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By John Schieszer
Medical Minutes 

New research on strokes, prostate and brain health

 


Stroke rates decreasing in older adults

A new analysis has found that there has been a 40 percent decrease in the incidence of stroke in adults over the age of 65. The decline is much greater than researchers had expected and the decline occurred in both ischemic and hemorrhagic strokes. In addition, deaths due to strokes are also steadily declining in older adults.

Stroke is the fourth leading cause of death in the United States, with approximately 795,000 strokes occurring each year. In the last 15 years, there has been a greater emphasis on treating and preventing high blood pressure in older adults. In addition, significant numbers of older adults are now routinely taking statin medications to lower elevated blood cholesterol levels. It is theorized that these two trends may help explain the declining rates of strokes. The decline in stroke rates have paralleled the increasing use of high blood pressure medications and statin medications.

“Antihypertensive (blood pressure lowering) medications reduce the risk of stroke by approximately 32 percent and statins by approximately 21 percent. Stroke rates seem to decrease most sharply after year 1998, approximately when statin use became more prevalent,” said lead investigator Dr. Margaret Fang, who is with the University Of California San Francisco School Of Medicine, San Francisco. “If true, then this illustrates how medical interventions have resulted in significant improvements in health on a population level.”

The team identified more than one million stroke events from 1988 to 2008, of which 87.3 percent were ischemic and 12.7 percent hemorrhagic strokes. The analysis showed a reduction in ischemic strokes from 927 per 100,000 in 1988 to just 545 per 100,000 in 2008. Hemorrhagic strokes decreased from 112 per 100,000 to 94 per 100,000 over the same time period. The risk-adjusted 30-day mortality rate for ischemic strokes fell from 15.9 percent in 1988 to 12.7 percent in 2008. For hemorrhagic stroke, the mortality rates declined slightly from 44.7 percent in 1988 to 39.3 percent in 2008.

 

Brain benefits associated with fish consumption

Eating baked or broiled fish once a week is good for the brain, regardless of how much omega-3 fatty acid it contains, according to researchers at the University Of Pittsburgh School Of Medicine. The findings, published online recently in the American Journal of Preventive Medicine, add to growing evidence that lifestyle factors contribute to brain health later in life.

Researchers estimate that more than 80 million people will have dementia by 2040. However, it is theorized that dementia and Alzheimer’s disease cases may decrease in the coming years if more people adopt healthy lifestyle changes, such as increasing physical activity levels, avoiding smoking and eating a healthful diet. The antioxidant effect of omega-3 fatty acids, which are found in high amounts in fish, seeds and nuts, and certain oils, have been associated with improved health, particularly brain health.

“Our study shows that people who ate a diet that included baked or broiled, but not fried, fish have larger brain volumes in regions associated with memory and cognition,” said James Becker, who is a professor of psychiatry at Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. “We did not find a relationship between omega-3 levels and these brain changes, which surprised us a little. It led us to conclude that we were tapping into a more general set of lifestyle factors that were affecting brain health, of which diet is just one part.”

The research team analyzed data from 260 people who provided information on their dietary intake, had high-resolution brain MRI scans, and were cognitively normal at two time points during their participation in the study. The researchers found that individuals who ate baked or broiled fish at least once a week had greater grey matter brain volumes in areas of the brain responsible for memory (4.3 percent) and cognition (14 percent) and were more likely to have a college education than those who didn’t eat fish regularly. However, no association was found between the brain differences and blood levels of omega-3s.

A new tool in battling prostate cancer

Doctors have a new tool to help men who may be at high risk for prostate cancer. It is a new blood test called the Prostate Health Index. The company that makes it claims it is three times more specific in detecting prostate cancer than the traditional PSA (prostate specific antigen) test. The Prostate Health Index’s accuracy reportedly decreases the need for many men who test positive for elevated PSA levels to undergo a biopsy in order to achieve a reliable diagnosis.

The most widely used screening test for prostate cancer is currently the PSA test, which measures the blood’s level of PSA (a protein that is naturally produced by the prostate gland and is typically increased when cancer is present). However, it is widely recognized that PSA results can often indicate the possibility of prostate cancer when none is present.

“The PSA test is based on the fact that men with higher levels of the PSA protein are more likely to have prostate cancer,” said Dr. William Catalona, MD, who helped develop the Prostate Health Index. “However, the problem is that higher levels of PSA can also be caused by a benign enlargement or inflammation of the prostate, leading to many false positives for cancer and ultimately unnecessarily invasive biopsies and an increased potential for patient harm.”

Results of a multicenter clinical study found a 31 percent reduction in unnecessary biopsies due to false positives as a result of using the new test.

John Schieszer is an award-winning national journalist and radio broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.

 
 

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