Longevity Means Getting Just Enough Sleep

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Sleep apnea not a problem over 60!

A new study, derived from novel sleep research conducted by University of California, San Diego researchers 14 years earlier, suggests that the secret to a long life may come with just enough sleep. Less than five hours a night is probably not enough; eight hours is probably too much.

A team of scientists, headed by Daniel F. Kripke, MD, professor emeritus of psychiatry at UC San Diego School of Medicine, revisited original research conducted between 1995 and 1999. In that earlier study, part of the Women’s Health Initiative, Kripke and colleagues had monitored 459 women living in San Diego (ranging in age from 50 to 81) to determine if sleep duration could be associated with mortality. Fourteen years later, they returned to see who was still alive and well.

Of the original participants, 444 were located and evaluated. Eighty-six women had died. Previous studies, based upon questionnaires of people’s sleep habits, had posited that sleeping 6.5 to 7.5 hours per night was associated with best survival. Kripke and colleagues, whose 1990s research had used wrist activity monitors to record sleep durations, essentially confirmed those findings, but with a twist.

“The surprise was that when sleep was measured objectively, the best survival was observed among women who slept 5 to 6.5 hours,” Kripke said. “Women who slept less than five hours a night or more than 6.5 hours were less likely to be alive at the 14-year follow-up.”

The findings are published online in the journal Sleep Medicine.

Kripke said the study should allay some people’s fears that they’re not getting enough sleep. “This means that women who sleep as little as five to six-and-a-half hours have nothing to worry about since that amount of sleep is evidently consistent with excellent survival. That is actually about the average measured sleep duration for San Diego women.”

Researchers uncovered other interesting findings as well. For example, among older women, obstructive sleep apnea (pauses in breathing during sleep) did not predict increased mortality risk. “Although apneas may be associated with increased mortality risk among those under 60, it does not seem to carry a risk in the older age group, particularly for women,” Kripke said.

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Wider statin use could be cost-effective preventive measure

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A new analysis suggests that broader statin use among adult patients may be a cost-effective way to prevent heart attack and stroke. The Stanford University School of Medicine study also found that using a popular test - a screening for high sensitivity C-reactive protein, or CRP - to identify patients who may benefit from statin therapy would be cost-effective, but only under certain scenarios.

"If statins are really as safe and effective as they appear to be, broadening the indications for statin therapy would be an effective and cost-effective strategy," said Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine. "But under different assumptions, targeted CRP screening would be a reasonable approach," Hlatky is the senior author of the findings, which will appear online Sept. 27 in Circulation.

The study comes almost two years after a major clinical trial, known as the JUPITER study, showed that millions more people could benefit from taking statins, even if they have low cholesterol. That study involved patients with low cholesterol levels but elevated levels of CRP, which indicates inflammation in the body and suggests a greater risk of heart attack and stroke.

Under current clinical guidelines, statin therapy is recommended for individuals at high risk: those identified as having a 20 percent or more risk of some sort of cardiovascular event in the next 10 years. But heart attacks and stroke also occur in many people at lower risk levels, and the findings from the JUPITER study suggested that measuring CRP levels might identify patients who would benefit from statin therapy.

Still, that research did not address whether it would be cost-effective to do more screening and/or to give more people statin therapy. Accordingly, Hlatky and his colleagues sought to compare the cost-effectiveness of different strategies to prevent heart disease.

For their study, the researchers developed a model to analyze the cost-effectiveness of three approaches: following current guidelines; doing CRP screening in individuals who don't meet the current guidelines for treatment, with statin therapy for those with elevated CRP levels; and providing statin therapy based on an individual's cardiovascular risk alone, without CRP testing. Their model followed hypothetical patients, starting at 40 years of age, with normal lipid levels and no clinical evidence of heart disease or diabetes.

The researchers then looked at which approaches met the threshold of costing no more than $50,000 per quality-adjusted-life-year, a common metric that takes into account quality of life as well as length of survival. (Therapies costing around $50,000 or less per quality-adjusted life-year are generally considered cost-effective.)

Their conclusion? Assigning statin therapy based on risk alone, without CRP testing, was the most cost-effective strategy. The optimal strategy for men with no risk factors, for example, would be to start a statin at the age of 55.

"Initiation of statin treatment at lower risk levels without CRP testing would further improve clinical outcomes at acceptable cost, making it the optimally cost-effective strategy in our analysis," the researchers wrote in their paper.

The researchers found, however, that the optimal strategy for prevention changed if the assumptions in the model were altered. For instance, if patients with normal CRP levels get little or no benefit from statin therapy, CRP screening would be the optimal strategy. And if harms from statin use are only slightly greater than currently thought, statin therapy would not be reasonable in low-risk individuals, and following current clinical guidelines would be the most cost-effective strategy.

Clearly, there are a lot of unknowns and assumptions - all of which tempered the researchers' conclusion. "This is not a slam-dunk decision in terms of: You should take people at low risk and put them all on treatment," said Hlatky. "If you run the model and change the assumptions even a little bit, you get a different answer. Our model shows that we need better data to be confident about the best approach to drug treatment of lower-risk individuals."

For co-author Douglas Owens, MD, the study points to a high priority for determining whether statins work as well in low-risk people (i.e. those with normal CRP levels) or just high-risk ones. "That's a big uncertainty," he said, and the answer would inform how cost-effective both screening and broad therapy are.

The researchers also said it would be important to know whether high CRP levels do more than identify people who are at risk of developing heart disease, but also identify which people are more likely to have lower risk of heart attack or stroke when treated with a statin. (The test could then spare certain patients from unnecessary treatment.)

"Ideally, a marker would tell us who will benefit from drug treatment and who will not," said Hlatky. "If a test could give us that information, it would be very cost-effective. But there's not good evidence yet that CRP, or any other test, works that well."

Hlatky said a National Heart, Lung, and Blood Institute working group is now updating the clinical guidelines for statin therapy, and he hopes this research will inform their recommendations. "Maybe the threshold for statin treatment ought to be lower than is currently recommended," he said.

In the meantime, the researchers have developed an interactive tool that physicians can reference to determine the most cost-effective approach to statin therapy for individual patients. The calculator can be found at http://med.stanford.edu/hsr/crp-screening/

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Regular moderate intake of both caffeinated coffee and alcohol appeared to reduce the risk of contracting late onset diabetes

In a very large cohort of African-American women in the US, the association between the consumption of alcohol, tea, and coffee and the development of type 2 diabetes mellitus (late onset diabetes) was studied for 12 years. Tea and decaffeinated coffee showed no relation with diabetes, but the regular moderate intake of both caffeinated coffee and alcohol appeared to reduce the risk of contracting late onset diabetes significantly.

This paper is particularly important because some previous studies have not shown a strong association between alcohol and the risk of cardiovascular disease among African-Americans. African-Americans, especially women, tend to drink little alcohol, yet are at markedly increased risk of late onset diabetes. In the present study, the approximately 30% lower risk for moderate alcohol drinkers was about the same in these African-American women as has been found in many previous studies of Caucasians.

Detailed critique of this paper by the International Scientific Forum on Alcohol Research.

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Garlic oil shows protective effect against heart disease

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Garlic has "significant" potential for preventing cardiomyopathy, a form of heart disease that is a leading cause of death in people with diabetes, scientists have concluded in a new study. Their report, which also explains why people with diabetes are at high risk for diabetic cardiomyopathy, appears in ACS' bi-weekly Journal of Agricultural and Food Chemistry.

Wei-Wen Kuo and colleagues note that people with diabetes have at least twice the risk of death from heart disease as others, with heart disease accounting for 80 percent of all diabetes-related deaths. They are especially vulnerable to a form of heart disease termed diabetic cardiomyopathy, which inflames and weakens the heart's muscle tissue. Kuo's group had hints from past studies that garlic might protect against heart disease in general and also help control the abnormally high blood sugar levels that occur in diabetes. But they realized that few studies had been done specifically on garlic's effects on diabetic cardiomyopathy.

The scientists fed either garlic oil or corn oil to laboratory rats with diabetes. Animals given garlic oil experienced beneficial changes associated with protection against heart damage. The changes appeared to be associated with the potent antioxidant properties of garlic oil, the scientists say, adding that they identified more than 20 substances in garlic oil that may contribute to the effect. "In conclusion, garlic oil possesses significant potential for protecting hearts from diabetes-induced cardiomyopathy," the report notes.

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Blueberries help fight artery hardening

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Blueberries may help fight atherosclerosis, also known as hardening of the arteries, according to results of a preliminary U.S. Department of Agriculture (USDA)-funded study with laboratory mice. The research provides the first direct evidence that blueberries can help prevent harmful plaques or lesions, symptomatic of atherosclerosis, from increasing in size in arteries.

Principal investigator Xianli Wu, based in Little Rock, Ark., with the USDA Agricultural Research Service (ARS) Arkansas Children's Nutrition Center and with the University of Arkansas for Medical Sciences, led the investigation. The findings are reported in the current issue of the Journal of Nutrition.

Atherosclerosis is the leading cause of two forms of cardiovascular disease--heart attacks and strokes. Cardiovascular disease is the number one killer of Americans.

The study compared the size, or area, of atherosclerotic lesions in 30 young laboratory mice. Half of the animals were fed diets spiked with freeze-dried blueberry powder for 20 weeks; the diet of the other mice did not contain the berry powder.

Lesion size, measured at two sites on aorta (arteries leading from the heart), was 39 and 58 percent less than that of lesions in mice whose diet did not contain blueberry powder.

Earlier studies, conducted elsewhere, have suggested that eating blueberries may help combat cardiovascular disease. But direct evidence of that effect has never been presented previously, according to Wu.

The blueberry-spiked diet contained 1 percent blueberry powder, the equivalent of about a half-cup of fresh blueberries.

All mice in the investigation were deficient in apolipoprotein-E, a trait which makes them highly susceptible to forming atherosclerotic lesions and thus an excellent model for biomedical and nutrition research.

Wu's group wants to determine the mechanism or mechanisms by which blueberries helped control lesion size. For example, by boosting the activity of four antioxidant enzymes, blueberries may have reduced the oxidative stress that is a known risk factor for atherosclerosis.

In followup studies, Wu's group wants to determine whether eating blueberries in infancy, childhood and young adulthood would help protect against onset and progression of atherosclerosis in later years. Early prevention may be especially important in light of the nation's epidemic of childhood obesity. Overweight and obesity increase atherosclerosis risk.

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DRINK MILK AND LOSE MORE WEIGHT

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Regardless of Diet, Study Participants Who Consumed the Most Milk Lost the Most Weight

A new weight loss study conducted by Ben-Gurion University of the Negev (BGU) researchers reveals that dieters who consumed milk or milk products lost more weight on average than those who consumed little to no milk products.

Regardless of diet, researchers also found participants with the highest dairy calcium intake, equal to 12 oz. of milk or other dairy products (580 mg of dairy calcium), lost about 12 pounds (6 kg.) at the end of the two years. In comparison, those with the lowest dairy calcium intake averaging about 150 mg dairy calcium, or about half of a glass, only lost seven pounds on average. The study was published in the current issue of the American Journal of Clinical Nutrition.

Beyond calcium, the researchers also found that blood levels of vitamin D independently affected weight loss success. Vitamin D levels increased among those who lost more weight. The dietary intervention study also confirmed other research that overweight participants have lower blood levels of vitamin D.

More than 300 overweight men and women, aged 40 to 65, participated in the study evaluating low fat, Mediterranean or low-carb diets for two years. Dr. Danit Shahar, of BGU’s S. Daniel Abraham Center for Health and Nutrition and the Faculty of Health Sciences, led the study. It was part of the Dietary Intervention Randomized Control Trial (DIRECT) conducted at the Nuclear Research Center in Israel.

According to Dr. Shahar, "It was known that over-weight people had lower levels of serum vitamin D but this is the first study that actually shows that serum Vitamin D increased among people who lost weight. This result lasted throughout the two years that the study was conducted, regardless of whether they were on a low-carb, low fat or Mediterranean diet."

Vitamin D increases calcium absorption in the bloodstream and in addition to sun exposure can be obtained from fortified milk, fatty fish and eggs. Americans generally consume less than the recommended daily requirement of Vitamin D which is found in four glasses of milk (400 international units).

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Vitamin D Review

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Vitamin D: Many Benefits:


Recent reports on vitamin D suggest that it offers many benefits, especially for older adults. Findings point to improved balance, reduction in the risk of bone fractures, and better thinking skills such as planning, organizing and abstract thinking. Low levels of vitamin D are associated with diabetes, cardiovascular disease, multiple sclerosis and other autoimmune disorders, infections such as tuberculosis, and periodontal disease. Low vitamin D levels also may affect certain cancers, including colon, breast and prostate cancers.


Vitamin D Fight Heart Disease in Elderly

Vitamin D deficiency leads to high blood pressure

Vitamin D Promotes Mental Agility in Elders

Vitamin D deficiency common across a range of rheumatic conditions

Vitamin D deficiency is highly prevalent in patients with Type 2 diabetes

New evidence shows low vitamin D levels lead to Parkinson's disease

Over 65's should take high dose vitamin D

Several trials have shown that vitamin D improves strength and balance among older people.To reduce the risk of falling, a daily intake of at least 700-1000 IU supplemental vitamin D is warranted in all individuals aged 65 and older, say the authors.

Higher doses may be even more effective and should be explored in future research to optimise the fall prevention benefit with vitamin D, they conclude.

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