extremely high sensitivity, but require IV contrast administration, and MRI is not well tolerated by people who are claustrophobic,” says Dr. Drotman. Women who have dense breasts should discuss supplemental screening options with their health-care provider.

Important Advancements

New diagnostic tools and personalized treatments are leading to better outcomes. For instance, the HER2DX test is a diagnostic tool used to personalize treatment for HER2-positive breast cancer. It helps determine the best therapeutic approach by analyzing the tumor’s genetic profile, potentially allowing some women to avoid chemotherapy.

Innovative drugs like datopotamab deruxtecan (Dato-DXd) and patritumab deruxtecan (HER3-DXd) target specific proteins in cancer cells, with the aim of providing more effective treatments with fewer side effects. Meanwhile, trilaciclib, a new CDK4/6 inhibitor, is showing promise in treating triple-negative breast cancer, potentially improving responses to immunotherapy and reducing chemotherapy side effects.

Brighter Outlook

Regular breast cancer screenings, cutting-edge treatments, and diagnostic innovations are enhancing both outcomes and quality of life for women today. “Breast cancer is a serious disease, and too many women continue to die of it every year, but we are doing better and aim to continue to do even better as new therapeutic agents and diagnostic modalities are developed,” says Dr. Astrow.

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The Centers for Disease Control and Prevention (CDC) recommend that all Americans over the age of six months get an updated COVID-19 vaccine when these become available this fall. By now, nearly all Americans have had a COVID infection, gotten a COVID vaccine, or both, but the updated vaccines offer a timely boost as immunity wanes and the virus continues to mutate. While mutations are thought to help COVID variants evade immune defenses and spread faster, there is no evidence they cause more severe illness. Even so, people ages 65 and older remain at great risk of COVID-related complications—they account for two-thirds of COVID hospitalizations and 82 percent of in-hospital deaths, according to the CDC. Only about 40 percent of Americans in that age group were immunized with the COVID vaccines that were offered last fall. You can visit the CDC’s dedicated COVID vaccine website for more information (http://tiny.cc/CDCCovid).

Plant-Based Meats May Reduce Cardiovascular Disease Risk

Plant-based meat alternatives often are marketed as being low in harmful saturated fat compared with “real” meat—however, up to now it hasn’t been clear if the products reduce the risk of cardiovascular disease. A recent review from researchers at the University of British Columbia, in Vancouver, suggests that they do even though they are classified as ultra-processed foods. The review (Canadian Journal of Cardiology, June 25) looked at studies published from 1970 to 2023, and found that cardiovascular risk factors like total cholesterol, LDL (“bad”) cholesterol, and body weight all improved when people substituted plant-based meat alternatives for real meat in their diets. Compared with real meat, plant-based meat products tend to be higher in sodium, which contributes to high blood pressure. However, the review did not find that the meat substitutes raised blood pressure.

Ultra-Processed Food Harms

A recent study underlines the mortality risks associated with diets that are high in ultra-processed foods. The National Cancer Institute study looked at data from more than 540,000 people who provided information about their eating habits and health in the mid-1990s, when they were ages 50 to 71. Over half of the participants have since died. The researchers analyzed overall rates of death among those who were in the 90th percentile for consumption of ultra-processed foods at the start of the study versus those in the 10th percentile. Processed foods were defined according to a standard classification system, and included deli meats, snacks, ready meals, fast foods, and soft drinks. People who ate the greatest amounts of ultra-processed foods over the median 23-year follow-up were 10 percent more likely to die early than those who ate the least. The study was presented at the annual meeting of the American Society for Nutrition in June.

Stroke Mortality Worse for Black People

Overall rates of long-term survival following stroke are getting better—but not for Black people, according to a new University of Cincinnati study (Neurology, July 15). Researchers identified 8,428 cases of ischemic stroke (the type caused by a blood clot) and 1,501 cases of intracerebral hemorrhage (a less common and more severe type of stroke caused by bleeding in the brain). Among participants with ischemic stroke, five-year survival decreased from 53 percent in 1993-94 to 48 percent in 2015. There were no changes in five-year survival following an intracerebral hemorrhage. While the overall numbers improved, Black study participants were found to be 20 percent more likely to die within five years after an ischemic stroke than white people. Long-term social, economic and environmental inequities likely contribute to the disparity. See this month’s From the Editor for stroke-prevention advice.

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Grief can be like that. It also can manifest as deep sorrow, hostility, guilt, confusion, and fatigue. It’s a process that waxes and wanes and an experience that varies from person to person. There’s no absolute timeline or way to grieve, but most people start to return to a sense of normalcy in about six to 12 months.

Grief occurs not only when a loved one passes but also can happen with a terminal diagnosis, such as cancer or Alzheimer’s disease. Known as “anticipatory” grief, it affects both the diagnosed person and loved ones.

Grief’s Impact on Health

The grieving process can lead to everything from bodily pain and a weakened immune system to stomach upset and insomnia. According to George Slavich, PhD, director of the Laboratory for Stress Assessment and Research at the Semel Institute for Neuroscience and Human Behavior at UCLA, the root of these symptoms can be traced back to our evolutionary response to the loss of a social connection.

“As humans, we are strongly motivated to seek out social bonds that are warm, dependable, friendly and supportive,” says Slavich. “Losing someone close to us terminates that bond and the social and physical protection they provided, which historically could have put the body at an increased risk of physical danger.”

When you lose someone that you’ve been with for a long time, the body and brain go on high alert to protect you from potential dangers. Your immune system ramps up and sends immune cells throughout the body to deal with possible physical wounds that might occur. At the same time, however, your immune system lowers its antiviral defense system, making your body more vulnerable to viral infections. “If you’ve ever come down with a cold after a stressful time, you may have experienced this response,” says Slavich.

The grieving process can cause prolonged inflammation and lead to psychological and behavioral symptoms such as fatigue, loss of pleasure, and social withdrawal. If these symptoms persist beyond six months, it may indicate prolonged grief, which can have serious health implications.

Prolonged Grief

This type of grief is marked by persistent and pervasive feelings of longing, sadness, and preoccupation with the deceased. It can significantly interfere with a person’s daily functioning and quality of life. Common symptoms include an inability to accept the loss, numbness, bitterness, difficulty engaging in life, and a feeling that life is meaningless without the deceased.

Prolonged grief is associated with increased cancer risk, cardiovascular problems, and early mortality. It may lead to heart attacks, especially in people who already have a higher risk of heart disease.

Takotsubo cardiomyopathy, also known as broken heart syndrome or stress cardiomyopathy, can be triggered by intense grief. This condition temporarily weakens the heart’s left ventricle and can mimic a heart attack, even in those who do not have cardiovascular disease. It tends to affect postmenopausal women much more than men. Recovery from this transient condition can take days or weeks. However, this doesn’t mean the condition should be ignored or untreated, because there can be long-term consequences.

Anticipatory Grief

Anticipatory grief is the emotional response experienced when a loss is expected but has not yet occurred, such as with a terminal illness diagnosis. Key characteristics of anticipatory grief include feelings of sadness, anxiety, anger, and helplessness. It affects both the diagnosed and loved ones. For example, loved ones can become consumed with imagining life after the loss and worrying about how to cope. It may change how an individual interacts with the dying person, such as increased closeness or emotional distancing as a protective measure.

Stress and anxiety can lead to physical symptoms like fatigue, changes in appetite, and sleep disturbances. Feelings of relief or guilt also can be part of anticipatory grief, especially if the loved one has been suffering. Understanding and acknowledging anticipatory grief can help in the processing of emotions and better prepare for the eventual loss.

Patience, Acceptance, and Self-Care

It’s important to accept that it is normal to grieve and give yourself permission to experience the full range of emotions. Surrounding yourself with supportive friends and family with whom you can share your feelings can provide comfort and validation. Support groups, both in-person and online, can also offer a sense of community and understanding. Sometimes, the intensity of grief requires professional intervention. Therapists or counselors specializing in grief can provide strategies and support to navigate the emotional turmoil.

After losing a loved one, thoughts can constantly drift between the past and the future. Practicing mindfulness meditation is one way of becoming aware of your thoughts, grounding your awareness in the present, and reducing overall psychological stress.

Sleep may become challenging. It may be difficult to fall and stay asleep. And a sense of purposelessness can make it hard to get out of bed up in the morning. However, “sleep is one of the strongest drivers of immune activity,” Slavich says, and “having a standard sleep schedule is really important for properly regulating your immune system.”

Along with quality sleep, a healthy diet and regular exercise are recommended for self-care. Choose nutritious foods daily. Include lean proteins, fruits, vegetables, healthy oils and leafy greens. These choices help reduce inflammation. Likewise, moving your body regularly supports brain and immune health. Breaking a sweat helps decrease feelings of stress and anxiety. Exercise triggers the release of dopamine and serotonin; two brain neurotransmitters that play a pivotal role in maintaining positive mood. Exercise also slows the release of cortisol, the hormone that can wreak havoc when it flows unabated under chronic stress.

“Each of these strategies can help promote resilience following interpersonal loss,” Slavich says, “but the most important thing is to begin with the strategy that you know you’ll actually follow through with.” He also recommends telling your healthcare provider about your loss. This will enable your provider to take your personal situation into consideration and to understand how your grief may be involved in any symptoms you may be experiencing.

Coming up with the best strategy for dealing with grief needs to be a team effort between you and your healthcare provider, Slavich says, but “if they don’t know what’s going on in your life, they won’t be able to help.”

Creating a memorial or engaging in rituals to honor the person you’ve lost can help with healing and acceptance. This could be through a dedicated space in your home, a scrapbook, or participating in activities that the deceased loved. It helps keep their memory alive and allows you to celebrate their life.

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If so, you may be headed for a longer, healthier, and happier life.

Numerous studies of happiness in recent years have consistently shown that having a sense of gratitude is a key part of the prescription for healthy well-being and a positive out­look. According to a recent study led by researchers from the Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, being thankful also may help you live longer.

“Prior research has shown an asso­ciation between gratitude and lower risk of mental distress and greater emotional and social well-being. However, its association with physi­cal health is less understood,” says lead author Ying Chen, a research scientist with Harvard’s Human Flourishing Program. “Our study provides the first empirical evidence on this topic, suggesting that experi­encing grateful affect may increase longevity among older adults.”

The study was published recently in JAMA Psychiatry. Other authors involved include Harvard and MGH researchers Olivia Okereke, MD; Henning Tiemeier, MD, PhD; Laura Kubzansky, PhD; and Tyler Vander­Weele, PhD.

Researchers relied on data from the Nurses’ Health Study to measure levels of gratitude and mortality among 49,275 older women. In 2016, study participants (average age 79) were scored on a six-item Gratitude Questionnaire. They either agreed or disagreed with statements such as, “I have so much in life to be thankful for” and “If I had to list everything that I felt grateful for, it would be a very long list.” In 2019, the researchers followed up to identify deaths among the study population, noting all-cause mortality (death from any cause) as well as specific causes such as cardiovascular disease, cancer, neurodegenerative disease, and injury. The researchers recorded 4,608 deaths over the course of the study period. Among the specific causes studied, cardiovascular dis­ease was the most common.

After adjusting for factors such as smoking and other health problems, the researchers found that partici­pants who scored highest on the Gratitude Questionnaire had a 9 per­cent lower risk of all-cause mortality over the next four years compared with those with the lowest scores. Gratitude appeared to have protective benefits against every specific cause of mortality studied, most signifi­cantly against cardiovascular disease.

Benefits of Gratitude

Previous studies suggest that grati­tude is associated with several markers of good health, including endothelial function—how well the cells that line your blood vessels and lymphatic vessels keep blood and lymph moving throughout the body. Experiencing and expressing grati­tude is also associated with lower levels of inflammation, a factor that affects the risks of developing car­diovascular disease, dementia, and most other health problems.

Research also suggests that people who embrace gratitude are more likely to adhere to a healthy lifestyle, involving regular exercise, a balanced diet, and medication adherence. Plus, focusing your thoughts on thankfulness helps you keep perspective when challenges and trouble threaten your peace of mind.

How to Experience Gratitude

Being thankful can take many forms. You can frequently express gratitude to others, from relatives and friends who are there for you when you need them to store clerks, restaurant servers, and the stranger who holds the door open for you.

If you are someone who writes thank-you notes for gifts, extend that idea and write “gratitude notes” to people you appreciate—even if there is no specific cause or reason. Not only might you feel better, but the recipient of your note is likely to get a mood boost, too.

You may find it helpful to take a few moments a day for silent grati­tude. Hit the pause button on your chores and errands and think about something nice someone did for you that day or last night’s beautiful sunset or your good health. Try not to  overlook the small acts and the big news that shape your world for the better.

“Prior research indicates that there are ways of intentionally fos­tering gratitude, such as writing down or discussing what you are grateful for a few times a week,” Chen says. “Promoting healthy aging is a public health priority, and we hope further studies will improve our understanding of grati­tude as a psychological resource for enhancing longevity.”

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What It Is.

While there is no single, universally accepted definition of frailty, it’s understood as a syndrome that impacts health, energy level, physical abilities, and, in some definitions, cognitive abilities. This syndrome is typically seen in older adults, although it can occur in younger people.

“Frailty is characterized by a reduced resilience,” says Roger A. Fielding, PhD, senior scientist and leader of the Nutrition, Exercise Physiology, and Sarcopenia Team at the Human Nutrition Research Center on Aging (HNRCA). “The body doesn’t respond adequately to external stressors such as an infection or other illness, surgery, or a fall. The individual may have a delayed or weak immune response to an infection, for example, or poor recovery from surgery.”

Researchers have come up with different ways to identify frailty. The most common approach, the Fried frailty phenotype, assess five criteria:

• Weakness, measured by low handgrip strength;

• Self-reported exhaustion or low energy;

• Walking speed of less than 0.8 miles per second with or without a walking aid;

• Low physical activity; and/or

• Unintentional weight loss of 10 pounds or more (or 5 percent or more of body mass) in a year.

People who have three or more of these criteria are considered frail. Those with any two are pre-frail, meaning they are at high risk of becoming frail. Poor balance and cognitive impairment can also be considered symptoms of frailty.

“All five of these criteria involve some change in muscle or muscle function,” says Fielding. “In fact, many people who are frail also have sarcopenia (and many who have sarcopenia also are frail). Sarcopenia is an ageassociated decline in muscle mass and strength first identified here at HNRCA. Everyone loses muscle mass and strength with age. With sarcopenia, that loss limits the person’s ability to function.”

Since there are no recommendations for routine testing (and no standard diagnostic test), it’s hard to know how common frailty is. Sources estimate that four to 16 percent of community-dwelling women and men aged 65 and older in the U.S. are frail. A full 25 percent of those over 84 are estimated to be frail. Many more are considered pre-frail.

Why it Matters.

As frailty progresses, people lose their independence. The loss of strength leads to poor mobility and increased risk of falls. People with frailty are at higher risk for infections, hospitalization and long hospital stays, surgical complications, and being unable to return to independent living after a surgical procedure. They may also experience loss of appetite, which increases risk for unintended weight loss and undernutrition. Ultimately, frailty increases risk of death.

What to Do.

“Take a pre-frail or frail individual and have them begin a program of physical activity, and we can reverse some of the symptoms,” says Fielding. “Physical activity also works to avoid becoming frail in the first place.”

Generally, being active, maintaining a healthy body weight, consuming a healthy dietary pattern, and staying socially and cognitively active are the recommended ways to stay strong, active, healthy, and independent as you age. For more tips, see the “Take Charge!” box.

Risk Factors for Frailty.

The most commonly cited risk factors for developing frailty are advanced age, smoking, underweight, overweight, obesity, lower socioeconomic status, and less education. “One of the biggest factors is a sedentary lifestyle,” says Fielding. “People who are less active are at greater risk.” Other factors include social isolation, living alone, a generally unhealthy lifestyle, and traumatic life events. People diagnosed with type 2 diabetes, respiratory disease, stroke, dementia, multiple sclerosis, connective tissue disease, osteoarthritis, and chronic fatigue syndrome or who suffer from multiple disorders are more likely to develop frailty. It is more common in women than men, but men with frailty have a higher mortality rate.

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“That’s why it’s helpful for patients to start cardiac rehab,” says cardiologist Boris Arbit, MD, UCLA Medical Center. “It relieves symptom, improves mortality, and increases general well-being.”

Reactions to Trauma

A heart attack can trigger a range of emotional responses. The sudden and life-threatening nature of the experience can lead to feelings of vulnerability, hopelessness, loss of control, and uncertainty about recovery.

“These reactions usually resolve within a few weeks to months,” explains Marwah Shahid, MD, UCLA Division of Cardiology. “For some patients, however, these symptoms can linger or even cause long-term consequences such as acute stress disorder or PTSD (post-traumatic stress disorder). Processing a cardiac event can be difficult not only for the person who had it, but also can impact their friends and family.”

A study published in Frontiers of Psychology analyzed data from 911 people who had either a heart attack, unstable angina, or major heart surgery. Study participants completed an anxiety and depression scale close to the event, and at two subsequent intervals (early and late convalescence). Anxiety rates were 43%, 28%, and 27% at the time of the event, early, and late convalescence. Depression rates were 22%, 17%, and 15%, respectively. Factors consistently associated with increased anxiety and depression risk were history of depression, financial burden of treatment, impact on jobs, and poor self-rated health.

Signs of Distress

Feeling a bit down after a heart event is normal, but sometimes the feelings don’t ease up. Symptoms of depression include increased negative thoughts, tearfulness, withdrawing from people and activities previously enjoyed, and having difficulty with daily routines.

Addressing both the physical and emotional aspects of recovery helps people achieve a more holistic and sustainable return to health.

“Some patients may find it helpful to create a heart-healthy goal, for example signing up for a fitness fundraiser walk, once they are cleared for such activity by their cardiologist,” says Dr. Shahid. “The goal-setting process can help transfer feelings of uncertainty into something that you have control over.”

Joining a heart attack survivors support group can be quite helpful. Sharing experiences with others who have gone through similar challenges can be incredibly comforting and empowering. Likewise, caregivers and family members who attend support groups can better understand what their loved ones are experiencing.

Cardiac Rehabilitation

After a heart attack, many people are advised to adopt a healthier lifestyle. The recommended changes can feel overwhelming and contribute to feelings of frustration and sadness. Cardiac rehab can be a game changer.

Cardiac rehabilitation is a medically supervised program designed to help people recover after a heart attack and other major heart events. Its benefits have been well documented. Unfortunately, despite its proven benefits, many people do not partake of it. Those who do, however, gain more energy and a better overall quality of life.

Supervised cardiac rehab exercise has been shown to reduce symptoms of moderate depression and increase physical function. But cardiac rehab is much more than exercise. The rehab staff can be a source of emotional support. It’s also an opportunity to socialize with other people recovering from heart attacks, which helps normalize emotional reactions to the event.

In addition, cardiac rehab educates people about heart-healthy living and offers insights for identifying and managing stress and other mental health needs.

The prevalence of depression and anxiety after a heart attack highlights the importance of understanding and addressing the mental health challenges that can accompany the event. Fortunately, there are many ways to facilitate recovery. Cardiac rehab is key. Support groups and psychotherapy, along with proper sleep, exercise, and nutrition, all help improve quality of life, and equally importantly, reduce risk of future heart attacks.

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The BMJ, May 2024

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Blood pressure is related to two forces: your heart pumping blood through your arteries, and the force of your arteries resisting this blood flow. With each heartbeat, blood pressure rises, and in between beats it falls. This is reflected in your blood pressure measurement: the top figure (systolic) is the pressure when your heart beats, and the lower (diastolic) is the pressure when your heart is at rest between beats. In older adults, lowering systolic blood pressure to 120 appears to decrease mortality. However, most people need to take two or three drugs to achieve this, and they may develop drug-related side effects. As such, most guidelines recommend you aim for a systolic blood pressure that is less than or equal to 140.

Other cardiovascular risk factors— including high cholesterol, triglycerides, and blood sugar—also are associated with potentially serious health outcomes like stroke and diabetes. Your doctor should be keeping tabs on these risk factors at your routine annual health check, but what target measurements should you be aiming for? Here’s a quick rundown:

• Cholesterol Too much LDL (also known as “bad” cholesterol) can cause plaque deposits to build up in your arteries, narrowing the channel through which blood flows. Your cholesterol levels are checked in a routine blood test called a lipid panel. If you do not have cardiovascular disease, your total level should be under 200 milligrams per deciliter (mg/dL), with LDL less than 100 mg/dL, and HDL (“good” cholesterol) 40 mg/dL or greater.

• Triglycerides These are fats that circulate in the blood, and—like LDL—they can contribute to plaque deposits in your arteries. Most experts recommend keeping fasting triglyceride levels (the level after you have fasted overnight) below 200 mg/dL.

• Blood sugar High blood sugar raises your risk for diabetes. If you already have diabetes, you’ll be familiar with the hemoglobin A1C test, which measures your average blood sugar control in the previous three months. While the American Diabetes Association recommends an A1C level of 7 percent for people with diabetes, 7.5 to 8 percent is considered a more reasonable goal for older adults.

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The U.S. Food & Drug Administration (FDA) has announced a recall of the HeartMate II and HeartMate 3 left ventricular assist devices (LVADs) after the devices were tied to 273 known injuries and 14 deaths. However, as of late April, the two devices are not being removed from the market, and the manufacturer says that people whose devices are functioning normally have no cause for concern. Both LVADs are used to help the heart pump blood when it cannot effectively do so on its own and can provide short- and long-term support to people with severe or end-stage heart failure. In rare cases, biological material can deposit in grafts connecting the devices to the heart. Such deposits can slow blood flow through the heart. The recall affects several models distributed starting April 21, 2008, and involves 13,883 devices. If you use an LVAD and have not been contacted by the device manufacturer, double-check with your cardiologist whether you are affected by the recall. Also stay alert for low-flow alarms emitted by the devices, and immediately contact your doctor if the alarm sounds.

Sweetened Drinks and AFib

Consuming too many sweetened drinks is linked to the abnormal heart rhythm atrial fibrillation (AFib), according to research published in the March issue of Circulation: Arrhythmia and Electrophysiology. For the study, researchers at Shanghai JiaoTong University looked at more than 200,000 people who were free of AFib. During a 10-year follow-up, there was a 20 percent increased risk of AFib among people who said they drank more than 2 liters per week of artificially sweetened beverages, and a 10 percent increased risk among participants who drank a similar amount of sugar-sweetened beverages. People who said they drank 1 liter or less of pure fruit or vegetable juice each week had an 8 percent lower risk of AFib. Since the analysis is based on dietary questionnaires that may not be accurate, the results show an association only, not cause and effect. However, previous research has linked artificially sweetened and sugary drinks to obesity and type 2 diabetes.

Stroke and Depression

A study carried out by researchers at King’s College London underlines the risk of depression faced by stroke survivors. The study (The Lancet Regional Health—Europe, March 25) included 6,600 stroke survivors, median age 68. Over an 18-year follow-up, nearly 60 percent of the participants experienced depression compared with 22 percent of the general population. About 88 percent of depression cases occurred within the five years following a stroke. Depression that occurred within three months of a stroke tended to be more severe, had a longer duration, and was more likely to recur than mild depression. Previous studies have associated post-stroke depression with poor functional ability and increased mortality. American Heart Association guidelines recommend routine screening for post-stroke depression—alert your doctor if you have not been screened.

How to Move More

Inactivity increases the risk of high blood pressure and other chronic health conditions, but it can be a challenge to get moving if you’ve fallen into sedentary habits. A new study led by researchers at Kaiser Permanente Washington Health Research Institute used a relatively simple approach to successfully reduce sitting time for a group of older adults by around 30 minutes a day. The study (JAMA Network Open, March 27) included 283 people, ages 60 to 89, who reported sitting for more than six hours per day. In the study, participants who used an activity tracker and took part in 10 health coaching sessions over six months sat for 32 minutes less per day, on average, compared with a control group who received health coaching only. If you need motivation to sit less during the day, a simple activity tracker may spur you to get moving, as long as you actually use it—you also may be able to find a fitness coach through your local gym.

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A healthful diet is the best source of vital nutrients. But as we age, the amount and kinds of foods that we eat may change. For example, many vitamins are found in fresh fruits and vegetables, something that may be lacking in the diet of older adults with dental issues that make it difficult to chew food. Our ability to release or absorb vitamins from food also changes as we grow older. This is particularly true for vitamin B12 (for this reason, many doctors recommend that older adults be screened for vitamin B12 deficiency). Vitamin B12 is easily absorbed in supplement form, and there also is evidence that vitamin D is worth supplementing.

There is no evidence that taking a daily multivitamin alone is harmful. But if you’re also taking additional single-nutrient supplements and eating vitamin-fortified foods, you may be ingesting too large a quantity of some vitamins. For example, too much vitamin A may weaken bones, and beta-carotene supplements (beta-carotene is converted into vitamin A by the body) have been linked to an increased risk of lung cancer in smokers. Supplement labels may list vitamin A as micrograms (mcg) or international units (IU). For men ages 51 and older, the recommended daily intake (RDI) is 900 mcg/3,000 IU, and for women in this age group, the RDI is 700 mcg/2,334 IUs). Don’t exceed 3,000 mcg (10,000 IU) daily.

For many years, vitamin E supplements were popular. However, studies have linked doses higher than 400 IU per day with increases in all-cause mortality. Vitamin E also has a blood-thinning effect, so megadoses may raise your risk of bleeding if you take the blood thinner warfarin (Coumadin®). Another nutrient—vitamin K—reverses the effect of warfarin and may put you at risk of developing a blood clot. If you take warfarin, your doctor likely has advised you to avoid taking supplements that contain vitamin K and to limit your dietary intake of vitamin K (which is found in green, leafy vegetables.)

Overall, if you eat a healthy diet rich in fruits, vegetables, whole grains, and lean protein, you should be consuming the right amounts of most vitamins. If you think you may be coming up short, discuss with your doctor whether taking additional vitamins or a multivitamin is advisable before you visit the supplements aisle at your local pharmacy.

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