Improving BP in Middle Age Pays Off Later

 

December 22, 2011, by Reed Miller (Chicago, IL) — Lowering blood pressure during middle age reduces the lifetime risk of cardiovascular events, a new analysis of data pooled from seven cohort study shows [1].

“Avoiding hypertension before middle age and delaying the onset of the development of hypertension both appear to have a significant impact on an individual’s remaining lifetime risk for cardiovascular disease,” study authors Dr Norrina Allen (Northwestern University, Chicago, IL) and colleagues explain in their report, published online December 19, 2011 in Circulation.

Allen et al analyzed data from 61 585 patients in seven diverse US cohort studies in the Cardiovascular Lifetime Risk Pooling Project to see how changes in blood pressure during middle age can affect lifetime risk of cardiovascular disease, coronary disease, and stroke after age 45. Each patient was followed for an average of 14 years and a total of 700 000 person-years.

Categorized by their BP at the age of 55, 25.7% of men and 40.8% of women had normal blood pressure; 49.4% of men and 47.5% of women had prehypertension; 18.1% of men and 9.6% of women had stage 1 hypertension; and 6.8% of men and 2.2% of women had stage 2 or treated hypertension. About half of the subjects stayed in the same BP category from age 41 to 55, while 30% of men and 40% of women increased their blood pressure before they were 55.

Study subjects who maintained or decreased their blood pressure to normal levels ( < 120/80 mm Hg) by the time they were 55 had the lowest remaining lifetime risk of cardiovascular disease of 22% to 41%, while people who developed hypertension by age 55 had a 42% to 69% lifetime risk.

The patients who improved their BP may have changed their diet and exercise habits, or the difference may have just been regression to the mean. Regardless, the worst lifetime risk of disease was seen in men who developed hypertension during middle age, while in women, the subjects who had hypertension from age 41 through 55 years of age had the worst lifetime risk. “Although it was not consistently evident that a longer duration of high BP was associated with increased lifetime risks, it is possible that a greater duration of hypertension is associated with increased competing risk from non-CVD mortality,” the authors state.

“Taking BP changes into account can provide more accurate estimates for lifetime risk for CVD and represent a step forward in developing individualized risk-prediction strategies,” Allen et al conclude.

The authors report that they have no disclosures.

 

 

A Reading of 110 Over 70 or 75 is Normal

 

 

 

From Medscape Medical News > Psychiatry

Blood Signature May Predict Alzheimer’s Disease

 

 

December 22, 2011, by Deborah Brauser  —  A molecular signature found in serum samples may predict future development of Alzheimer’s disease (AD), even before the first symptoms of the disease occur in patients, new research suggests.

In a cohort study of more than 100 elderly patients with mild cognitive impairment (MCI), investigators found that those who progressed to AD less than 4 years later had a molecular signature suggesting a state of increased hypoxia.

“The study is important, as it identifies molecular changes associated with AD progression years in advance,” lead author Matej Orešič, PhD, research professor of systems biology and bioinformatics at the VTT Technical Research Center of Finland in Espoo, told Medscape Medical News.

“The study therefore suggests that a blood test may eventually be available to identify the patients at risk of AD who could then be followed-up more tightly,” said Dr. Orešič.

The investigators note that the application of a simple biochemical assay from these blood tests could complement neurocognitive assessments given to elderly patients.

“Establishment of pathogenic relevance of predictive biomarkers such as ours may not only facilitate early diagnosis, but may also help identify new therapeutic avenues,” they write.

The study was published online December 13 in Translational Psychiatry.

Small Molecules as Predictors?

MCI is considered a transitional phase between normal aging and AD.

“MCI confers an increased risk of developing AD, although the state is heterogeneous with several possible outcomes, including even improvement back to normal cognition,” the investigators write.

Dr. Orešič reported that he has been investigating metabolome (the complete set of small-molecule metabolites) in relation to health and disease for nearly 10 years, with lipids being one of his main areas of study.

“Lipids are known to play an important role in AD pathogenesis, but it has not yet been known whether lipids or any other small molecules can also be good predictive markers of AD,” he explained.

For this study, the investigators used metabolomics, a method of detecting small metabolites, to produce blood profiles associated with the progression of AD.

They evaluated information on 143 patients diagnosed with MCI from longitudinal databases and then compared their findings to data from 46 healthy control volunteers and 37 patients with AD.

Blood samples were collected at baseline (time of diagnosis or upon identification as healthy control participants) and during a follow-up period, the average of which was 27 months (±18 months).

Hypoxia May “Kick Off” AD

Results showed that 52 of the patients with MCI progressed to AD by the end of the follow-up period.

“At baseline, AD patients were characterized by diminished ether phospholipids, phosphatidylcholines, sphingomyelins, and sterols,” write the investigators.

Although 3 metabolites were identified in the molecular signature of the MCI patients who progressed to AD, “the main contributor to the predictive model” was 2,4-dihydroxybutanoic acid (P = .0048). This indicated the potential involvement of hypoxia.

Analysis of metabolic pathways showed that upregulation of the pentose phosphate pathway was associated with AD progression; this also implicated hypoxia, along with oxidative stress, as having a role in early disease process.

Dr. Orešič noted that there were two surprising aspects to the study. First, although past research has shown that several membrane phospholipids, as measured in blood, were diminished in patients with AD, “these lipids were not early predictors of AD in our study.”

Instead, “the lipid-specific changes may be a later event in AD pathogenesis,” he said.

“Second, instead of lipids, we observed metabolic changes associated with hypoxia as early predictor of AD, suggesting that hypoxia may be an early event kicking off the AD.”

Dr. Orešič reported that the investigators are now “aiming to validate our findings” in a large prospective cohort. In addition, they are striving to better understand the physiological origin of the molecular changes observed in the blood.

“For this reason, we are currently undergoing detailed metabolomics analyses of cerebrospinal fluid samples from the same patients. Further related studies in this direction are also being considered.”

The study was supported under the 7th Framework Program by the European Commission and by grants from the Health Research Council of The Academy of Finland and from Kuopio University Hospital. Dr. Orešič has disclosed no relevant financial relationships.

Transl Psychiatry. Published online December 13, 2011

 

 

 

Great Engineering:

Gotthard Base Tunnel

 

Alp Transit

 

 

PopSci.com, December 22, 2011  —  The Swiss have solved one of Europe’s great problems: The Alps make shipping freight expensive. A decade ago, miners began digging outward from two 2,600-foot vertical shafts in Sedrun, Switzerland. They’ve since moved 31 million tons of rock to connect Italy to Germany via high-speed rail through the world’s longest train tunnel, 35.4 miles long. Manufacturer Herrenknecht built four 3,000-ton boring machines for the project, and after one of them encountered a zone of dangerous soft rock, crews began using a unique system of deformable steel rings to hold the tunnel open. The Gotthard will double freight capacity through one of Europe’s most vital trade corridors and will cut an hour from the four-hour trip between Zurich and Milan.

Target Health Inc. 23rd Floor

 
Target Health Inc. on left: 23rd Floor Conference Room. Behind the Tree is the IT Department and a Kitchen. Other side of the floor is the Statistics Dept and Systems Administrators

 

 

Target Health Inc. 24th Floor

 
Decorations in the Large Reception Area. To the left, conference room and clinical offices. To the right, Quality and Clinical Offices and Kitchen