10 Dec Mediterranean Diet Linked to Lower Long-Term Cardiovascular Events in Women
Posted at 20:43h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Mediterranean Diet, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_46414" align="alignleft" width="117"] Dr. Mora[/caption]
Samia Mora, MD, MHS
Associate Professor of Medicine
Harvard Medical School
Director, Center for Lipid Metabolomics
Brigham and Women’s Hospital
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit.
Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors.
Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites.
Dr. Wadhera[/caption]
Dr. Rishi Wadhera, MD
Cardiology Fellow
Brigham and Women's Hospital
Harvard Medical School.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In the United States, an estimated half a million people are homeless on any given night. In recent years, policy efforts to improve the health of homeless individuals have intensified, but there is little large-scale, contemporary data on how these efforts have impacted patterns of acute illness in this vulnerable population.
In this study, we examined trends, causes, and outcomes of hospitalizations among homeless individuals in three states – Massachusetts, Florida, and California – from 2007 to 2013. We found that hospitalization rates among homeless adults increased over this period of time.
Strikingly, over one-half of these hospitalizations were for mental illness and substance use disorder. More broadly, homeless adults were hospitalized for a very different set of reasons compared with demographically similar non-homeless adults. In addition, homeless individuals had longer lengths of hospitalization but lower total costs per hospitalization.
Prof. VanderWeele[/caption]
Professor Tyler VanderWeele Ph.D
John L. Loeb and Frances Lehman Loeb Professor of Epidemiology
Harvard University
MedicalResearch.com: What is the background for this study? What are the key points of the paper?
Response: Several prior studies have suggested that religious service attendance is associated with lower rates of divorce. However, many of these studies have been with small samples and have not had rigorous study designs. In addition, most studies have focused on women earlier in life and there has been little research on the effects of religious service attendance on divorce later in life. While divorce rates in the United States in general has been falling, it has in fact been increasing for middle-aged groups, doubling between 1990 and 2010.
In our study we found that among women in mid- to late- life, regular religious service attendance was subsequently associated with 50% lower divorce rates over the following 14 years of the study.
We also found that among those who were widowed, religious service attendance was associated with a 49% increase in the likelihood of remarrying over the 14 years of the study.
Dr. Daniel Romer[/caption]
Daniel Romer PhD
Annenberg Public Policy Center
The University of Pennsylvania
Philadelphia, PA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous research has found some troubling relations between adolescent cannabis use and subsequent increases in conduct problems and other unhealthy consequences. These studies were done in New Zealand in the late 90’s and we wanted to re-examine those relationships using more contemporary data in the US.
We had data on 364 adolescents who were followed from age 13 to 19 in Philadelphia that could provide a more up to date picture of the effects of using cannabis on one important outcome, conduct disorder. We also wanted to use more sensitive methods than had been used in prior research that would enable us to examine reciprocal relations between cannabis use and c (CP). That is, it might be the case that youth with CP are prone to using cannabis and that this helps to explain why there appears to be a relation over time between cannabis use and CP rather than cannabis use leading to CP.
Our findings supported that hypothesis. There was no prospective relation between changes in cannabis use and subsequent changes in conduct problems. Instead, changes in conduct problems were found to predict changes in use of cannabis. Youth with conduct problems also affiliated more with peers who used cannabis, adding further to their own use. There was also no evidence that youth who used cannabis sought out peers who used it apart from the effects of CP.
Finally, both use of cannabis and conduct problems predicted subsequent development of a mild cannabis use disorder (CUD). 
Dr. Papoutsidakis[/caption]
Nikolaos Papoutsidakis, M.D., Ph.D.
Associate Research Scientist,
Yale University School of Medicine
New Haven, CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Lifestyle education is a significant part of Hypertrophic Cardiomyopathy management. HCM patients, who frequently have to abstain from intense athletics, often ask if such restrictions extend to thrill-seeking activities they previously enjoyed, such as rollercoaster rides. Werealized there is very little data on this topic, which prompted us to set up this study.
We found that for Hypertrophic Cardiomyopathy patients who elected to participate in thrill-seeking activities, adverse events (defined as losing consciousness or experiencing a shock from an implantable cardioverter-defibrillator) were rare. We also asked patients (participating and non participating) about advice received from their physician on this topic. We found that, probably due to the lack of data, physicians often avoid providing advice or provide conflicting advice regarding participation in thrill seeking activities. 
Nicholas Reed AuD[/caption]
Nicholas S. Reed, AuD
Assistant Professor | Department of Otolaryngology-Head/Neck Surgery
Core Faculty | Cochlear Center for Hearing and Public Health
Johns Hopkins University School of Medicine
Johns Hopkins University Bloomberg School of Public Health
MedicalResearch.com: What is the background for this study?
Response: This study was a true team effort. It was funded by AARP and AARP Services, INC and the research was a collaboration of representatives from Johns Hopkins University, OptumLabs, University of California – San Francisco, and AARP Services, INC. Given all of the resent research on downstream effects of hearing loss on important health outcomes such as cognitive decline, falls, and dementia, the aim was to explore how persons with hearing loss interacted with the healthcare system in terms of cost and utilization.
MedicalResearch.com: What are the main findings?
Response: Over a 10 year period, untreated hearing loss (hearing aid users were excluded from this study as they are difficult to capture in the claims database) was associated with higher healthcare spending and utilization. Specifically, over 10 years, persons with untreated hearing loss spent 46.5% more, on average, on healthcare (to the tune of approximately $22000 more) than those without evidence of hearing loss. Furthermore, persons with untreated hearing loss had 44% and 17% higher risk for 30-day readmission and emergency department visit, respectively.
Similar relationships were seen across other measures where persons with untreated hearing loss were more likely to be hospitalized and spent longer in the hospital compared to those without evidence of hearing loss. 
Dr. Yano[/caption]
Yuichiro Yano MD PhD
Assistant Professor in Community and Family Medicine
Duke University
MedicalResearch.com: What is the background for this study?
Response: New blood pressure guidelines, issued in 2017 in the US, lowered the blood pressure thresholds for hypertension from systolic blood pressure/diastolic ≥140/90 mm Hg to systolic/diastolic ≥130/80 mm Hg. This change increased the prevalence of hypertension two- to three-fold among young adults. The guidelines also newly defined elevated blood pressure as, 120-129 mmHg systolic blood pressure over 80 mmHg diastolic or less. However, no study investigated that high blood pressure, as defined by the new criteria, is something that younger people should be concerned about as a potential precursor to serious problems.
Our study is among the first to report that people younger than age 40 who have elevated blood pressure or hypertension are at increased risk of heart failure, strokes and blood vessel blockages as they age. 
Dr. Wanpen Vongpatanasin, M.D.
Professor of Medicine
Program Director, Hypertension Fellowship Program
UT Southwestern Medical Center in Dallas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The new US hypertension guideline places a greater emphasis on out-of-office blood pressure measurement, and maintains that a clinic BP of 130/80 mm Hg is equivalent to the same reading for home BP monitoring or daytime ambulatory BP monitoring. That is based, however, on data from non-US cohorts, primarily from Japanese cohorts and some European populations. None has been studied in the US population until now.
To find out, we analyzed large multi-ethnic studies of primarily young and middle-aged adults in Dallas, Texas, and Durham, N.C., that compared home blood pressure to clinic measurements, using the regression correlation (i.e. regression approach). To confirm the findings, we use another approach called “outcome approach” by determining risks of stroke, MI, and death associated with a clinic systolic blood pressure reading of 130 mmHg from the 3,132 participants in the Dallas study during an 11-year follow up.
Then, we determined the home blood pressure levels that carried the same heart disease risk and stroke risk as the clinic systolic 130 mm Hg reading.
We found that the level of home blood pressure of 130/80 mm Hg actually best correlates with blood pressure taken at the doctor’s office of 130/80 mmHg. This is true for whites, blacks and Hispanic patients in both treated and untreated population. 
