TIME remembrance

B.B. King Died From Mini Strokes, Coroner Says

The blues legend was remembered by celebrities and musicians this week

B.B. King died after having a series of mini strokes stemming from his type 2 diabetes, the Associated Press reports.

The musician’s physician, Dr. Darin Brimhall, and Clark County Coroner John Fudenberg told the AP that King’s cause of death was multi-infarct dementia—also known as vascular dementia—a condition caused by a series of small strokes.

Brimhall attributed King’s strokes to the 89-year-old musician’s chronic diabetes, which caused reduced blood flow.

King was mourned this week by Barack Obama, Eric Clapton,Morgan Freeman and many more celebrities and musicians.

Read next: T Bone Burnett Remembers B.B. King: ‘He Conjured the Very Soul of Our Country’

TIME Mental Health/Psychology

Depression Can Double Risk for Stroke—Even When It’s Treated

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People with prolonged depression had 114% higher risk of stroke than those without symptoms

As if depression isn’t hard enough on the mind, the condition can also wreak havoc all over the body, increasing risk of health problems that at first don’t seem remotely connected to feeling low. Depressed people are at increased risk for type 2 diabetes and cardiovascular death, and according to a new study published Wednesday in the Journal of the American Heart Association, they’re also at greatly increased risk for stroke. Adults over age 50 who report persistent symptoms of depression have double the risk for stroke, the study finds—and that increase lingers even after they report feeling better.

The researchers analyzed data from more than 16,000 middle-aged adults ages 50 and older. Every two years from 1998-2010, the people in the study were asked about their history of stroke, stroke risk factors and symptoms of depression.

People who reported high symptoms of depression—three or more symptoms from an eight-item depression scale—for four consecutive years had about 114% higher risk of stroke compared to those who did not have symptoms of depression at either interview.

It remains unclear exactly how prolonged depressive symptoms lead to an increased stroke risk, but the elevated risk appears to stick around for a long time, even after depression goes away. People whose depressive symptoms had subsided at the second interview still had a 66% higher risk of stroke than those without symptoms.

“We do not know if, had we been able to examine individuals who had been symptom free for a longer time, stroke risk would have declined more,” said study author Paola Gilsanz, a postdoctoral fellow at Harvard T.H. Chan School of Public Health, in an email. “To assess that, we really need a larger study.”

Just as stroke risk was slow to subside, it was slow to take hold, too. People who had just begun developing depressive symptoms weren’t at higher stroke risk than those without symptoms. “We were surprised to see that changes in depressive symptoms seem to take more than two years to influence risk of stroke,” Gilsanz said.

It’s difficult to say from this study whether treatment has mitigating effects, since the authors didn’t specifically look at why people’s symptoms went away. But even though the data suggest that getting rid of symptoms of depression might not immediately erase the increased risk for stroke, they emphasize the importance of early treatment.

“If our findings are replicated, they suggest depressive symptoms merit prompt attention soon after they begin, before they have time to substantially impact stroke risk,” Gilsanz says. “We also recommend that people with depression also focus on keeping their overall stroke risk profile as healthy as possible, as we all should.”

TIME Heart Disease

Risk for Stroke Is Greater in People Who Oversleep

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Regularly sleeping over eight hours may be a sign of a serious health risk

Oversleeping feels like a treat on the weekend, but regularly sleeping too much is actually a sign that there may be a medical problem at play. According to a new study, people who sleep more than eight hours a day have a higher risk for a stroke compared with people who sleep six to eight hours.

In the new study, published in the journal Neurology, researchers followed nearly 10,000 people ages 42 to 81 for almost 10 years. They recorded both the amount of sleep they typically got each night, as well as whether they had a stroke.

Around 7 out of 10 of the men and women slept six to eight hours, and about 1 in 10 slept more than eight hours a night on average. The people who slept the most had a 46% higher than average risk of stroke when the researchers accounted for other variables that could contribute to risk. Their risk was about double that of people who reported getting a typical amount of shut-eye each night.

The study only shows an association, but it’s fairly surprising since in the past, sleep deprivation has been linked to a greater stroke risk too. The researchers speculate that long nights of sleep may be linked to increased inflammation, which can eventually lead to cardiovascular problems.

“Prolonged sleep might be a useful marker of increased stroke risk in older people, and should be tested further for its utility in clinical practice,” the authors conclude. Stroke isn’t the only risk that’s linked to sleeping too much. Physicians sometimes use sleep duration as an indicator for how well a patient is feeling. Getting too much sleep can often mean something under the hood is off.

“If people are sleeping too much, it’s a bad sign,” says Dr. David Gozal, a pediatric sleep disorders physician at the University of Chicago Medicine. “Very few people can sleep more than what they need. It’s a sign there is an underlying health-related problem, whether it’s depression, cancer or neurological deterioration. It’s usually not a good thing.” Gozal was not involved in the study.

If you like to sleep in on the weekends, don’t fret. Occasionally spending extra time in bed is likely not a bad sign, experts say, but when it becomes a regular habit, it might be worth checking out. For now, the researchers of the new study say their findings need further investigation, and priority should be given to understanding the underlying mechanisms.

TIME Heart Disease

Daily Aspirin May Not Prevent Heart Attacks

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Taking low dose aspirin may not help people with high blood pressure, high cholesterol or diabetes to avoid a heart event

There’s a lot of evidence that taking low doses of aspirin daily can help heart attack patients avoid a second event. Aspirin’s ability to reduce inflammation and keep blood from forming vessel-blocking clots can be a life-saver. But what about the many Americans who take it daily hoping to avoid a first heart attack or stroke? The data there is more conflicting, and a large new study in JAMA published Monday suggests it may not make much of a difference.

The Food and Drug Administration recently said there was not enough evidence to support the idea that aspirin can prevent a first heart attack. So researchers in Japan decided to investigate the issue among 14,646 volunteers between the ages of 60 years and 85 years. Between 2005 and 2007, these participants, none of whom had had any heart events, but all of whom had at least one of the risk factors that could make them vulnerable, were randomly assigned to take a low-dose aspirin every day or not. They were allowed to continue taking whatever medications they were already or, or begin taking new drugs if their doctor prescribed them during the study.

Now, reporting in JAMA, scientists say that after five years, the study’s review board ended the trial when it was clear that there were no significant differences between the two groups when it came to heart attacks, strokes, other heart events or death. In that time, 58 people in the aspirin group died of heart-related causes, while 57 in the non-aspirin group did. Overall, 2.77% of those taking aspirin had a heart attack or stroke, compared to 2.96% among those not taking the drug — a difference that was not statistically significant.

MORE: A Low Daily Dose of Aspirin Can Cut Deaths From 3 Kinds of Cancer

The results add to the growing data on what role aspirin can play in preventing first heart events; previous studies showed that the over-the-counter drug was linked to anywhere between a 12% to 23% lower risk of events compared to non-aspirin use. But concerns over aspirins side effects, which include gastrointestinal bleeding, have made doctors more wary of recommending it for patients who have not yet had a heart event. Studies on aspirin in this group of otherwise healthy people are also difficult to conduct, since many people currently take multiple medications for various heart risks, including blood pressure drugs and cholesterol-lowering medications, making it difficult to determine what effect aspirin may have.

That’s why three other studies are currently investigating aspirin’s potential role in helping patients who have not yet had heart disease to avoid having heart attacks or strokes. One involves those with diabetes, another focuses on those with multiple heart-disease risk factors and the final trial concentrates on people over 70. Until those results are available, the authors say that patients should discuss with their doctors whether daily low-dose aspirin can help them to lower their risk of having a heart attack. For some, the benefits may outweigh the risks of bleeding, while for others, the side effects may not be worth the risks.

 

TIME Diet/Nutrition

8 Salt-Free Flavor Boosters

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Swap salt for ingredients and spices like cilantro and cinnamon

By now, you probably already know that overdoing it on sodium can lead to high blood pressure and up your risk for stroke. But giving up salt can be tough. One way to slash your intake right away is to check labels on processed foods, and avoid fast food restaurants, the menus of which are often chock full of sodium bomb after sodium bomb. But you can also chip away at your salty total with a little bit of kitchen creativity. Many recipes rely on salt as a way to improve the aroma, reduce bitterness, and balance out the flavors of a dish. But real food whizzes know there are plenty of substitutes that add just as much flavor—and provide some health benefits, too.

HEALTH.COM: 13 Foods That Are Saltier Than You Realized

We went to a few of our favorite chefs as well as some registered dietitians to find out their favorite easy swaps.

1. Parsley

Ah, humble parsley. It’s available fresh in almost every season, and you can use it to add a complex, fresh taste to everything from soups and stews to eggs, says Mark Bittman, author of How to Cook Everything Fast (October 2014).

Pro tip: “Don’t mince it,” Bittman says. “You want to be able to chew it to get the most flavor out of it.”

Health bonus: Parsley is an excellent source of vitamin K, which helps blood clot and keeps your bones strong.

2. Ginger

Ginger is a unique flavor that’s both sweet and spicy. You can use it when searing any protein: fish, chicken, pork, and even beef, says Libby Mills, RD, a spokesperson for the American Academy of Dietetics.

Pro tip: Combine it with garlic for double the flavor—and the health benefits, Mills says.

Health bonus: “Anti-inflammatory compounds called gingerols can bring relief and mobility to those with arthritis. It also protects us from damaging free radicals, so it’s perfect for winter months when you want your immune system at its strongest,” Mills says.

HEALTH.COM: How to Peel Fresh Ginger With a Spoon

3. Basil

Fresh basil is a dream on tomatoes (which people love to salt), sauteed vegetables, or even grilled meat or fish, Bittman says.

Pro tip: “It works best raw, which is why people use it to make pesto. But if you want to use it when cooking, throw it in the pan at the last minute so it doesn’t lose flavor,” Bittman says.

Health bonus: “Basil contains flavonoids, which are powerful antioxidants that protect cells from damage,” Mills says.

HEALTH.COM: 6 Health Benefits of Basil

4. Rosemary

This herb has a very strong, woodsy flavor that works in pasta sauces. Or any time you sautee something, use garlic, oil, and add a few whole sprigs of rosemary, Bittman says.

Pro tip: “The good thing about rosemary one is it keeps for weeks,” Bittman says. “Just put in a baggie and then keep in the fridge.”

Health bonus: Rosemary is an old folk remedy for heartburn. “It’s a delicious way to stimulate the digestion,” Mills says.

5. Cilantro

People have a love-hate relationship with cilantro. Some absolutely adore it, while others say it tastes like soap. Fun fact: Studies show that whether you fall in the love or hate camp depends on your genes. If you can stomach it, cilantro is great for Asian-inspired stir-fries or other rice dishes.

Pro tip: “Cilantro doesn’t keep that well so it’s best to use it pretty soon after you buy it fresh,” Bittman says.

Health bonus: This herb is a powerful antimicrobial. Cilantro leaves have even been found to fight back against salmonella germs.

6. Mint

Mint is great in spaghetti or any chilled grain dish like couscous or quinoa salad because it adds a bright freshness.

Pro tip: Grow it yourself! Mint can easily be grown indoors through the cold winter months, so you can pick it fresh each time you cook.

Health bonus: Mint is an excellent source of vitamin C, which helps the body build important proteins that keep skin healthy and hair shiny, Mills says.

HEALTH.COM: 5 Ways to Use Fresh Mint

7. Cinnamon

Mostly thought of as a sweetener or sugar substitute, you can use cinnamon to reduce sodium by combining it with low-sodium broth when preparing whole grains, like barley, millet, or quinoa.

Pro tip: Use it to make a spicy-sweet chicken rub: combine 1 to 2 teaspoons of chili powder (two if you like it hot), half a teaspoon cinnamon, and 1 tablespoon of cocoa powder. This will give you enough for four to six medium chicken breasts.

Health bonus: What can’t cinnamon do? “Cinnamon has essential oils that are both antiinflammatory and antimicrobial,” Mills explains. “It can also be helpful in reducing PMS symptoms, but it’s most famous for it’s ability to slow stomach emptying and thus reduce the rise of blood sugar after a meal.”

8. Wine

You can use wine to deglaze after sauteeing meat to create a nice pan sauce. “Also, even just enjoying your meal with a glass of wine helps distribute the food flavors in the mouth,” Mills says.

Pro tip: Here’s a step-by-step guide to making a red wine reduction pan sauce.

Health bonus: If you use it in your recipes, much of the alcohol will cook off. But studies have linked a nightly glass of wine to a reduced risk for heart disease. (If you’re not a drinker, this would be no reason to start, but one glass for women and up to two for men would be within healthy reason, Mills adds.)

Discover 8 more salt-free ways to flavor your food at Health.com.

TIME medicine

Growth Hormone Linked to Higher Risk of Stroke

Children treated with growth hormone are more likely to experience strokes decades later

Since the Food and Drug Administration approved a synthetic form of growth hormone (GH) in 2003 to treat short stature in kids, it’s become a popular medication not just among parents who want their children to grow but also in locker rooms of professional athletes who believe the collagen-building features of the drug can both protect and improve recovery from injury.

Now the latest study shows that children treated with GH are at risk of bleeding in the brain nearly 20 years later. French researchers report Wednesday in the journal Neurology that among a group of children treated for short stature or low levels of growth hormone had between a 1.5 to 5.3 times higher risk of having a stroke during the follow-up period than the general population.

“Subjects on or previously treated with growth hormones should not panic on reading these results,” the authors said in a written statement. “The results of this study highlight the importance of studies of this kind for the evaluation of the long-term effects of treatment.”

While the researchers can’t explain why the hormone treatments, which are usually given in daily injections over four to five years, led to the strokes, earlier studies on animals with a metabolic disorder in which they produced excessive amounts of the hormone showed that they tend to have more bleeding events. The scientists admit, however, that it’s also possible that short stature itself may have some connection to stroke risk since other disorders in which people don’t grow properly are also linked to abnormal blood flow to the brain.

The study, which involved nearly 7,000 participants, provides good reason for people taking growth hormone to discuss the potential risk of stroke with their doctors, say the authors. Whether the findings apply to others who take growth hormone – athletes who use it for performance enhancement, or those affected by other diseases such as kidney disorders – isn’t clear yet.

MONEY Aging

As You Age, You Need to Protect Your Money — From Yourself

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Andy Roberts—Getty Images

A financial planner explains why he couldn't stop his client from making irrational decisions.

After three decades as a financial planner, I’m seeing more and more clients reach, not just retirement, but their final years. An issue that becomes especially important at this stage of life is how to help clients protect their financial resources from an unexpected threat — themselves.

One of my saddest professional experiences came several years ago when one of my long-time clients, a woman in her late 80s with no family and few close friends, abruptly fired me. Because Mary had no one else, I had helped her in many ways beyond the usual client/planner relationship and even reluctantly agreed to serve as her trustee and power of attorney in case she became incapacitated.

At what proved to be our final quarterly review meeting, Mary initially seemed confused. I was able to reassure her about the stability of her finances, and she seemed clearer by the time we finished. Three weeks later, I received a handwritten letter from her: “You have my finances in a mess. I can’t get to my money. You are fired.”

I was stunned. Yet ethically I was required to comply with her wishes by moving her holdings to another broker.

Several subsequent conversations demonstrated that Mary was suffering from periodic memory loss and delusion. Had she been disabled by a sudden accident or a stroke, I could have stepped in. Yet, because her decision to fire me was made at a time when she was arguably still competent, my hands were tied.

In theory, I could have gone to court with my power of attorney or in my position as trustee and petitioned to have Mary declared incompetent. But that posed a problem: Essentially, I would have been telling a judge, “Mary fired me as her adviser. I’d like to have her declared incompetent so I can re-hire myself as her adviser.” There was no way I was going to ask a judge to do that. I had a clear conflict of interest.

Since this experience, I have confirmed the wisdom, given the potential for conflict of interest, of never serving as a trustee or power of attorney for a client. With the help of suggestions from several other planners, I’ve also learned some strategies to help protect clients from themselves.

One tool is to ask clients to sign a statement authorizing a planner concerned about possible irrational behavior to contact someone, such as a family member or physician, designated by the client. While this would not prevent a client from firing an adviser, it would provide a method of discussing the issue and also involve another person in the decision.

Another possibility is to put clients’ assets into either an irrevocable living trust or a Domestic Asset Protection Trust (in states that allow them) and naming someone other than the client or the planner as trustee. While the client, as the beneficiary, would have the power to fire the trustee, concern about a trustee being fired irrationally could be mitigated to some degree by having a corporate trustee. In addition, with a DAPT, the beneficiary client would not have the power to amend the trust without the agreement of the trustee. This would give some protection against self-destructive choices by a client who was gradually losing competency. One disadvantage of this approach is cost, so it isn’t an option for everyone.

Perhaps the most important strategy is to work with clients to create a contingency plan in the event of mental decline. It could include arrangements to consult with family members or other professionals such as physicians, social workers, and counselors. For clients without close family members, the plan might authorize the financial adviser to call for an evaluation, by professionals chosen in advance by the client, if the client’s behavior appeared irrational. This team approach might alleviate clients’ fears about being judged incompetent by the person managing their assets.

The possibility of mental decline is something no one wants to consider. Yet it’s as essential a financial planning concern as making a will. Helping clients build financial resources for old age includes helping them create safety nets to protect those resources from themselves.

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Rick Kahler is president of Kahler Financial Group, a fee-only financial planning firm. His work and research regarding the integration of financial planning and psychology has been featured or cited in scores of broadcast media, periodicals and books. He is a co-author of four books on financial planning and therapy. He is a faculty member at Golden Gate University and the president of the Financial Therapy Association.

TIME Heart Disease

Americans Are Having Fewer and Fewer Strokes

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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 Stroke

This Microwave Helmet Can Sense Strokes

Scientists have invented a helmet that can detect the occurrence and type of a stroke by bouncing microwaves off the brain

Scientists in Sweden have invented a helmet that can identify whether a person has experienced a stroke, the BBC reports.

The headwear can further determine what kind of a stroke has occurred, allowing doctors to quickly diagnose and treat patients.

The helmet works by bouncing microwaves off a person’s brain and identifying whether there’s a bleed or a clot within it. Initial tests, involving 45 patients, proved successful. The helmet’s inventors now plan to roll the device out to ambulance teams and eventually put the technology in pillows as well.

At present, doctors treating stroke victims need to determine whether a clot or a leaking blood vessel caused the stroke. A CT scan is able to show this, but CT scanners aren’t available in every hospital and a scan can take time to set up. Delays in stroke treatment can be serious — brain tissue can begin to die if more than four hours passes between a stroke and treatment. The microwave helmet could reduce such delays, though researchers say more testing is required.

Some doctors have suggested that the helmet won’t completely replace other forms of diagnosis.

Dr. Shamim Quadir from the UK’s Stroke Association said that “while this research is at an early stage, microwave-based systems may become a portable, affordable, technology that could help rapidly identify the type of stroke a patient has had, and get them treated faster.”

[BBC]

 

TIME medicine

FDA Clears the Way for New Blood-Clot Medication

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Getty Images A microscopic view of blood clotting inside an artery.

Zontivity, a new drug from Merck, can be used to reduce the risk of stroke or cardiovascular death and treat patients who have suffered a heart attack

The FDA gave the go-ahead to a new drug on Thursday that can be used to inhibit blood clots.

The new medication, which reduces the risk of heart attacks and strokes, is produced by American pharmaceutical manufacturer Merck & Co. and will be sold under the name Zontivity.

“In patients who have had a heart attack or who have peripheral arterial disease, this drug will lower the risk of heart attack, stroke and cardiovascular death,” said Ellis Unger, director of the FDA’s Office of Drug Evaluation I.

However, like other blood-clot inhibitors, Zontivity increases the risk of bleeding by hindering platelets in the blood from clustering together. For these reasons, the FDA advises patients who have suffered from a stroke or traumatic head injury to avoid the medication.

The approval of the drug was reportedly delayed over safety concerns due to fatal bleeding in patients who were given the medication during clinical trials, according to Reuters.

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