Prevent cancer by being fit!

Being Fit Can Protect Against Developing, Dying of Cancer!

Cardiorespiratory fitness (CRF) appears to be a strong independent predictor of not only developing 2 common cancers, but also the prognosis.

The risk of developing both lung and colorectal cancer were decreased by 68% and 38%, respectively, in men with the highest levels of fitness, as compared with those who were the least fit, according to a new study.

A high level of fitness was also associated with a 14% reduction in cancer-specific mortality, and a 23% reduction in cardiovascular-specific mortality.

 

Dr. Lakoski presented the findings of her research at a press briefing held in advance of the 2013 annual meeting of the American Society of Clinical Oncology® (ASCO).

 

The cohort included 17,049 men (mean age, 50 years) who had received a single cardiovascular fitness assessment as part of a specialized preventive health check-up visit that was offered at the Cooper Institute, in Dallas, Texas. Performance was recorded in established units of fitness called metabolic equivalents (METs). The participants were then separated into 5 quintiles according to their fitness performance.

Medicare claims were then subsequently analyzed to identify the participants who had developed lung, colorectal, or prostate cancer. The mean times from their initial CRF assessment to cancer incidence and death were 20.2 ± 8.2 years and 24.4 ± 8.5 years, respectively. During this time period, a total of 2885 men were diagnosed with prostate, lung, or colorectal cancer (2332 with prostate cancer, 276 with colorectal cancer, and 277 with lung cancer).

Within the study period, a total of 769 men died of all-cause mortality, with 347 of those deaths due to cancer, and 159 to cardiovascular disease.

 

Compared with men in the lowest CRF quintile, the adjusted hazard ratio for lung and colorectal cancer incidence among men in the highest CRF quintile was 0.32 and 0.62 respectively.

Even a small improvement in fitness levels (1-MET increase in CRF) was associated with a 14% reduction in cancer-specific mortality.

Everyone Can Benefit!

The study authors also found that that even if the men weren’t obese, those who had low fitness had an increased risk for cancer and cardiovascular disease.

“This suggests that everyone can benefit from improving their fitness,” said Dr. Swain, who served as a comoderator of the briefing.

 

via Being Fit Can Protect Against Developing, Dying of Cancer.

AMA Declares Obesity a Disease!

 

Physicians voted overwhelmingly to label obesity as a disease that requires a range of interventions to advance treatment and prevention.

However, there was impassioned debate in the hours before the vote at the American Medical Association (AMA) 2013 Annual Meeting.

The physicians in favor of classifying obesity as a disease  explained. “Obesity is a pathophysiologic disease. There is a treatment for this disease; it involves behavioral modifications, medications, and surgeons.” said Jonathan Leffert, MD, alternate delegate for Endocrinology, Diabetes, and Metabolism. “The scientific evidence is overwhelming.

However, all are not convinced. Some say that obesity does not meet the criteria for disease.

Russell Kridel, MD, incoming chair of the AMA Council on Science and Public Health (CSPH), feels that there is no debate about the importance and urgency of addressing the problem, but he doesn’t believe it qualifies as a disease. “It’s more like smoking. Smoking isn’t a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension,” he explained. “We’re really talking nomenclature here, not philosophy.”

Some feel that since body mass index, an imperfect measure, is used to determine obesity, people who are otherwise healthy are being diagnosed as obese.

“Why should one third of Americans be diagnosed as having a disease if they aren’t necessarily sick?” they ask.

One Third of Americans!

According to the Centers for Disease Control and Prevention, 35.7% of Americans are obese. Obesity-related conditions, including heart disease, stroke, type 2 diabetes, and certain cancers, are some of the leading causes of preventable death.

Take a poll on what you feel!

 

 

via AMA Declares Obesity a Disease.

Tea and Coffee Lower Blood Pressure!

Are you addicted to tea or coffee?

A large French retrospective analysis provides good news for caffeine lovers: investigators showed that drinking tea or coffee was associated with a small statistically significant reduction in systolic and diastolic blood pressure.

Drinking tea and coffee was also associated with a significant reduction in pulse pressure and heart rate, although the heart-rate reductions were greater with tea.

The results of this data were presented at the recently held European Society of Hypertension ESH 2013 Scientific Sessions, at Paris, France.

Presenting the data on 176 437 subjects aged 16 to 95 years of age who had a checkup at their center between 2001 and 2011, the authors explained that the analysis was based on a questionnaire asking participants how much coffee or tea they drank per day. Individuals were classified into three groups: those who drank no coffee/tea, those who drank one to four cups, and those who drank more than four cups.

Overall, coffee is consumed more frequently than tea.  Men were more likely to drink coffee, while women were more commonly tea drinkers.

Both coffee and tea consumption was associated with a significant reduction in systolic and diastolic blood pressure.

So go ahead. Grab your cuppa!

via Tea and Coffee Lower Blood Pressure.

Patient Involvement Key to Patient Centered Care.

The path to a better health care environment for patients starts with

1. engaging patients in decision-making,

2. encouraging dialogue between patients and physicians, and

3. using electronic health records (EHRs) as a collaborative communication tool in the exam room,

according to the authors of three separate viewpoint articles published June 11 in the Journal of the American Medical Association.

 

Patients have a responsibility to take part in care decision-making, according to viewpoint authors Mary E. Tinetti, MD, and Ethan Basch, MD, MSc.

 

In a separate article, Timothy J. Judson, MPH,  and Matthew J. Press, MD, MSc, examine the lack of patient engagement during care — particularly surrounding the barriers that “prevent patients and physicians from meaningful question-and-answer exchanges.”

On the patient side, a reluctance to ask questions — known as “white-coat silence” — can plague patients who fear “being labeled difficult,” taking “too much of the physician’s time” or the underlying “asymmetry of power” that exists between patients and physicians. Physicians are less likely to embrace dialogue due to time constraints or even competency challenges.

 

The authors suggest a few solutions to the dialogue dilemma. Encouraging patients to ask questions is a start, but needs to be part of a more fundamental reengineering of health care toward a patient-centered experience in which white coats provoke more open dialogue and less apprehensive silence,” write the authors.

 

A third viewpoint article reasons that EHRs in the exam room can facilitate patient-physician communication. The authors note that EHRs can help via electronic messaging, giving patient access to records, tools and test results that are otherwise difficult to obtain, and giving patients the ability to read over physician notes online post-exam which in turn provides a sense of control in their care.

 

Moving forward, the physicians need to communicate more with their patients while on patient’s side, patients need to get rid of their inhibition to ask questions about their care to their physicians.

via CardioSource – Patient Involvement Key to Patient Centered Care.

ESH/ESC publish hypertension guidelines: Lifestyle changes reduce BP!

The European Society of Cardiology and the European Society of Hypertension released Guidelines for Physicians to treat Hypertension (high BP). The joint guidelines are designed to reduce the morbidity and mortality associated with hypertension.

Worldwide, 1.5 billion people currently have high blood pressure, according to the World Health Organization.

Dr Robert Fagard, the chair of the ESH/ESC writing committee, reiterated that treatment decisions for patients should be dictated by their overall level of risk and a holistic approach to treatment should be advised by physicians.

 

Lifestyle changes for treatment!.

 

The new guidelines make a host of lifestyle recommendations for lowering blood pressure.

1. Salt intake:  The Guidelines recommend salt intake of approximately 5 to 6 g per day, in contrast with a typical intake of 9 to 12 g per day. A reduction to 5 g per day can decrease systolic blood pressure about 1 to 2 mm Hg in normotensive individuals and 4 to 5 mm Hg in hypertensive patients.

2. Lower BMI:  While the optimal body-mass index (BMI) is not known, the guidelines recommend getting BMIs down to 25 kg/m2 and reducing waist circumferences to <102 cm in men and <88 cm in women. Losing about 5 kg can reduce systolic blood pressure by as much as 4 mm Hg.

3. Exercise: Aerobic endurance training in hypertensive patients can reduce systolic blood pressure by 7 mm Hg.

 

Fagard said that physicians can typically give low/moderate-risk individuals a few months with lifestyle changes to determine whether they’re having an impact on blood pressure. They should be more aggressive with higher-risk patients, however, noting that drug therapy is started typically within a few weeks if diet and exercise are ineffective.

 

via ESH/ESC publish hypertension guidelines | theheart.org.

Four Healthy Lifestyle Behaviors Lower Risk of Death.

Adopting a healthy lifestyle, one that includes not smoking, eating right, daily physical activity, and a healthy weight, is associated with a low incidence of calcium in the coronary arteries, as well as a slower progression of coronary artery calcium as measured over a three-year period, according to the results of a new study.

This study was published online June 4, 2013 in the American Journal of Epidemiology.

This is the first study to look at biological progression every step of the way in a single longitudinal fashion.

The study included 6229 US adults aged 44 to 84 years old. All patients were given a lifestyle score, ranging from 0 to 4, based on whether or not they followed

1. a Mediterranean-style diet,

2. their exercise habits (achieving 150 minutes of moderate-intensity physical activity per week),

3. body-mass index (BMI), and

4. smoking status.

One point was awarded for each healthy lifestyle behavior. The patients also underwent coronary artery calcium screening at baseline and a follow-up scan was performed 3.1 years later.

 

Overall, just 2% of the participants met all four healthy-lifestyle criteria!

The median annual progression in coronary artery calcium for individuals with a score 0, 1, 2, 3, and 4 was 25 Agatston points/year, 20 points/year, 18 points/year, 18 points/year, and 14 points/year, respectively.

Lower Risk of Death

Clinically, a healthier lifestyle also translated into a significant reduction in all-cause mortality and a trend toward lower coronary heart disease risk over a seven-year follow-up period.

Individuals who adopted all four healthy behaviors had an approximate 80% lower risk of death than those with no healthy behaviors.

 

“The benefits were cumulative, meaning the more healthy behaviors, the better,” commented Ahmed, one of the investigators. “So if you maintained a normal weight and ate healthy but weren’t exercising, this shows you can still have even more benefit from adding exercise to your life.”

Of the behaviors investigated, however, smoking was the most devastating. “In fact, if you exercised, ate healthily, and maintained normal weight, but smoked, you still were worse off than people who did nothing else right but stayed away from cigarettes. This really highlighted how important it is to stay away from smoking. It is probably singlehandedly the best thing you can do for your cardiovascular and overall health.”

You can’t pick your family history or change your age, but you can start exercising today, and you can start changing your diet today. All these interventions are things that cost us very little to nothing and are 100% in our hands. With these we have the ability to control our own wellness and health.

via Four Healthy Lifestyle Behaviors Lower Risk of Death.

Mediterranean Diet Slows Atherosclerosis Progression

 

High adherence to a Mediterranean diet appears to slow the progression of carotid plaque (fat deposition in the carotid arteries), a PREDIMED substudy suggests.

Investigators also found attenuation of plaque progression in the Mediterranean diet arm of the study that included supplementation with nuts and no such change in the other intervention arm, which included supplemental extra virgin olive oil.

This study was presented at the European Atherosclerosis Society 2013 Congress .

PREDIMED was a large  trial that randomized 7447 patients at high cardiovascular (CV) risk (but no CV disease) to a control diet (including advice to reduce dietary fat) or Mediterranean diet (MedDiet) supplemented with extra virgin olive oil or mixed nuts (walnuts, almonds, and hazelnuts).

 

 

After 4.8 years, the risk of major CV events (MI, stroke, death from CV causes) was reduced by 30% in the Mediterranean groups combined, compared with the control diet. The Mediterranean diet group assigned to the extra virgin olive oil supplementation saw a 30% reduction, while those in the nut supplementation group saw a 28% reduction, both compared with the control group.

 

Imaging Insights

A total of 61 patients in the control group, 57 in the MedDiet plus supplementary olive-oil group, and 46 in the MedDiet plus nuts group underwent carotid ultrasound imaging at baseline and after a minimum of two years on their assigned diet. They looked at plaque volume and carotid-artery intima thinkness.

They saw a significant reduction in carotid plaque in the  MedDiet group. There was delayed progression in the olive-oil group, and slight regression in the nuts group.”

Though the patient volume invloved in the trial was less, it suggested that a mediterranean diet rich in nuts could slow down atherosclerosis and also reduce CV disease and mortality.

 

via Mediterranean Diet Slows Atherosclerosis Progression.

Study Shows Obstructive Sleep Apnea Increases Risk of Sudden Cardiac Death.

 

Obstructive sleep apnea (OSA)  is a novel risk factor for sudden cardiac death (SCD), according to a study published June 11 in the Journal of the American College of Cardiology JACC.

 

The study looked at 10,701 adults referred for polysomnography (sleep study) and followed them for an average of 5.3 years for incidents of resuscitated or fatal SCD.

 

Results showed that 142 patients experienced SCD, with the most common predictors being a patient aged 60 years or above , having 20 apnea episodes an hour and having a lowest nocturnal oxygen saturation level of below 78 percent.

 Results showed that the severity of nocturnal hypoxemia strongly predicts SCD independently of other risk factors. In the lowest nocturnal oxygen saturation, a drop to below 78 percent increases a patient’s risk of SCD by 81 percent.

“People at risk for OSA ought to be screened with a sleep study, and potentially then being treated for sleep apnea might reduce the risk of dying suddenly,” says Deepak Bhatt, MD, MPH, FACC, in a CardioSource Video News interview on the study’s findings.

It is well known that sleep apnea is seen in obese individuals and can lead to high blood pressure and heart beat problems in the long run.

Prompt recognition and Early treatment of OSA in obese individuals is recommended. 

via CardioSource – Study Shows Obstructive Sleep Apnea Increases Risk of Sudden Cardiac Death.

Check for sleep apnea in individuals with diabetes and hypertension.

All patients with type 2 diabetes or hypertension should be evaluated for sleep apnea by a board-certified sleep medicine physician, the American Academy of Sleep Medicine (AASM) advised this week in a position statement.

“Type 2 diabetics and people with hypertension are much more likely to have obstructive sleep apnea [OSA] than other people, and as a result, should immediately discuss their risk for sleep apnea with a sleep specialist,” AASM president Dr M Safwan Badr said in statement.

 

Obstructive sleep apnea (OSA) is a sleep disorder seen in overweight and obese individuals where patients have obstruction of their upper airways during sleep leading to disruption of sleep. This disturbed sleep at night causes excessive daytime somnolence and fatigue. This disorder also causes hypertension, increase in blood sugars and increased incidence of a heart beat disorder called atrial fibrillation.

 

New research has consistently proved that sleep apnea may drive uncontrolled BP. Prompt recognition and treatment of sleep apnea improves BP control and also reduces average 24-hour blood sugar by 11 mg/dl. This also improves diabetes control and reduces the number of drugs required for BP control.

Prompt recognition of sleep apnea and its treatment will improve control of BP and diabetes!

 

via AASM says check for sleep apnea in diabetes, hypertension | theheart.org.