Posts Tagged ‘Stroke’

Singing the Birthday Blues

Wednesday, June 27th, 2012

People aged 60 and over are 14 percent more likely to die on their birthdays A recent study of more than two million people found that the birthday blues bring a rise in deaths from heart attacks, strokes, falls, suicides and even cancer.  The findings – based on a study over 40 years in Switzerland – back up the idea that birthday stress has a major impact on lifespans.  The majority of the increase was attributed to heart attacks, which rose 18.6 percent on birthdays and were significantly higher for men and women.  Levels of strokes were up 21.5 per cent – primarily in women – and there was a surprisingly large increase in cancer deaths in both sexes of 10.5 per cent.

Dr Vladeta Ajdacic-Gross, a senior researcher in psychiatry at the University of Zurich, said: Birthdays end lethally more frequently than might be expected.”  One notable person who died on his birthday is William Shakespeare, who passed away in 1616 of causes unknown.

The Swiss research is confirmed by data on Canadian hospital admissions showing that strokes are more likely to occur on birthdays than other days, especially among patients with a history of high blood pressure.  A substantial rise in suicides and accidental deaths for the over-60s on birthdays was found only in men.  There was a 34.9 percent rise in suicides; 28.5 percent rise in accidental deaths not related to cars; and a 44 percent rise in deaths from falls on birthdays.  The risk increases for about four days before the big day.

It was previously thought that people are more likely to die after their birthday as the thought of reaching a milestone would help them hold on for more time.  The researchers said this theory was disproved by their findings, and they support the anniversary reaction theory – also known as the birthday blues.

Dr Lewis Halsey, a senior lecturer in environmental physiology at the University of Roehampton, said: “One interesting finding is that more suicides happen on birthdays, though only in men.  The authors suggest that this increase could be related to them drinking more alcohol on birthdays.  But perhaps men are more likely to make a statement about their unhappiness when they think people will be taking more notice of them.  Or perhaps women feel that it is unfair on others who might be celebrating with them to put them through dealing with suicide.”

American researchers have found similar increases in heart deaths on Christmas and New Year’s Day.  They list stress among possible causes — and say people having chest pain or other symptoms might wait too long to get medical help on days when they are thinking about celebrating.

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning. Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

Physician, Patient Must Share in Decision Making

Monday, March 12th, 2012

Heart devices save lives, but too often make the patient miserable.  That unpleasant possibility is why physicians are being urged to talk more honestly with people who have very weak hearts and are considering pumps, pacemakers, new valves or procedures to clear clogged arteries.  Patients with advanced heart failure often don’t realize what they are getting into when they agree to a treatment, and doctors assume they want everything possible done to keep them alive, according to the American Heart Association. The directive recommends shared decision making when patients face chronic conditions that frequently prove fatal; they need to decide what they really want for their remaining days.  If they also have dementia or kidney failure, the answer may not be a heart device.

“Patients may feel that the treatment was worse than the disease,” said Dr. Larry Allen of the University of Colorado Anschutz Medical Center, who helped draft the new advice. One of Dr. Allen’s former patients was a 74-year-old man too weak to shop or take walks.  He was so despondent that physicians thought he would feel better with a “mini artificial heart” — a $100,000 left ventricular assist device to improve his heart’s ability to pump blood.  “Even if it goes well, people are left with an electrical cord coming out of their belly” and a higher risk of stroke and bleeding from the nose or throat, Allen said.

More than five million Americans suffer heart failure, and the number is increasing as the population ages.  More and more high-tech treatments treat advanced disease, but they usually don’t slow its progression, they just keep people alive.  And that means living longer with symptoms that do nothing but worsen.  Patients typically don’t understand the repercussions when they agree to gadgets like a $30,000 to $50,000 implanted defibrillator, which shocks a quivering heart back into normal rhythm.  “Defibrillators don’t actually make people feel better — it doesn’t treat the underlying heart failure.  All it does is abort sudden death,” Allen said.

Allen and other physicians involved in the study stressed the importance of building a patient-doctor consensus with respect to questions of survival, symptom relief and quality of life issues.  Depending on their personal situation, not all patients want to “do everything” at all costs.  One way to facilitate such a discussion, according to the authors, is to reserve one day a year to review the patient’s situation, focusing on prognosis and possible treatments alongside an appreciation for the patient’s values and goals.  This annual review is not intended to replace appropriate discussions about the patient’s ongoing care, such as when a turn for the worse or hospitalization occurs.  “The process of checking in with patients on a regular basis is extremely important because heart failure and general health change over time,” Allen said.

Shared decision making goes beyond informed consent, requiring that healthcare providers and patients consider information together and work toward consensus.  This process should focus on the outcomes that are most important to the patients, including not only survival but also relief of symptoms, quality of life and living at home.  “For patients with advanced heart failure, the decision-making process should be proactive, anticipatory, and patient-centered. This involves talking about goals of care, expectations for the future, and the full range treatment options, including palliative care,” according to Dr. Allen.

Because the time required for shared decision making is tricky to fit into a regular clinic visit, the authors suggest a yearly review to discuss prognosis, consider realistic therapies, and spell out the patient’s values, goals and preferences.  This review is in addition to discussions triggered by events such as hospitalizations and other changes in the patient’s health.  “The process of checking in with patients on a regular basis is extremely important because heart failure and general health change over time,” Dr. Allen said.

Heart failure typically progresses with time.  During the early stages, it can often be managed with medicines and lifestyle changes in diet, stopping smoking and exercise.  Advanced heart failure requires additional treatments, including heart transplantation.  A focus of the decision making process is understanding that “doing everything” is not always the best thing.  For many patients with advanced disease, receiving symptom relief, comfort, and support and medical therapy are preferred.

“Good” Cholesterol Can Protect Against Alzheimer’s Onset

Wednesday, December 22nd, 2010

Researchers at the Columbia University College of Physicians and Surgeons studied 1,130 people over the age of 65 and determined that so-called “good” cholesterol can reduce the risk of developing Alzheimer’s Disease.   In the study, the researchers recorded baseline measurements of the participants’ cholesterol levels and their neurological status.  Additionally, they determined if the seniors had a certain mutation in their APOE genes that might increase their risk of developing Alzheimer’s.

All volunteers were monitored for four years.  In that time, 89 of the study participants were diagnosed as having “probable” Alzheimer’s; another 12 had “possible” Alzheimer’s.  When comparing the participants with the lowest levels of high-density lipoprotein – the so-called “good” cholesterol, also known as HDL – the volunteers with the highest levels were 60 percent less likely to have a probable or even possible case of Alzheimer’s.

In completing their analysis, the researchers took into accounts age, gender, body-mass index, education and ethnic group.  Another point under consideration was the type of APOE gene,  as well as their general health or the presence of heart disease or type 2 diabetes.

The results are not unexpected, given that high levels of good cholesterol already have been associated with a lesser risk of carotid artery atheroschlerosis — which can lead to cognitive impairment – and strokes.

America Is Losing the War Against Obesity

Wednesday, September 22nd, 2010

America is putting on the pounds during this recession.  Americans are not getting thinner, and obesity rates have hit 30 percent of the population or higher in nine states last year, compared with just three states in 2007. Looking at the numbers from a different perspective, this means that 2.4 million additional Americans became obese in just two years, bringing the total to 72.5 million individuals, or 26.7 percent of the population.  Because the survey is based on a phone survey with 400,000 participants, the statistics probably underestimate true obesity rates.

According to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), which issued the survey, “Over the past several decades, obesity has increased faster than anyone could have imagined.”  If the numbers keep climbing, Frieden says that “more people will get sick and die from the complications of obesity, such as heart disease, stroke, diabetes and cancer.”  The report says that obesity’s medical costs could be as high as $147 billion a year and notes that “past efforts and investments to prevent and control obesity have not been adequate.”  Too little exercise and too much fast food that is full of sugar and fat share much of the blame for the obesity epidemic.

The nine states with obesity rates of 30 percent or higher are Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and West Virginia.  Mississippi reported an obesity rate of whopping 34.4 percent.  Colorado and Washington, D.C., had the lowest obesity rates at less than 20 percent.  According to Dr. Heidi Blanck, the CDC’s chief of the obesity branch, Americans aged 50 and above had the highest obesity rates.