TIME Aging

Gains in Life Expectancy in the U.S. May Be Slipping

Nearly four in five Americans over age 67 have multiple chronic medical conditions

The more chronic medical conditions you have, the shorter your life will be, say researchers from Johns Hopkins Bloomberg School of Public Health.

In the study, published in the journal Medical Care, the team found that nearly four in five Americans over the age of 67 have multiple chronic conditions such as heart disease, hypertension and diabetes.

Obesity may be driving much of this trend, and may responsible for slowing recent gains in life expectancy. Life expectancy has been growing at about .1 years per year in the U.S., (that’s slower than rates in other developed countries).

The study used the Medicare 5 percent sample, a nationally representative group of 1.4 million Medicare beneficiaries, which included data on 21 chronic conditions. On average, life expectancy decreased by 1.8 years with each additional chronic condition among older Americans.

“When you’re getting sicker and sicker, the body’s ability to handle illness deteriorates and that compounds,” says senior study author Gerard Anderson, a professor in the Department of Health Policy and Management at Johns Hopkins. “Once you have multiple conditions, your life expectancy becomes much shorter.”

For example, he says, a 75-year-old woman with no chronic medical conditions would likely live to at least 92 years old, or another 17.3 years. However, a 75-year-old woman with five chronic conditions will likely only live another 12 more years, and a woman of the same age with 10 chronic conditions would only live to about 80 years old. According to the data, women fare better than men and white people live longer than black people even with the burden of additional health conditions.

The type of chronic disease older people develop also seems to affect their life expectancy. A 67-year-old diagnosed with Alzheimer’s will only live an additional 12 years, while someone with a heart condition can expect another 21.2 years. But once people develop more than one chronic condition, the specific illnesses no longer matter.

“There are interaction effects among the diseases that result in decreases in life expectancy. Any condition on its own has a particular effect. When you have heart disease plus cancer, that has a particular affect, and then those start to accumulate,” says lead study author Eva DuGoff.

The findings may be important for calculating health costs in coming years, especially for Social Security and Medicare programs. Currently, 60% of people over age 67 have three chronic medical conditions that require medical care — a significant increase from previous years when individuals didn’t live long with chronic conditions.

“In some ways we’re a victim of our own success. As we’re living longer and our health system has gotten better, no longer are people dying of heart disease at age 50 so now they’re dying of heart disease later when they have other things like cancer as well,” says DuGoff. Whatever gains improved health care has provided may be eroded by the effect of these accumulating chronic conditions. “We need to reorient our healthcare system to care for chronic conditions. If we don’t reorientate ourselves in that way, the impact of chronic conditions on life expectancy could be extremely negative.”

TIME Heart Disease

Mississippi Men Learn About Heart Disease — At the Barber

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John Sigler—Getty Images

Barbershops may be the new doctor's office, at least in Mississippi where African American men are learning about high blood pressure...while they get their hair cut

Barber shops and hair salons are great community hubs where residents gather for both grooming and gossip. So public health experts in the Mississippi Delta have decided to exploit these social meccas to connect with groups that don’t often see health care providers, including African American men.

Heart disease and stroke, for example, disproportionately affect this population of men, partly due to genetics, and partly due to lifestyle behaviors. But in places like the Mississippi Delta region, these men also do not get regular heart disease screenings. They do, however, go to barbershops for trims and to catch up on community news. So the Centers for Disease Control and Prevention (CDC) is funding a barbershop initiative called Brothers (Barbers Reaching Out to Help Educate Routine Screenings) located throughout the Mississippi Delta, where heart disease and stroke are the second and fourth leading causes of death in black men.

The Mississippi Department of Health spent a year recruiting and training barber shop workers on how to read a blood pressure screening, and discuss risk factors. During appointments, barbers talk to their clients about heart health, take their blood pressure, and refer them to a physician if they need further counseling. Recruitment was, and continues to be a challenge since some of the barbers were on board with the benefits of educating their clients, but worried about whether the program would hurt their business.

So far, thought, the barbers are being pretty persuasive. The project, which involves 14 barbershops that have so far served 686 men, just released its first set of data. Only 35% of the customers said that they had a doctor and 57% did not have health insurance. Among the men who received blood pressure readings, 48.5% had prehypertension, and 36.4% had high blood pressure. The findings, published in the journal Preventing Chronic Disease, shows that the program provides care to men who need it, as well as gives public health care workers a better idea of how prevalent heart disease is in the region, and how many patients are in need of medical care. The next step for the researchers is to create a community health worker network that could introduce these men to the health care system and help them navigate more regular screenings and better treatment of their condition.

Shifting health care from the clinic to the community isn’t a new idea; in some areas, health screenings and education are conducted in churches. But the faithful are a select group, and the study’s lead author says it’s important to bring services to hard-to-reach populations, such as young black men, to where they are. “We realized in our standard community health screenings–which were happening in churches–that we were not reaching adult black men,” says lead study author Vincent Mendy, an epidemiologist at the Mississippi State Department of Health. “We think the best way to reach them is through barbershops.” The program is part of a partnership between the CDC and the Mississippi State Department of Health, and is funded through September 2015.

Mendy is hopeful that the program will reach more men and bring them into treatment, since a similar 2011 initiative in Texas, funded by the National Institutes of Health, found that barbers helped to lower blood pressure in a population of African American men by 20%. Based on this growing body of research, the CDC is considering relying on community health workers to help improve the health of minority groups that have a disproportionate risk of disease and death in the U.S. — but are often outside of the health care system. Barbershops aren’t clinics, but they do seem to be a good place to get health messages across.

TIME sexual abuse

Childhood Sexual Abuse Raises Heart Disease Risk In Adulthood

Researchers link early sexual abuse to greater risk of developing blocked heart arteries

Sexual and physical abuse during childhood can have long term effects on both mental and physical health, and previous studies have linked childhood sexual abuse to a greater risk of heart attack and other heart events—but it has been unclear exactly why. New research published Thursday in the journal Stroke adds to the case, showing thatwhether or not women had other risk factors for heart problems, a history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

“What was a surprise was that when we controlled for [heart disease] risk factors, such as smoking and obesity, the association didn’t go away. We just couldn’t get rid of the association,” says Rebecca Thurston, director of the Womens’ Biobehavioral Health Laboratory at the University of Pittsburgh, who led the research with a team of colleagues.

MORE: Viewpoint: Why a Mandatory Child Abuse Reporting Law Could Backfire

More than 1,000 middle-aged women of various ethnic backgrounds from across the U.S. had yearly clinical exams beginning in 1996 for 12 years. At the end of the study, they also answered questions about sexual and physical abuse and had an ultrasound of their carotid arteries. About a quarter of the women reported being sexually abused as a child, and a similar percentage reported the experience as an adult.

When Thurston compared the women’s answers to their ultrasound, she found that those who reported childhood sexual abuse showed higher rates of plaque buildup in their arteries. They also had hearts and vessels that looked about two to three years older than those of women who hadn’t been abused.

MORE: Psychological Abuse: More Common, as Harmful as Other Child Maltreatment

Thurston’s findings suggest that whether or not the women had other risk factors for heart problems, their history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

Thurston plans to continue the work by studying women who have had heart events – in this study, only women without heart disease were included – to see if the correlation still holds. She also wants to better understand how the early abuse affects women in later life. There is some evidence that traumatic experiences may change the stress response system in lasting, and possibly permanent ways.

While none of the women had signs of heart disease at the start of the study, Thurston says the results hint that physicians should be considering childhood experience, particularly traumatic ones, as part of comprehensive heart care for women. If the results are validated, then they might lead to ways of intervening with stress reduction or other psychological techniques to hopefully slow down the hardening of the arteries and lower their risk of heart disease.

TIME Heart Disease

A Common Cholesterol Drug’s Safety Is In Question

New studies suggest Niacin doesn't help, but harms users

Two new studies suggest significant dangers from the common cholesterol drug niacin, and some doctors say the risks are not worth it.

One of the studies published in New England Journal of Medicine looked at extended-release niacin, and the other study looked at the combination of extended-release niacin and another drug, laropiprant, that makes it more effective. Neither found significant benefits, and both found high risk for adverse side effects in the gastrointestinal and musculoskeletal systems like bleeding, diarrhea and even gout. The niacin-laropiprant study found a 9% increase in death risk.

In a corresponding editorial, “Niacin and HDL Cholesterol — Time to Face Facts,” Dr. Donald Lloyd-Jones of Northwestern University in Chicago writes, “on the basis of the weight of available evidence showing net clinical harm, niacin must be considered to have an unacceptable toxicity profile for the majority of patients, and it should not be used routinely.” He notes that niacin may still have a role for patients at a very high risk for cardiovascular disease who do not tolerate statins.

It’s been thought in the past that niacin, a type of B vitamin, are a viable alternative or complement to statins. But the NEJM studies show that not only does niacin not work as well as statins, but it has some serious side effects. The researchers found that people taking niacin had about the same rates of disease as people on placebos, suggesting that the drug is not as effective as it’s thought to be.

Though many people will likely remain on niacin, members of the medical community caution people on the drugs, warning they should talk to their doctors about whether or not they should continue.

TIME Obesity

The Question of Healthy Obesity Continues

Is the obesity paradox real?

In a new review published in the journal Mayo Clinic Proceedings, researchers looked at 36 studies and found that among people with coronary artery disease, those with a high BMI had the lowest cardiovascular mortality risk compared to people with a normal weight.

The researchers say it’s further evidence of an obesity paradox, where being overweight or obese actually protects people from heart-related death.

Now, there are a few things to point out before we accept headlines like “Yes, Healthy Obesity Exists.” For one, the study population already had heart disease, and being obese puts people at a greater risk for heart-related ailments like stroke and high blood pressure. Second, it’s possible that the reasons the obese people had better outcomes was because they are more likely to be prescribed heart medications like statins compared to the normal population. It’s also possible that there is some sort of protective benefit from body fat that makes obese people less likely to have the worst effects from heart disease.

But doctors are not quick to conclude that being obese can protect your health. After all, the new study was looking at people who were already sick. But many in the medical community will agree that there are other factors critical to health that have nothing to do with the number on the scale, and that ultimately, concentrating on a person’s lifestyle behaviors over their size is a good strategy.

Read more of our coverage on the obesity paradox here.

TIME heart

Pigs Can Grow Their Own Pacemakers

And the scientists say that the technique, which involves cutting edge reprogramming of cells, may be tested in people soon

+ READ ARTICLE

Pacemakers are remarkable devices that save the lives of 300,000 people in the U.S. each year. They essentially take over for failing hearts, but since the devices require invasive surgery to implant in the heart, researchers have been looking for less invasive approaches to keeping the heart ticking. And now, reporting in the journal Science Translational Medicine, Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute, has a lead—thanks to pigs.

“We were able for the first time to create a biological pacemaker using minimally invasive methods, and show that the new pacemaker cells suffice to support the demands of daily life,” he said. “When the pigs exercised, the hearts beat faster. When they were at rest, their hearts slowed down.”

He and his colleagues say that a single gene can transform existing heart cells to take over the function of ailing pacemaker cells in the heart, The group tested their theory in mice, and were encouraged enough by the results to predict that human trials may be as close as three years away.

MORE: A ‘Vaccine’ for Heart Disease Could Mean No Pills, Lettuce or a Gym

Marban has been working for more than a decade to find a better way to keep pacemaker patients’ hearts pumping at the right rate. In particular, he was focused on the 2% of them who need to go on antibiotics to treat an infection—because the devices are foreign objects implanted into the body, infections are possible—and in the interim have their pacemakers removed to be cleaned. During that time, these patients receive a temporary pacing device connected to a catheter, but the catheter itself may be an additional source of infection and make the antibiotic treatment less effective.

MORE: Single Gene Responsible for Group of Heart Disease Risk Factors

In Marban’s experiment, he simply loaded deactivated cold viruses, which are able to easily infect cells, with a gene—called TBX18—that is active during fetal development but later shuts off. Earlier studies showed that simply bathing cells in TBX triggered normal heart cells to start morphing into the ones that keep hearts working. That’s exactly what happened in the seven pigs whose hearts were injected with the gene. A small proportion of their normal heart cells, the size of a peppercorn, were transformed into electrically pulsing cells and essentially took over the pacemaker function of the pigs’ hearts.

Dr. Eugenio Cingolani, director of the cardiogenetics-familial arrhythmia clinic at Cedars Sinai and a co-author of the paper, said that while encouraging, more studies on the efficacy of the genetic reprogramming process, as well as a more in-depth analysis of the potential adverse effects are needed.

But the findings represent a promising first step toward a potentially new technique for treating certain life-threatening conditions.

“This development heralds a new era in gene therapy, where genes are used not only to correct deficiency disorders but to convert one cell to another to treat disease,” said Marban. “Now that we and others are hot on the trail of developing therapeutics based on this principle of cell reprogramming, I anticipate that the flood gates will open and people will look for genes of interest to do whatever they want in particular organs or tissues of interest.”

At the very least, he believes that a hardware-free, biological pacemaker based on the technique could become reality.

TIME Heart Disease

Americans Are Having Fewer and Fewer Strokes

Blood pressure check-up
Getty Images

In the last two decades the stroke rate among Americans has dropped, and those that do have strokes have a lower risk of dying from then than they did in the past.

In a new study, researchers followed 14,357 Americans who were stroke-free in 1987 until 2011. They found a 24% overall drop in first-time strokes in each of the last two decades and an overall 20% decline per decade in deaths after stroke. The authors note that progress in stroke rates was primarily seen in the over-65 age group and stressed the continued need to lower the number of strokes in younger people.

The study, published in the Journal of the American Medical Association (JAMA), reports that the declines can be credited to better control over risk factors like blood pressure, getting people to quit smoking, and the fact that so many Americans are on cholesterol-controlling statins.

There’s still concern, however, over the high number of Americans suffering from obesity and type 2 diabetes, since both can increase the risk for stroke. About a third of American adults are obese, and if trends continue, one in three Americans will have a form of diabetes by 2050, according to CDC data. Considering already about 80,000 people in the U.S. have a stroke each year, the number still needs to drop, and addressing all risk factors is one way to get Americans’ overall health in check and continue to lower the stroke rate.

TIME Research

Here’s Why Tibetans Can Live Comfortably At Crazy-High Altitudes

Tibetans Can Live at High Altitudes
The Potala Palace in Lhasa, Tibet. Dave Bartruff—Getty Images

Ancient mating patterns seem to have given these plateau dwellers an odd advantage

When you or I go up to high altitude, we gasp for a while, maybe faint, and then gradually adapt. The way we do it is by furiously generating more red blood cells, to increase the blood’s ability to absorb oxygen, which gets thinner the higher we go. But we pay a price: all of those extra blood cells can make the blood sticky, leading to a risk of high blood pressure, heart attack and, in pregnant women, the delivery of low-birth-weight babies.

We pay that price, that is, unless we’re natives of the Tibetan plateau, where people live more or less cheerfully at altitudes of 13,000 feet and more. The secret lies in their genes—mostly in a gene known as EPAS1, which allows them to absorb scarce oxygen without creating extra blood cells. But while genetic traits are often created by mutations within a given species, this one evidently came from outside. According to a paper just published in the current Nature, the Tibetans’ ancestors evidently mated with a now extinct human species known as the Denisovans, which went extinct somewhere around 40,000 years ago.

It’s no surprise that matings have happened between modern humans and other human species. We share a fair number of genes with the more familiar Neanderthals, for example, who were the Denisovan’s distant cousins. But it’s not clear (although it’s certainly possible) that Neanderthal genes gave our ancestors any specific evolutionary advantages.

For Tibetans, though, the high-altitude gene allowed them to colonize a region nobody else could survive (some Han Chinese, which make up more than 90% of the population of China, also have the gene, but it’s relatively rare). “We found part of the EPAS1 gene in Tibetans is almost identical to the gene in Denisovans,” said lead author Rasmus Nielsen, of the University of California, Berkeley, in a statement, ” and very different from all other humans.”

What’s perhaps even more surprising is that the scientists had Denisovan genes to work with in the first place. “The only reason we can say that this bit of DNA is Denisovan, said Nielsen, “is is because of this lucky accident of sequencing DNA from a little bone found in a cave in Siberia. We found the Denisovan species at the DNA level, but how many other species are out there that we haven’t sequenced?”

TIME E-Cigarettes

Snuff and E-Cigs Are Not Harmless, Say Scientists

New research casts doubt on nicotine's safety—even if you aren't smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.”

The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME.

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.

“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association.

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants.”

Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.

TIME Genetics

Basketball Star’s NBA Dreams Crushed by Marfan Syndrome Diagnosis

Baylor center Isaiah Austin shoots during the second half of an NCAA men's college basketball tournament regional semifinal, in Anaheim, Calif. on March 27, 2014.
Baylor center Isaiah Austin shoots during the second half of an NCAA men's college basketball tournament regional semifinal, in Anaheim, Calif. on March 27, 2014. Jae C. Hong—AP

Isaiah Austin was diagnosed with Marfan syndrome. But what's that?

Former Baylor center Isaiah Austin’s hopes of playing in the NBA were dashed this weekend when he was diagnosed with a disorder called Marfan syndrome. A standard EKG during a routine exam for the NBA draft revealed an abnormality, and further genetic testing showed he has Marfan syndrome.

But what is that exactly?

Marfan syndrome is a genetic disorder that affects the connective tissues in the body, and can interfere with the functionality of the heart, eyes, blood vessels and skeleton. According to the Mayo Clinic, it’s common for people with Marfan syndrome to be tall with disproportionately long arms, legs, fingers and toes. Austin is 7 ft. 1 in. tall.

The severity of the disease can differ from person to person, but if the heart and blood vessels are affected it can become a fatal disease. For example, aortic enlargement is a possible life threatening side effect and some players have died in the middle of a game due to the disease.

“They said I wouldn’t be able to play basketball anymore at a competitive level,” Austin told ESPN. “They found the gene in my blood sample. They told me that my arteries in my heart are enlarged and that if I overwork myself and push too hard that my heart could rupture. The draft is four days away, and I had a dream that my name was going to be called.”

According to the Marfan Foundation, around 1 in 5,000 people have Marfan syndrome across all races and ethnicities, though only about half of those with the disorder know they have it. The majority of people with the disease inherited it from a parent, since children of an individual with the disease have a 50% chance of getting the mutated gene that causes the disorder. About 25% of people will be the first to have the gene, meaning the disease can also be spurred by what’s called a spontaneous mutation.

It’s been rumored but not confirmed that Michael Phelps has Marfan syndrome, and in 1962, Cincinnati doctor Abraham Gordon was the first to propose that former president Abraham Lincoln suffered from the disease — just one of several theories to explain Abe’s lanky stature.

Treatment for Marfan syndrome usually includes taking medication to make sure blood pressure stays in check so that heart strain stays low. In some cases, heart, spine or eye surgery may be necessary.

“This is devastating news, but Isaiah has the best support system anyone could ask for, and he knows that all of Baylor Nation is behind him,” head coach Scott Drew said in a statement. “His health is the most important thing, and while it’s extremely sad that he won’t be able to play in the NBA, our hope is that he’ll return to Baylor to complete his degree and serve as a coach in our program.”

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