Category: Morbidity

Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome

Mary Pat Campbell

Link: https://jnnp.bmj.com/content/early/2025/03/21/jnnp-2024-334925.long

Excerpt:

Abstract

Background At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

Methods A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The β-coefficients were normalised to assess relative impact.

Results Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised β-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).

Conclusions This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.

Author(s): http://orcid.org/0009-0002-6540-480XJasper Senff1,2,3,4,5, http://orcid.org/0000-0003-3204-0309Reinier Willem Pieter Tack1,2,3,4,5, Akashleena Mallick1,2,3,4, Leidys Gutierrez-Martinez1,2,3,4, Jonathan Duskin1,2,3,4, Tamara N Kimball1,2,3,4,6, Benjamin Y Q Tan1,2,3,4,7, Zeina N Chemali1,2,8, Amy Newhouse1,9, Christina Kourkoulis1,2,3,4, Cyprien Rivier10,11, Guido J Falcone10,11, Kevin N Sheth10,11, Ronald M Lazar12, Sarah Ibrahim13,14,15,16,17, Aleksandra Pikula14,15,16,17, Rudolph E Tanzi1, Gregory L Fricchione8, Hens Bart Brouwers5, Gabriel J E Rinkel5, Nirupama Yechoor1,2,3,4, Jonathan Rosand1,2,3,4, Christopher D Anderson1,2,3,4,6, Sanjula D Singh1,2,3,4

https://doi.org/10.1136/jnnp-2024-334925

Publication Date: April 2025

Publication Site: Journal of Neurology, Neurosurgery, & Psychiatry

17 Ways to Cut Your Risk of Stroke, Dementia and Depression All at Once

Mary Pat Campbell

Link: https://www.nytimes.com/2025/04/23/well/dementia-stroke-depression-prevention.html?smid=url-share

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Excerpt:

New research has identified 17 overlapping factors that affect your risk of stroke, dementia and late-life depression, suggesting that a number of lifestyle changes could simultaneously lower the risk of all three.

Though they may appear unrelated, people who have dementia or depression or who experience a stroke also often end up having one or both of the other conditions, said Dr. Sanjula Singh, a principal investigator at the Brain Care Labs at Massachusetts General Hospital and the lead author of the study. That’s because they may share underlying damage to small blood vessels in the brain, experts said.

….

The study, which looked at data from 59 meta-analyses, identified six factors that lower your risk of brain diseases:

  • Low to moderate alcohol intake (Consuming one to three drinks a day had a smaller benefit than consuming less than one drink a day.)
  • Cognitive activity, meaning regular engagement in mentally stimulating tasks like reading or doing puzzles
  • A diet high in vegetables, fruit, dairy, fish and nuts
  • Moderate or high levels of physical activity
  • A sense of purpose in life
  • A large social network

The study also identified 13 health characteristics and habits that make you more likely to develop dementia, a stroke or late-life depression. (Altogether, the protective and harmful factors add up to 19 factors because two of them, diet and social connections, can increase or decrease risk, depending on their type and quality.)

  • High blood pressure
  • High body mass index
  • High blood sugar
  • High total cholesterol
  • Depressive symptoms
  • A diet high in red meat, sugar-sweetened beverages, sweets and sodium
  • Hearing loss
  • Kidney disease
  • Pain, particularly forms that interfere with activity
  • Sleep disturbances (for example, insomnia or poor sleep quality) or sleep periods longer than eight hours
  • Smoking history
  • Loneliness or isolation
  • General stress or stressful life events (as reported by study subjects)

Author(s): Nina Agrawal

Publication Date: 23 Apr 2025

Publication Site: NYT

BRCA1, BRCA2, and Associated Cancer Risks and Management for Male Patients

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamaoncology/article-abstract/2821594

Excerpt:

Importance  Half of all carriers of inherited cancer-predisposing variants in BRCA1 and BRCA2 are male, but the implications for their health are underrecognized compared to female individuals. Germline variants in BRCA1 and BRCA2 (also known as pathogenic or likely pathogenic variants, referred to here as BRCA1/2 PVs) are well known to significantly increase the risk of breast and ovarian cancers in female carriers, and knowledge of BRCA1/2 PVs informs established cancer screening and options for risk reduction. While risks to male carriers of BRCA1/2 PVs are less characterized, there is convincing evidence of increased risk for prostate cancer, pancreatic cancer, and breast cancer in males. There has also been a rapid expansion of US Food and Drug Administration–approved targeted cancer therapies, including poly ADP ribose polymerase (PARP) inhibitors, for breast, pancreatic, and prostate cancers associated with BRCA1/2 PVs.

Observations  This narrative review summarized the data that inform cancer risks, targeted cancer therapy options, and guidelines for early cancer detection. It also highlighted areas of emerging research and clinical trial opportunities for male BRCA1/2 PV carriers. These developments, along with the continued relevance to family cancer risk and reproductive options, have informed changes to guideline recommendations for genetic testing and strengthened the case for increased genetic testing for males.

Conclusions and Relevance  Despite increasing clinical actionability for male carriers of BRCA1/2 PVs, far fewer males than female individuals undergo cancer genetic testing. Oncologists, internists, and primary care clinicians should be vigilant about offering appropriate genetic testing to males. Identifying more male carriers of BRCA1/2 PVs will maximize opportunities for cancer early detection, targeted risk management, and cancer treatment for males, along with facilitating opportunities for risk reduction and prevention in their family members, thereby decreasing the burden of hereditary cancer.

Author(s): Heather H. Cheng, MD, PhD1,2; Jeffrey W. Shevach, MD3; Elena Castro, MD, PhD4; et al

JAMA Oncol. 2024;10(9):1272-1281.

doi:10.1001/jamaoncol.2024.2185

Publication Date: July 25, 2024

Publication Site: JAMA Oncology

Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821348

Graphic:

Excerpt:

Key Points

Question  What is the colorectal cancer mortality benefit of screening with fecal immunochemical tests (FITs)?

Findings  In this nested case control study of 10 711 individuals, completing a FIT to screen for colorectal cancer was associated with a reduction in risk of dying from colorectal cancer of approximately 33% overall, and there was a 42% lower risk for left colon and rectum cancers. FIT screening was also associated with lower risk of colorectal cancer death among non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White people.

Meaning  This study provides US community-based evidence that suggests FIT screening lowers the risk of dying from colorectal cancer and supports the strategy of population-based screening using FIT.

Author(s): Chyke A. Doubeni, MD, MPH1,2; Douglas A. Corley, MD, PhD3; Christopher D. Jensen, PhD3; et al

Publication Date: July 19, 2024

Publication Site: JAMA Netw Open. 

2024;7(7):e2423671.

doi:10.1001/jamanetworkopen.2024.23671

From a Simple Test to Open Heart Surgery: How a Cardiac Screening Saved George’s Life

Mary Pat Campbell

Link: https://www.chestercountyhospital.org/news/health-eliving-blog/2020/february/how-cardiac-screening-saved-georges-life

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Excerpt:

George, who is 51 years old, has been a police officer in Chester County for 31 years. He has lived a life of action — which comes with some feelings of invincibility. “As a police officer, there are times we think we are indestructible,” he explains.

Because of his active lifestyle — and no signs of heart problems whatsoever — heart disease was the furthest thing from George’s mind. “I walked anywhere from 6 to 8 hours a day. I was never winded, never tired, and I had no numbness. All of those telltale signs of heart disease — I never got any of them,” George explains.

Through a collaboration between Chester County Hospital and local police departments, George was offered a free cardiac risk screening for first responders. Despite zero signs of heart disease, he figured he might as well take advantage. Little did he know, he would end up having open-heart surgery just a few months later.

Publication Date: 10 Feb 2020

Publication Site: Chester County Hospital, Penn Medicine blog

The Latest Research on Why So Many Young Adults Are Getting Cancer

Mary Pat Campbell

Link: https://www.mskcc.org/news/why-is-cancer-rising-among-young-adults

Graphic:

MSK breast oncologist Dr. Shari Goldfarb

Excerpt:

Men and women in the prime of their lives are increasingly being diagnosed with serious cancers, including colorectal, breast, prostate, uterine, stomach (gastric), pancreatic, and more. One forecast predicts cancer for this age group will increase by 30% globally from 2019 to 2030.

“This is serious and worrisome,” says Shari Goldfarb, MD, breast oncologist and Director of MSK’s Young Women With Breast Cancer program.   

“This is not a blip,” explains Andrea Cercek, MD, gastrointestinal oncologist and Co-Director of The Center for Young Onset Colorectal and Gastrointestinal Cancer. “The more data we gather, the clearer this becomes.”

MSK is a pioneer in caring for the specific needs of people facing what are often called early-onset cancers, who confront very different challenges than older adults. The coming surge in cases is a key reason MSK is building a new state-of-the-art hospital, called the MSK Pavilion.

Just as importantly, MSK experts are leading the investigation into why this is happening.

Author(s): Bill Piersol

Publication Date: 3 Sept 2024

Publication Site: Memorial Sloan Kettering News

Heat killed a record number of Americans last year

Mary Pat Campbell

Link: https://www.usatoday.com/story/news/health/2024/08/26/2023-heat-deaths-record-number/74937063007/

Excerpt:

More Americans died from heat in 2023 than any year in over two decades of records, according to the findings published Monday. Last year was also the globe’s hottest year on record, the latest grim milestone in a warming trend fueled by climate change.

The study, published in the American Medical Association journal JAMA, found that 2,325 people died from heat in 2023. Researchers admit that number is likely an undercount. The research adjusted for a growing and aging U.S. population, and found the death toll was still staggering.

….

Howard – along with researchers from the Uniformed Services University of the Health Sciences, in Maryland, and Pennsylvania State University – examined death certificate data between 1999 and 2023. Deaths were counted if heat was listed as an underlying or contributing cause of death.

Reported deaths remained relatively flat until around 2016, when the number of people dying began increasing, in what Howard, who studies health effects from extreme weather, calls a “hockey stick.” The hockey stick analogy has been used to describe warming global temperatures caused by climate change, where temperatures have swooped upward at alarming rates in recent years. 

Howard’s study suggests the human toll follows the same outline. An important indicator is age-adjusted deaths per 100,000 people. That heat-related death rate has increased dramatically compared to the early 2000s, regardless of age or population size.

The upward trajectory appears to be sharpening recently. In 2022, 1,722 people died at an adjusted rate of 0.47. But 2023 saw 603 more deaths than the previous year, with an adjusted rate of 0.63, the highest on record.

Deaths weren’t evenly spread nationally. In an interview, Howard said deaths were overwhelmingly concentrated in traditionally hot regions: Arizona, California, Nevada and Texas.

The study is limited in how local governments classify heat-related deaths, which could mean the actual number of deaths is an undercount. It’s also potentially skewed as more people become aware of the fatal risks of heat. The study didn’t break down vulnerable groups. For example, people without air conditioning, those who live or work outdoors, and people with underlying health conditions, are all at greater risk of serious illness or death from heat.

Author(s): Eduardo Cuevas and Dinah Voyles Pulver

Publication Date: 26 Aug 2024

Publication Site: USA Today

Work Longer, Die Sooner! America’s Dire Need to Expand Social Security and Medicare

Mary Pat Campbell

Link: https://www.ineteconomics.org/perspectives/blog/work-longer-die-sooner-americas-dire-need-to-expand-social-security-and-medicare

Excerpt:

Are we all really living longer? Let’s first point out that Princeton economists Anne Case and Angus Deaton, noted for their research in health and economics, recently showed that many Americans are not, in fact, enjoying extended lives. As they stated in their own New York Times op-ed, those without college degrees are “scarred by death and a staggeringly shorter life span.” According to their investigation, the expected lifespan for this group has been falling since 2010. By 2021, people without college degrees were expected to live to about 75, nearly 8.5 years shorter than their college-educated counterparts.

Overall life expectancy in America dropped in 2020 and 2021, with increases in mortality across the leading causes of death and among all ages, not just due to COVID-19. In August 2022, data confirmed that Americans are dying younger across all demographics. Again, the U.S. is an outlier. It was one of two developed countries where life expectancy did not bounce back in the second year of the pandemic.

So the argument that everyone is living longer greatly stretches the truth—unless, of course, you happen to be rich: A Harvard study revealed that the wealthiest Americans enjoy a life expectancy over a decade longer than their poorest counterparts.

Could the idea that working into our seventies and beyond boosts our health and well-being hold true? Obviously, for those in physically demanding roles, such as construction or mining, prolonged work is likely to lead to a higher risk of injury, accidents, and wearing down health-wise. But what about everybody else? What if you have a desk job? Wouldn’t it be great to get out there, do something meaningful, and interact with people, too?

Perhaps it’s easy for people like Steuerle and Kramon to imagine older people working in secure, dignified positions that might offer health benefits into old age – after all, those are the types of positions they know best.

But the reality is different. Economist Teresa Ghilarducci, a professor at the New School for Social Research, focuses on the economic security of older workers and flaws in U.S. retirement systems in her new book, Work, Retire, Repeat: The Uncertainty of Retirement in the New Economy. She calls those praising the health perks of working longer “oddballs” – those fortunate folks in cushy positions who have a lot of autonomy and purpose. Like lawmakers or tenured professors, for example.

Author(s): Lynn Parramore

Publication Date: 8 May 2024

Publication Site: Institute for New Economic Thinking

Dangers firefighters face include higher cancer risks

Mary Pat Campbell

Link: https://www.upi.com/Health_News/2024/05/10/firefighters-face-cancer-dangers/8411715363541/

Excerpt:

Compared to the general public, firefighters have a 9% higher rate of certain cancers, likely due to their exposure to high levels of carcinogens released into the air as buildings burn. The incidence of multiple myeloma — the first cancer Perez developed — is about 50% higher in firefighters than in the general population.

….

Dr. C. Ola Landgren has been researching links between occupational exposures and multiple myeloma for a number of years — particularly in first responders such as firefighters. At Memorial Sloan Kettering Cancer Center in New York and the National Cancer Institute, Landgren began to recognize patterns.

In New York, for example, Landgren had three myeloma patients who lived on the same block on Staten Island. Their houses had been covered by dust after the World Trade Center towers fell in 2001.

“Myeloma has a precursor condition known as MGUS, which is more common in the population, allowing us to identify risks earlier,” Landgren said. “We’ve actually observed higher rates of MGUS in first responders compared to the general population.”

MGUS — which stands for monoclonal gammopathy of undetermined significance — has also been linked to pesticide use among farmers and exposure to Agent Orange among veterans of the Vietnam War. Levels also were higher in firefighters, police officers and construction workers who were on-site immediately after the 9/11 attacks.

Author(s): Lori Saxena, HealthDay News

Publication Date:

Publication Site:

Observational studies of COVID vaccine efficacy are riddled with bias/ Not counting cases 14 days after dose 2 is a problem

Mary Pat Campbell

Link:https://www.drvinayprasad.com/p/observational-studies-of-covid-vaccine

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Excerpt:

In the experiment, he says, what if we compare the control arm of the Pfizer study against an imaginary vaccine arm. And for the thought experiment assume the vaccine is useless. As the table above shows, both groups have identical numbers of covid cases— just what you would expect from a useless vaccine. A straight forward analysis shows no benefit (second to last row)

But in the ‘fictional vaccine observational study’ cases are excluded for 36 days. When this is done the useless vaccine, looks like it reduces infections by 48%!!

Doshi makes a very good point in his paper that the solution is to subtract the 36 day infection rate from the observational control arm. Sadly most investigations don’t do that.

This is one of several biases Doshi discusses, and it plagues the vaccine literature.

Author(s): Vinay Prasad

Publication Date: 14 May 2024

Publication Site: Vinay Prasad’s Observations and Thoughts, substack

An Iowa farm county seeks answers amid cancer rates 50% higher than national average

Mary Pat Campbell

Link: https://www.thenewlede.org/2024/05/an-iowa-farm-county-seeks-answers-amid-cancer-rates-50-higher-than-national-average/

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Excerpt:

Palo Alto’s [County, Iowa] 2022 tally of 842 farms generates nearly $800 million in annual market value. But nearly 400 small farms have been absorbed into bigger operations or otherwise stopped operating over recent decades, and Palo Alto’s population has dropped by 4,200 people since 1970.

Today’s Iowa farms are largely focused on raising hogs and growing corn, both of which are linked to numerous environmental problems. Farmers growing corn, for example, often rely heavily on applications of toxic pesticides and fertilizers, while livestock operations generate millions of tons of manure annually. The chemicals and manure pollute food and water consumed by people even far from farm fields.

When nitrogen from fertilizer and manure combine with oxygen they create nitrates, which routinely drain from farm fields into groundwater, streams, and rivers, contaminating water sources. Babies can suffer severe health problems when consuming nitrates in drinking water, and a growing body of literature indicates potential associations that include an increased risk of cancer. Exposure to elevated levels of nitrates in drinking water has been linked by researchers to cancers of the blood, brain, breast, bladder and ovaries.

As well, there are years of research showing that many herbicides and other pesticides applied to farm fields are linked to cancers and other diseases. The National Cancer Institute and the National Institute of Environmental Health Sciences have been funding research to investigate the links between disease and farming for more than 30 years, focusing their work on people in Iowa and North Carolina. Among the findings are links between pesticides and malignant brain tumors, multiple myeloma, pancreatic cancer and certain breast cancers.

Concerns about connections between the farm pollutants and cancer have been mounting, particularly in Palo Alto County, which had the highest incidence of cancer of any county in the state and the second-highest incidence of cancer among all US counties, with 83 new cases of cancer on average each year, in a population of 8,996, according to a 2023 report by US News.

Author(s): Keith Schneider

Publication Date: 7 May 2024

Publication Site: The New Lede