Many types of leisure time activities may lower risk of death for older adults

Older adults who participate weekly in many different types of leisure time activities, such as walking for exercise, jogging, swimming laps, or playing tennis, may have a lower risk of death from any cause, as well as death from cardiovascular disease and cancer, according to a new study led by researchers at the National Cancer Institute, part of the National Institutes of Health.

Photo credit: United Nations

The findings suggest that it’s important for older adults to engage in leisure time activities that they enjoy and can sustain, because many types of these activities may lower the risk of death, the authors wrote.

The findings appear Aug. 24 in JAMA Network Open.

Using data from 272,550 adults between ages 59 and 82 who had completed questionnaires about their leisure time activities as part of the NIH-AARP Diet and Health Study, the researchers looked at whether participating in equivalent amounts of seven different exercise and recreational activities—including running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise — was associated with lowered risk of death.

The researchers found that achieving the recommended amount of physical activity per week through any combination of these activities was associated with a 13% lower risk of death from any cause compared with no participation. When they looked at the role of each activity individually, playing racquet sports was associated with a 16% reduction in risk and running with a 15% reduction. However, all activities were similarly associated with lower risks of death.

The second edition of the Physical Activity Guidelines for Americans recommends that adults engage in 2.5 to 5 hours of moderate-intensity aerobic physical activity, or 1.25 to 2.5 hours of vigorous-intensity aerobic physical activity, each week.

The levels of activity by the most active individuals (those who exceeded the recommended levels of physical activity) were associated with even greater reductions in the risk of death, but there were diminishing returns as activity levels increased. Even people who did some recreational activity, though less than the recommended amount, had a 5% reduction in risk of death than those who did not participate in any of the activities studied.

These activities were also associated with a lower risk of death from cardiovascular disease and cancer. Playing racquet sports was associated with the greatest reduction in risk of cardiovascular deaths (27% reduction), while running was associated with the greatest reduction in risk of cancer deaths (19% reduction).

Tobacco smoking rates are decreasing in people with major depression and substance use disorder

Significant reductions in cigarette use were found among U.S. adults with major depression, substance use disorder, or both from 2006 to 2019, according to a new analysis of nationally representative survey data published today in JAMA. 

Smoking is a modifiable risk factor for cardiovascular disease and 73% of African American adults who smoke want to quit,

The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

These findings suggest that groups at higher risk of cigarette smoking can be reached by, and may have benefitted from, tobacco use prevention and cessation efforts that have led to significant declines in tobacco use in the general population. At the same time, the findings highlight remaining disparities, documenting higher smoking rates in people with psychiatric disorders than in those without.

“This study shows us that, at a population-level, reductions in tobacco use are achievable for people with psychiatric conditions, and smoking cessation should be prioritized along with treatments for substance use, depression, and other mental health disorders for people who experience them,” said Nora Volkow, M.D., director of NIDA and co-author of the study. “Therapies to help people stop smoking are safe, effective, and may even enhance the long-term success of concurrent treatments for more severe mental health symptoms in individuals with psychiatric disorders by lowering stress, anxiety, depression, and by improving overall mood and quality of life.”

Cigarette smoking, the leading preventable cause of disease, disability and death in the U.S., has been declining. Experts attribute this in part to increases in available treatments, insurance coverage of these treatments, cigarette prices, smoke-free and tobacco-free policies, mass media and educational campaigns and other evidence-based strategies to help people avoid or quit using cigarettes that have been implemented in recent decades.

Quitting cigarette smoking and tobacco use reduces the risk of cancer, heart disease, stroke and lung diseases. Studies have also found that smoking cessation in people with psychiatric disorders can help decrease anxiety, depression and stress; lower likelihood of a new-onset substance use disorder; and improve quality of life.

Past studies have documented that smoking rates remained essentially unchanged in people with substance use disorders, major depression or other psychiatric disorders. Now, analyzing data from more than 558,000 individuals aged 18 and older who participated in the 2006 to 2019 National Surveys on Drug Use and Health (NSDUH), researchers found that while people with major depression, substance use disorder or both were more likely to smoke cigarettes than people without these disorders; improvements in smoking cessation were seen among those with these psychiatric disorders during the 14-year period. The NSDUH, conducted annually by SAMHSA, provides nationally representative data on cigarette smoking, tobacco use, major depressive episode and substance (alcohol or drug) use disorders among the US civilian, non-institutionalized adult population. Among the population studied here, roughly 53% were women, 41% were aged 18 to 25 and 62% were non-Hispanic white.

After controlling for factors such as age, sex, race/ethnicity, education and family income, the researchers found that past-month smoking rates declined by 13.1% from 2006 to 2019 among adults with a past-year major depressive episode and by 8.2% from 2006 to 2019 among adults without. The difference in past-month cigarette smoking among those with versus without past-year major depressive episode significantly narrowed from 11.5% in 2006 to 6.6% in 2019.

Similarly, past-month cigarette smoking declined by 10.9% from 2006 to 2019 among adults with past-year substance use disorder and by 7.8% among adults without. For people with co-occurring substance use disorder and major depression, past-month smoking rates decreased by 13.7% during this 14-year period and by 7.6% among adults without these disorders.

“These declines tell a public health success story,” said Wilson Compton, M.D., NIDA’s Deputy Director and the senior author of the study. “However, there’s still a lot of work to be done to ensure tobacco use in patients with substance use disorder, depression, or other psychiatric conditions continue to decrease. It is crucial that healthcare providers treat all the health issues that a patient experiences, not just their depression or drug use disorder at a given point in time. To do this, smoking cessation therapies need to be integrated into existing behavioral health treatments. The result will be longer and healthier lives for all people.”

During 2006 to 2019, among adults with past-year major depressive episodes or substance use disorder, past-month cigarette smoking declined significantly across every examined age, sex, and racial and ethnic subgroup, except that among non-Hispanic American Indian or Alaska Native adults smoking rates did not decline. Given that American Indian and Alaska Native communities face the highest smoking and lowest quitting rates among racial and ethnic subgroups in the United States, this highlights the need to channel additional prevention and treatment efforts into these communities.

In future work, the researchers note the need to include data on certain populations at high risk of psychiatric disorders and cigarette smoking, such as institutionalized individuals or those experiencing homelessness without living in a shelter. More work is also needed to continue to monitor national trends in differences in tobacco use and nicotine vaping among adults with or without psychiatric conditions – including substance use disorder – during the COVID-19 pandemic.

Higher olive oil consumption linked with lower risk of premature death

People who consume higher amounts of olive oil may lower their risk of premature death overall and from specific causes including cardiovascular diseasecancer, and neurodegenerative disease, compared to people who never or almost never consume olive oil, according to a new study led by researchers from Harvard T.H. Chan School of Public Health.

Bottle pouring virgin olive oil in a bowl close up

The researchers also found that people who consumed olive oil instead of animal fat had a lower risk of total and cause-specific mortality.

The study was published online January 10, 2022 in the Journal of the American College of Cardiology.

This is the first long-term observational study on olive oil consumption and mortality in the U.S. Most previous research on olive oil and health has focused on populations from Europe and the Mediterranean, where olive oil consumption is higher.

“Olive oil consumption has been linked to lower cardiovascular disease risk, but its association with premature death was unclear,” said Marta Guasch-Ferré, a senior research scientist in the Department of Nutrition at Harvard Chan School. “Our findings confirm current dietary recommendations to replace animal fats with plant oils for the prevention of chronic diseases and premature death.”

The researchers used health data collected between 1990 and 2018 for 60,582 women participating in the Nurses’ Health Study and 31,801 men in the Health Professionals Follow-up Study. All participants were free of cardiovascular disease or cancer at the beginning of the study and completed dietary questionnaires every four years. During the study period, 36,856 people died.

Participants were asked how often they used olive oil in salad dressings, added to food or bread, or in baking or frying. According to the findings, people in the highest category of olive oil consumption (more than seven grams per day) had 19% lower risk of total and cardiovascular disease mortality, 17% lower risk of cancer mortality, 29% lower risk of neurodegenerative mortality, and 18% lower risk of respiratory mortality, compared with those who never or rarely consumed olive oil. Compared to margarine, butter, mayonnaise, or dairy fat, the use of olive oil was associated with lower risk of total and cause-specific mortality, although no significant risk reduction was observed when use of olive oil was compared to use of other vegetable oils.

“Clinicians should be counseling patients to replace certain fats, such as margarine and butter, with olive oil to improve their health,” Guasch-Ferré said. “Our study helps make specific recommendations that will be easy for patients to understand and hopefully implement into their diets.”

New Study Emphasizes Critical Need for Diversity of Research Participants in Genetic Studies

Studies of whites dominate the research literature to date despite being one of the smallest populations worldwide. 

A new paper in Nature presents evidence that the field of human genetics must improve the diversity of research participants to avoid worsening existing health inequities among different racial and ethnic groups, particularly where heart disease is concerned.

Blood cholesterol levels (also called lipid levels) are both highly genetic and a highly treatable health trait, and serve as a primary risk factor for heart disease, the leading cause of death worldwide. However, most previous genome-wide association studies, a study design used to detect associations between genetic variants and common diseases or traits in a population, have been conducted in European ancestry populations. Therefore, they may have missed genetic variants contributing to lipid level variation in other ancestry groups. 

The Nature article is a large collaboration with hundreds of coauthors from over 200 studies in 44 countries. It takes a look at the blood cholesterol levels of around 350,000 participants with Hispanic, African, East Asian, or South Asian ancestry, in addition to 1.3 million participants with European ancestry.

The paper’s key findings include:

  • Most genetic variations that influence lipid levels are observed across all populations, but at least some variants are uniquely observed in one population, particularly among individuals with African ancestry or Hispanics.
  • The ability to pinpoint the genetic variants most likely responsible for biological effects and to predict lifelong LDL cholesterol (“the bad cholesterol”) levels using genetic risk scores improves significantly when the initial genetic study includes diverse ancestries.
  • There is a need not only for future larger genetic studies of lipid levels but also for studies that prioritize the enrollment of individuals from diverse ancestries to improve genetic studies of health traits and diseases, such as cardiovascular disease.

“A sensible and equitable approach is to ensure diverse ancestries are represented in genetic studies whenever possible. Diversity helps to determine the degree to which findings can be generalized to other health traits and diseases, says Yan Sun, PhD, associate professor of epidemiology, who is co-senior author on the paper.

Article published courtesy of Emory University

Nutrient in plant-based foods may help lower heart disease risk

A type of molecule called a lignan, found in plant-based foods, may help lower heart disease risk, according to a new study by Harvard T.H. Chan School of Public Health researchers. The molecule, which is found in whole grainsfruits and vegetablesnuts and seeds, red wine, and coffee, was found to have antioxidant and anti-inflammatory effects.

The study was published online in the August 2021 issue of the Journal of the American College of Cardiology.

First author Yang Hu, a research fellow in the Department of Nutrition at Harvard Chan School, and colleagues studied data on the eating patterns of more than 200,000 people. They found that those whose diets included higher amounts of foods rich in lignans had a significantly reduced risk of coronary heart disease compared to those who ate low amounts of lignans. The protective effect appeared to increase among those who had higher amounts of fiber in their diet.

“This opens another avenue of research because we can take further steps to see how the gut microbiota and fiber interact with the production of lignans and how these might affect disease risk for other conditions, such as diabetes,” Hu said in an August 9 article in WebMD.

Are eggs good or bad for your health?

Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, is one of the skeptics. Willett, who co-authored a study last year that found that eating one egg per day did not increase the risk of cardiovascular disease, commented on the new findings in a February 9, 2021, CNN article. “The study results are problematic because they only asked people once about their egg consumption, then followed them for many years without checking to see if their diet had changed,” he said. “They’re only getting a snapshot in time.”

While there has been ongoing concern that the cholesterol in eggs could lead to health problems, Willett said that cholesterol’s role in the diet is “more complicated than we used to think.” He said that the key is to look at the overall nutritional pros and cons of a particular food, as well as what that food is replacing in the diet.

“If someone replaces eggs with doughnuts, other refined starches and sugar or saturated fats, I’d rather they eat eggs,” Willett said. “But for someone who really wants to be in optimal health, putting the emphasis on plant-based protein sources like steel-cut oatmeal and nuts would be a better way to go.” He added that certain populations, such as people on cholesterol-lowering medications, “would be better off keeping eggs on the low side.”

In general, he said, “I think the old recommendation of not more than two eggs per week for most people is actually still a good recommendation.”

Cardiac arrest treatment that uses life support machine boosts survival

Using a life support machine to replicate the functions of the heart and lungs significantly improved the survival of people who suffered from out-of-hospital cardiac arrest, according to a new study published today in The Lancet(link is external).

The treatment program involving the life support machine called extracorporeal membrane oxygenation (ECMO) proved so much more effective than the standard treatment for this usually fatal condition that the trial was stopped early after enrolling just 30 of the expected 165 patients.

The study, known as the Advanced Reperfusion Strategies for Refractory Cardiac Arrest (ARREST) trial, was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

“This is the first trial to show a significant difference in outcomes after hospital admission among patients treated for out-of-hospital cardiac arrest with a team-based ECMO strategy,” said George Sopko, M.D., M.P.H., program director in the NHLBI’s Division of Cardiovascular Sciences. “We can improve outcomes for this common health condition, and we believe this study is a significant step in that direction.”

Approximately 340,000 people die of cardiac arrest each year in the United States. The condition occurs when the heart suddenly stops beating. There is no blood flow to the body, including the heart and brain. Immediate emergency treatment is essential to prevent death, but standard treatments are only marginally effective. Less than 10% of people who suffer a cardiac arrest survive. Some cardiac arrest patients do not respond to any standard cardiac arrest treatments. The ARREST investigators, led by Demetris Yannopoulos, M.D., a cardiologist and professor of medicine at the Center for Resuscitation Medicine at the University of Minnesota Medical School in Minneapolis, hypothesized that this was because these patients had severe and extensive blockages in the arteries to their heart. To find out what approach might help cardiac arrest patients, the ARREST trial compared standard treatment with treatment with ECMO as soon as possible in 30 people who suffered a cardiac arrest. The average age was 61, and 25 of the 30 patients were men.

The ECMO machine connects to a patient by tubes inserted in an artery and vein in the groin. The machine pulls blood out of the patient’s body, pumps it through a part of the machine that acts as an artificial lung, and then returns it back to the body. This gives doctors time to stabilize the patient and, if suitable, clear any blockages in the arteries of the heart