Health for life

While aspirin has been shown to be effective in preventing heart attacks in men, it also increases the risk of gastrointestinal bleeding and possibly stroke, even at low doses. As such, national guidelines suggest that aspirin be used for prevention only in men at higher risk for cardiovascular events, so that the benefits of aspirin are greater than its adverse effects.

Recent data suggest that aspirin may also be effective for reducing cancer deaths. Would the possible combined health benefits of reducing heart attacks and cancer outweigh the risks of gastrointestinal bleeding and stroke for middle-aged men?

A research team, including UNC scientists, reports that including the positive effect of aspirin on cancer mortality influences the threshold for prescribing aspirin for primary prevention in men. The benefit of aspirin for cancer mortality prevention would help offset the risks and thus lower the age and increase the number of men for whom aspirin is recommended.

Their results were published in the June issue of the Journal of General Internal Medicine.

Michael Pignone, MD, MPH, and study lead author, says, “We found that including a risk reduction for cancer deaths had a substantial impact on the overall benefits of aspirin, especially for early middle-aged men from 45 to 55 years of age. Based on this effect, several million men who were not previously good candidates for aspirin prevention would now become eligible.

The U.S. Preventive Services Task Force, of which Dr. Pignone is a recently appointed member, recommends aspirin for primary prevention in men “when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage.” This recommendation was issued in 2009, before the potential benefits for cancer reduction were recognized.

Men who are overweight or obese when they are diagnosed with prostate cancer are more likely to die from the disease than men who are of healthy weight, according to a Kaiser Permanente study published today in the journal Obesity Research & Clinical Practice. In patients with more aggressive forms of prostate cancer, the researchers also found an even stronger correlation between obesity and mortality.

This study included 751 Kaiser Permanente patients with prostate cancer who underwent radical prostatectomy, an operation that includes removal of the prostate and surrounding tissue. The researchers explored the association between the patients body mass index and prostate cancer mortality, adjusted for tumor aggressiveness and other characteristics.

The researchers found men who died from prostate cancer were 50 percent more likely to be overweight or obese at diagnosis compared to men who did not die from the disease. Men with high Gleason scores, a rating of the aggressiveness of prostate cancer cells, had the highest association between BMI and death, specifically men with Gleason scores of 8 or higher. The Gleason score ranges from 2 to 10, with the highest number representing the greatest likelihood of tumor cells spreading.

"We found among patients undergoing surgical treatment for prostate cancer, weight at time of diagnosis is more strongly correlated with prostate cancer survival than many other factors researchers have studied in the past, including some prostate cancer treatments," said lead author Reina Haque, PhD, a researcher at Kaiser Permanente Southern Californias Department of Research & Evaluation in Pasadena, Calif. "Moving forward, we are hoping future studies will examine the effect of weight loss and other lifestyle modifications on prostate cancer mortality."

Additional studies are needed to determine which lifestyle modifications, such as diet or exercise, could prolong a prostate cancer patients life. Further investigation also is needed to determine if the findings of this study, which looked at men who had prostate cancer surgery, apply to men who received other treatments such as radiation or hormone therapy.

Although the connection between mens weight at prostate cancer diagnosis and likelihood of survival has been examined, many previous studies were limited by self-reported body weight data or it was unclear when the BMI data were obtained. So the link between obesity and prostate cancer mortality remains controversial. However, the methodology of this study was different because the researchers used BMI collected from medical records, instead of self-reported data. The researchers identified men who died of prostate cancer and compared their BMI at time of diagnosis to controls to determine if body weight is related prostate cancer death. The biological relationship between obesity and prostate cancer prognosis is still not understood, and is an active area of research.

Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality in over a decade and should be added to standard treatment, according to lead author Professor Svend Aage Mortensen (Copenhagen, Denmark).

Heart Failure 2013 is being held from 25-28 May in Lisbon, Portugal. It is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Coenzyme Q10 (CoQ10) occurs naturally in the body and is essential to survival. CoQ10 works as an electron carrier in the mitochondria, the powerhouse of the cells, to produce energy and is also a powerful antioxidant. It is the only antioxidant that humans synthesise in the body.

CoQ10 levels are decreased in the heart muscle of patients with heart failure, with the deficiency becoming more pronounced as heart failure severity worsens. Statins are used to treat many patients with heart failure because they block the synthesis of cholesterol, but these drugs also block the synthesis of CoQ10, which further decreases levels in the body.

Double blind controlled trials have shown that CoQ10 improves symptoms, functional capacity and quality of life in patients with heart failure with no side effects. But until now, no trials have been statistically powered to address effects on survival.

The Q-SYMBIO study (2) randomised 420 patients with severe heart failure (New York Heart Association (NYHA) Class III or IV) to CoQ10 or placebo and followed them for 2 years. The primary endpoint was time to first major adverse cardiovascular event (MACE) which included unplanned hospitalisation due to worsening of heart failure, cardiovascular death, urgent cardiac transplantation and mechanical circulatory support. Participating centres were in Denmark, Sweden, Austria, Slovakia, Poland, Hungary, India, Malaysia and Australia.

CoQ10 halved the risk of MACE, with 29 (14%) patients in the CoQ10 group reaching the primary endpoint compared to 55 (25%) patients in the placebo group (hazard ratio=2; p=0.003). CoQ10 also halved the risk of dying from all causes, which occurred in 18 (9%) patients in the CoQ10 group compared to 36 (17%) patients in the placebo group (hazard ratio=2.1; p=0.01).

CoQ10 treated patients had significantly lower cardiovascular mortality (p=0,02) and lower occurrence of hospitalisations for heart failure (p=0.05). There were fewer adverse events in the CoQ10 group compared to the placebo group (p=0.073).

Professor Mortensen said: "CoQ10 is the first medication to improve survival in chronic heart failure since ACE inhibitors and beta blockers more than a decade ago and should be added to standard heart failure therapy."

He added: "Other heart failure medications block rather than enhance cellular processes and may have side effects. Supplementation with CoQ10, which is a natural and safe substance, corrects a deficiency in the body and blocks the vicious metabolic cycle in chronic heart failure called the energy starved heart."

CoQ10 is present in food, including red meat, plants and fish, but levels are insufficient to impact on heart failure. CoQ10 is also sold over the counter as a food supplement but Professor Mortensen said: "Food supplements can influence the effect of other medications including anticoagulants and patients should seek advice from their doctor before taking them."

Patients with ischaemic heart disease who use statins could also benefit from CoQ10 supplementation. Professor Mortensen said: "We have no controlled trials demonstrating that statin therapy plus CoQ10 improves mortality more than statins alone. But statins reduce CoQ10, and circulating CoQ10 prevents the oxidation of LDL effectively, so I think ischaemic patients should supplement statin therapy with CoQ10."

A large study of nearly half a million older adults followed for about 12 years revealed a clear trend: as coffee drinking increased, the risk of death decreased. Study author Neal Freedman, PhD, MPH, National Cancer Institute, discusses the significance of these findings and the potential links between coffee drinking, caffeine consumption, and various specific causes of disease in an interview in Journal of Caffeine Research, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available on the Journal of Caffeine Research website.

"Epidemiology of Caffeine Consumption and Association of Coffee Drinking with Total and Cause-specific Mortality" presents an in-depth interview exploring the many factors that could contribute to the association between coffee, disease, and mortality.

Dr. Freedman examines the relationship between coffee drinking and behaviors such as smoking and alcohol abuse, the physiological effects of caffeine on blood pressure and cardiac function, and the importance of differentiating between the effects of coffee and caffeine.

Achieving and maintaining a healthy body weight, staying physically active and maintaining a healthy diet improved survival after cancer diagnosis in an elderly female cancer survivor population, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held here Oct. 16-19, 2012.

Researchers examined cancer survivors adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for body weight, physical activity and diet.

"Elderly female cancer survivors who achieve and maintain an ideal body weight, stay physically active and eat a healthy diet have an almost 40 percent lower risk for death compared with women who do not follow these recommendations," said Maki Inoue-Choi, Ph.D., R.D., research associate in the Division of Epidemiology and Community Health in the School of Public Health at the University of Minnesota.

Study participants included 2,080 women from the Iowa Womens Health Study who had a confirmed cancer diagnosis between 1986 and 2002 and who completed a follow-up questionnaire in 2004. Women provided information on body weight, physical activity level, dietary intake and other demographic and lifestyle factors.

Through annual linkage with the State of Health Registry of Iowa and the National Death Index, researchers identified 495 deaths from 2004 to 2009, including 197 from cancer and 153 from cardiovascular disease. Researchers adjusted for age, number of comorbid conditions, general health, smoking, type and stage of cancer, current cancer treatment and subsequent cancer diagnosis. They found all-cause mortality was 37 percent lower for women with the highest (6 to 8) versus the lowest (0 to 4) adherence scores.

Reaching the WCRF/AICR physical activity recommendation was also associated with lower risk for death from any cause, from cardiovascular disease or from cancer after the researchers adjusted for dietary and body weight recommendation adherence scores and other covariates.

However, reaching the dietary recommendations was not associated with mortality following adjustment for body weight and physical activity recommendation adherence scores.