Three public health interventions could prevent 94 million premature deaths

A worldwide effort to lower people’s blood pressure, cut their sodium intake, and eliminate trans fat from their diet could dramatically reduce the incidence of premature death from cardiovascular disease (CVD) over a quarter century, according to a new study led by Harvard T.H. Chan School of Public Health.

“Focusing our resources on the combination of these three interventions can have a huge potential impact on cardiovascular health through 2040,” said lead author Goodarz Danaei, associate professor of global health at Harvard Chan School.

The study was published online June 10, 2019 in the journal Circulation.

Researchers used global data from multiple studies and estimates from the World Health Organization in making their calculations.

They estimated that scaling up treatment of high blood pressure to 70% of the world’s population could extend the lives of 39.4 million people. Cutting sodium intake by 30% could stave off another 40 million deaths and could also help decrease high blood pressure, a major risk factor for CVD. And eliminating trans fatcould prevent 14.8 million early deaths.

More than half of all delayed deaths, and two-thirds of deaths delayed before age 70, are projected to be among men, who have the highest numbers of noncommunicable disease deaths globally, researchers found. Regions expected to benefit most from the interventions include East Asia, the Pacific, and South Asia, as well as countries in sub-Saharan Africa.

The authors said that a variety of programs and policies would be necessary to reduce premature CVD-related deaths. One important strategy would be to increase the use of blood pressure medications, many of which are safe and affordable.

The researchers acknowledged that scaling up the three interventions would be a “huge challenge,” requiring countries to commit additional resources to boost health care capacity and quality. But they added that previous analyses have shown that the interventions are achievable and affordable. For example, a Kaiser Permanente program in Northern California increased control of hypertension to 90% among thousands of the health system’s patients between 2001 and 2013, using strategies such as improved treatment protocols, patient-friendly services, and healthcare information systems that facilitate tracking people with hypertension. Similar approaches have been adapted and tested in some low- and middle-income countries, leading to notable improvements in hypertension treatment and control, the authors said.

“These are realistic goals that have been shown to be attainable on smaller scales,” said Danaei. “We need the commitment to scale up the programs to achieve them globally.”

“Three Public Health Interventions Could Save 94 Million Lives in 25 Years,” Vasilis Kontis, Laura K. Cobb, Colin D. Mathers, Thomas R. Frieden, Majid Ezzati, Goodarz Danaei, Circulation, June 10, 2019, doi: 10.1161/CIRCULATIONAHA.118.038160

Increasing red meat consumption linked with higher risk of premature death

People who increased their daily servings of red meat over an eight-year period were more likely to die during the subsequent eight years compared to people who did not increase their red meat consumption, according to a new study led by researchers from Harvard T.H. Chan School of Public Health.

The study also found that decreasing red meat and simultaneously increasing healthy alternative food choices over time was associated with lower mortality.

The study was published online June 12, 2019 in BMJ.

A large body of evidence has shown that higher consumption of red meat, especially processed red meat, is associated with higher risk of type 2 diabetes, cardiovascular disease, certain types of cancers including those of the colon and rectum, and premature death. This is the first longitudinal study to examine how changes in red meat consumption over time may influence risk of early death.

For this study, researchers used health data from 53,553 women in The Nurses’ Health Study and 27,916 men in the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer at baseline. They looked at whether changes in red meat consumption from 1986–1994 predicted mortality in 1994–2002, and whether changes from 1994–2002 predicted mortality in 2002–2010.

Increasing total processed meat intake by half a daily serving or more was associated with a 13% higher risk of mortality from all causes. The same amount of unprocessed meat increased mortality risk by 9%. The researchers also found significant associations between increased red meat consumption and increased deaths due to cardiovascular disease, respiratory disease, and neurodegenerative disease.

The association of increases in red meat consumption with increased relative risk of premature mortality was consistent across participants irrespective of age, physical activity level, dietary quality, smoking status, or alcohol consumption, according to the researchers.

Study results also showed that, overall, a decrease in red meat together with an increase in nuts, fish, poultry without skin, dairy, eggs, whole grains, or vegetables over eight years was associated with a lower risk of death in the subsequent eight years.

The researchers suggest that the association between red meat consumption and increased risk of death may be due to a combination of components that promote cardiometabolic disturbances, including saturated fat, cholesterol, heme iron, preservatives, and carcinogenic compounds produced by high temperature cooking. Red meat consumption has also recently been linked to gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) that might promote atherosclerosis.

“This long-term study provides further evidence that reducing red meat intake while eating other protein foods or more whole grains and vegetables may reduce risk of premature death. To improve both human health and environmental sustainability, it is important to adopt a Mediterranean-style or other diet that emphasizes healthy plant foods,” said senior author Frank Hu, Fredrick J. Stare Professor of Nutrition and Epidemiology and chair, Department of Nutrition.

The first author of the study is Yan Zheng, a former postdoctoral associate in the Department of Nutrition at Harvard Chan School and now a professor at Fudan University, Shanghai, China. Other Harvard Chan School authors include Yanping Li, Ambika Satija, Mercedes Sotos-Prieto, Eric Rimm, and Walter Willett.

The study cohorts were supported by grants of UM1 CA186107 and UM1 CA167552 from the National Institutes of Health. The current study was supported by grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL60712, HL126024), the National Institute of Diabetes and Digestive and Kidney Diseases (DK091718, DK100383, DK112940, DK078616), and the Boston Obesity Nutrition Research Center (DK46200).

“Association of Changes in Red Meat Consumption with Total and Cause-Specific Mortality Among U.S. Women and Men: Two Prospective Cohort Studies,” Yan Zheng, Yanping Li, Ambika Satija, An Pan, Mercedes Sotos-Prieto, Eric Rimm, Walter C. Willett, Frank B. Hu, BMJ, online June 12, 2019, doi: 10.1136/bmj.l2110.

Personal care product chemicals found in men’s urine samples

Chemicals known as phthalates and parabens are widely used in personal care products, however, it is unknown if this is an important exposure source for men. A new study by Harvard T.H. Chan School of Public Health researchers found these chemicals present in urine samples taken several hours after men in the study used the products.

The study was published online August 24, 2017 in Environmental Health Perspectives.

Phthalates are used as plasticizers in scores of products ranging from vinyl flooring to food packaging and parabens are widely used in personal care products, such as cologne, sunscreen, and deodorants, to extend shelf life. Some of these chemicals are endocrine disruptors and have been linked with adverse health outcomes.

Lead author Feiby Nassan, postdoctoral fellow in the departments of Environmental Health and Nutrition, and colleagues tested 1,037 urine samples from 400 men in the Environment and Reproductive Health (EARTH) Study. The men reported their use of 14 personal care products and provided urine samples between 2004–2015.

The largest amount of one phthalate was associated with use of cologne/perfumes as well as deodorants. The largest percent increase for parabens was associated with the use of sunblock lotion and hand/body lotion. The presence of the chemicals was generally higher within six hours of product use.

Other Harvard Chan authors included Russ Hauser, Frederick Lee Hisaw professor of reproductive physiology and acting chair, Department of Environmental Health, senior author; Dean Michelle A. Williams; Brent Coull, professor of biostatistics; Joseph Braun, visiting scientist in environmental health; Audrey Gaskins, research associate in nutrition; and Jennifer Ford, research nurse manager for the EARTH study.

Cancer alarm at the fire houses

Harvard researchers have teamed up with local fire departments to tackle a health care mystery: How does the firehouse itself increase cancer risk among firefighters?

Led by postdoctoral fellow Emily Sparer, researchers including students from Harvard and MIT tested air quality in three older Boston firehouses and examined the results against air quality in a newer Arlington station, renovated roughly a decade ago to minimize transfer of pollutants from the truck bay to living quarters.

Compared with conditions inside a burning building, firehouses may seem benign places. But because firefighters spend so much time in the firehouse, even low-level exposure might be hazardous, said Professor Glorian Sorensen, director of the Harvard Chan School’s Center for Work, Health, and Well-Being and Dana-Farber Cancer Institute’s Center for Community-Based Research, who has overseen the research.

Diesel exhaust, for example, is a carcinogen, and in older firehouses — Boston’s date from the 1800s to 1980s — the truck bays are near the living quarters. Also, the design of the buildings is such that air flows easily through doorways and the hole in the floor for the fire pole, Sparer said.

“[Fighting fires] is very important, however, a lot of firefighters actually don’t spend the majority of their shifts fighting fires,” Sparer said. “They respond to car accidents or are at the fire station, where there might be other kinds of exposures that haven’t been looked at.”

Sparer’s team investigated three locations at the four stations — truck bay, kitchen, and outside the building — and conducted interviews with firefighters about living conditions and health habits.Arlington Deputy Fire Chief John Kelly demos a device that ventilates exhaust fumes from the muffler of a fire truck. Kris Snibbe/Harvard Staff Photographer

The pilot study, supported by the National Institute for Occupational Safety and Health, examined two types of pollutants: tiny particles generated in fossil fuel combustion that have been shown to be harmful, and potentially cancer-causing chemicals called polycyclic aromatic hydrocarbons (PAHs). The results were published in the Journal of Occupational and Environmental Medicine.

The research showed that age and layout of the station affected how effectively truck exhaust was captured and vented, that pollutants at each station were highest in the truck bays, and that pollutant levels in the living areas — where the firefighters spend a substantial amount of time — were lowest in the Arlington station designed to restrict air flow from the truck bay.

The results not only show that building design is an important factor in protecting firefighters, Sparer said, they also support the case for a larger study on which recommendations for interventions can be based.

The project launched about two years ago, when the Boston Fire Department approached Dana-Farber to discuss concerns about anecdotal evidence of high cancer rates among city firefighters. Institute officials referred them to Sorensen, an expert on cancer in the workplace. Sorensen turned the project over to Sparer, who had just begun her postdoctoral fellowship.

Boston Deputy Fire Chief Jim Hoar, who heads the department’s Safety, Health, and Wellness Division, said it is well accepted among firefighters that cancer is a serious occupational threat.

“It’s not just the folks who are active-duty, it’s the ones who retire,” Hoar said. “‘Here’s your gold watch after 40 years on the line.’ You’re 65 years old and you don’t make it to 66 or 67.

“The hardest thing for guys who’ve been on [the job] like myself, 20 years or a little bit more, is you start to hear about guys you worked with cheek by jowl. … There are a lot of those folks, too many to mention, who didn’t make it.”

Arlington Deputy Chief John Kelly described the same pattern. Early in his career, Kelly thought that older firefighters developed cancer mainly due to age, like the rest of the population. But as more research linked pollutants and disease, his thinking changed.

The Arlington firehouse in the new study was renovated about a decade ago to separate the truck bay from the living quarters, Kelly said. The original truck bay was longer, he said, and gym equipment and a card table were located at the end of the bay, exposed to diesel fumes from the engine. Soot from the diesel exhaust used to settle throughout the station.

“You’re sitting on a couch covered in it,” Kelly said. “Your clothes are always dirty and you just didn’t think anything of it. Very few of our guys have died without cancer over the last 10 years.”

With the new design, the truck bay was shortened to make room for a separate kitchen, and the gym was moved to the basement, away from truck exhaust.

High cancer rates in firefighters have been documented in several studies, Sparer said, including a recent reportthat examined work- and health-related data between 1950 and 2009 for 30,000 firefighters in Philadelphia, Chicago, and San Francisco. The research showed an elevated rate of cancer diagnoses and deaths for firefighters, mainly for digestive, oral, respiratory, and urinary disease. In addition, firefighters were about twice as likely to develop malignant mesothelioma, a rare cancer related to asbestos exposure.

The study also showed that younger firefighters had more cases of certain types of cancer, such as bladder and prostate, than expected, that chances of lung cancer increased with time spent at fires, and that chances of dying from leukemia increased with the number of fire runs.

Diesel fumes aren’t the only firehouse cancer threat, Sorensen said. Toxins can be absorbed by gear and released in the station. Some stations have industrial washing machines to clean gear, but many still don’t. Unusual job shifts are another factor, Sparer noted. While most OSHA regulations regarding workplace pollutants are based on the conventional eight-hour shift, firefighters typically work 24 hours at a time.

“These guys are sleeping, eating, exercising, training, reading a book, hanging out at their workplace,” Sparer said. “And so, in a given shift of 24 hours … they can be in the station for a long period of time.”

Though an ideal fix would be to renovate all older firehouses to separate people and pollutants, that solution is expensive and won’t happen overnight. Hoar said the average age of a Boston firehouse is 76 years, with some built for horses and wagons. Right now the city has three renovations underway or in planning.

In the near-term, one obvious improvement would be to ensure that all firefighters get basic cancer screenings. Sorensen said other simple interventions should be considered, such as efforts to encourage better dietary practices.

“We are trying to look at what are the exposures, what are the opportunities for potential intervention,” she said.

Published courtesy of Harvard Chan, School of Public Health