One of the most significant studies in health has just celebrated 65 years since it started, and it’s still going strong.

Over those 65 years, residents of the small town of Framingham in Massachusetts, USA, have been participating in long-term studies looking at heart disease and its causes.

By the mid-1950s, the number of middle-aged men succumbing to coronary heart disease was causing serious concern – not least when several world leaders developed it. The disease had been on the rise since the start of the 20th century and the Framingham Heart Study set out in 1958 to establish what was behind this.

The study initially recruited more than 5,000 men and women, nearly a fifth of the whole population of Framingham. The researchers collected data about each of the participants every two years using interviews, clinical examinations and laboratory tests. The data covered participants’ lifestyle and environment as well as looking at their health and genetic profiles. This helped to show the importance of not smoking, taking enough physical activity, treating high blood pressure, avoiding obesity and the importance of blood fats in preventing coronary heart disease.

By 1971 the study had recruited a second generation of participants and in 1994 it extended its recruitment to reflect the changing population resulting from an influx of South Americans. 2002 saw the recruitment of a third generation. Over time, the study was widened to include other diseases, notably type 2 diabetes and dementia.

There were similar studies going on elsewhere but none was quite so comprehensive or prolonged. The Framingham study resulted in many papers published in leading scientific journals, and the work was widely discussed in scientific societies worldwide, greatly influencing research, debate and health policy.

Indeed, the findings in this and the other studies changed the way doctors looked at illness. Previously, most doctors thought of an illness as being caused by germs. If the germs could be killed or prevented from spreading, the illness would be eliminated. The Framingham discoveries required a rethink. This resulted in the concept of ‘non-communicable disease’ to explain much of modern illness and highlighted the importance of what we as individuals could do to prevent these diseases, as well as transforming the public health agenda.

There are questions over the future of this study, and whether it will continue to bring sufficient returns on the cost now that its primary objectives have been achieved. The US government has cut substantially its share of the funding.

But the fact remains that this study generated a novel way of looking at all disease and increased phenomenally our understanding of coronary heart disease.

About the study:  http://www.framinghamheartstudy.org/about/

 

We can get the vitamins we need from a healthy diet containing fruit and vegetables, yet an industry has grown up based on the tempting idea that using supplements to boost our intake will make us even healthier. But will it?

In Britain we spend roughly £400 million pounds a year on supplements, most bought by the middle-aged and elderly. We don’t know how many people use them here but it’s likely to be much the same as in the United States, where one in three people regularly take a vitamin supplement.

But does taking supplements bring any benefits? Over the past few decades there has been a lot of research to find out, comparing the health of those taking supplements with those who didn’t. Unfortunately, many of these studies have not been able to provide a clear answer. They had too few participants or did not go on for long enough, or inconsistencies allowed conflicting interpretations.

There have been some large-scale studies, though. For example, the Cancer Prevention Study in the early 1980s recruited 1 million people and the Women’s Health Initiative another 160,000. Neither showed any substantial benefits from supplements in reducing cardiovascular disease such as heart attacks or stroke. Another study – the Nurses Health Study involving 89,000 nurses over 5 years – indicated that supplements gave some protection from colon cancer. But, worryingly, a study in Sweden of 35,000 women found a 19% increase in breast cancer.

When researchers examined 68 studies involving 230,000 subjects together in a meta-analysis, they found no overall benefit from taking supplements, even though some of the individual studies had suggested there might be.

These somewhat mixed findings have made coherent advice difficult. An absolutely rigorous study has been needed, with enough participants unfailingly taking either the supplement under investigation or an inactive placebo for enough years.

Such a study has now been carried out. The Physicians’ Health Study II involved 14,600 male physicians with a mean age of 64 years, 70 per cent of whom continued for more than 10 years in a randomised controlled double blind trial. Two papers have been published so far*. The first showed no reduction in heart attacks or stroke, the other a modest but statistically significant reduction in cancer (from 18 per thousand person-years down to 17). More papers are likely to follow, covering eye disease and cognitive decline.

So at last there is clear evidence from a rigorously controlled trial that taking vitamin supplements can result in a significant (but modest) reduction in cancer in men. There’s no reason to suppose the findings wouldn’t also apply to women. But there’s an equally clear indication of no benefit in heart disease or stroke. So what advice should be given?

Some people may feel that the modest reduction in cancer warrants the trouble and expense of taking a vitamin supplement. On the other hand, it might be better simply to eat the recommended levels of fruit and vegetables – as people have done for millennia.

 

*Links to the papers:

Gaziano JM et al. Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II randomized controlled trial. JAMA 2012 Oct 17; [e-pub ahead of print]. (http://dx.doi.org/10.1001/jama.2012.14641)

Sesso HD et al. Multivitamins in the prevention of cardiovascular disease in men: The Physicians’ Health Study II randomized controlled trial. JAMA 2012 Nov 7; 308:1751. (http://dx.doi.org/10.1001/jama.2012.14805)

 

Do you eat breakfast? Many people don’t, but they could be putting themselves at greater risk of diabetes, heart disease and increased body fat.

Surveys vary in the number of people who don’t eat breakfast. Part of the problem, of course, is defining what counts as a ‘breakfast’. Assuming it to be a meal rather than a snack taken on the run to work, then somewhere between 30% and 40% regularly skip it.

Thankfully, parents and teachers – whatever they do themselves – usually insist that children eat something. Past studies have shown the importance of breakfast for learning, and some schools even provide breakfast for pupils.

Two recent studies have now reinforced the benefits of breakfast for adolescents and adults.

In a study of nearly 3,000 European adolescents*, those that ate breakfast regularly had less body fat, were fitter and showed fewer of the risk factors for heart disease – especially in the boys.

The other study** looked at more than 29,000 adult men, following them for 16 years. After taking account of other factors, those who regularly skipped breakfast were 21% more likely to get type 2 diabetes, a serious disease that is increasing rapidly among adults and young people.

These findings have considerable significance in confirming and adding to earlier work.

Nutritionists have long suggested that we should eat something at the beginning of the day. Food that releases energy slowly can stave off feelings of hunger and reduce the amount of snacking through the morning. Debate will continue about what makes the ideal breakfast – although most nutritionists won’t be suggesting a daily fry-up!

 

Professor Brian Kirby, Author of How to Live to 110: Your comprehensive guide to a healthy life

 

*Link to the study of adolescents: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8536196

**Link to the study of adult men: http://www.ajcn.org/content/early/2012/03/27/ajcn.111.028209.abstract

 

 

 

Many people think bad news can make you ill. It seems it may go even further.

A study* of over 6 million Swedes who were told they had cancer showed that a high number committed suicide in the first week after they were given the news – especially among those who were told their outlook was poor. It’s a sad finding, but perhaps not surprising.

More striking, though, was the number of others who suffered a heart attack soon after being told. The risk of dying from a heart attack during the first week increased more than five-fold. The risk remained high over the first four weeks but decreased rapidly back to normal levels.

This fits with other work confirming that death can be precipitated by the death of someone close. It seems that people really can die of a “broken heart”.

Unfortunately, observational studies like these can’t explain why this happens. Bad news is part of everyday life, and the closer the news is to us personally the greater is its effect. But what exactly is going on? If we knew this, we could take action to avert the adverse effects.

There are good reasons to think that bad news may result in metabolic effects that affect an already precariously diseased heart or raise blood pressure to bring on a heart attack or a stroke. Perhaps surges of certain hormones produce these effects: this is certainly plausible but that does not mean it is correct. Unfortunately it is difficult to investigate something as unpredictable as bad news.

Whatever the explanation, the findings highlight how important it may be for friends, workmates and colleagues to offer each other support at troubled times.

 

*Link to study: Fang F et al. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med 2012 Apr 5; 366:1310.

 

Professor Brian Kirby, Author of How to Live to 110: Your comprehensive guide to a healthy life

 

 

It might seem an odd question to ask, but does health advice actually reduce the risk of people getting diseases? You’d expect the answer to be ‘of course it does’, but things may not be that simple.

Research studies on the subject tend to look at a single piece of advice at a time, checking whether it leads, for example, to fewer people getting a particular disease. When you look at it like that, the advice will often be shown to be effective. People who follow the advice – assuming it is good advice, of course – do better. But in everyday life, people are often expected to follow many different pieces of advice all at once, especially regarding lifestyle. Does that make a difference?

For example, the American Heart Association has been encouraging the US population not to smoke, to be physically active, to keep their blood pressure at a normal level, to eat a healthy diet and to ensure their weight and their glucose and cholesterol levels are kept within recommended limits.

Does anyone actually achieve all seven of these objectives? What effects has this advice had on disease and death rates in America?

To answer these questions, researchers looked at data for 45,000 people collected over 22 years. They came to the conclusion that the risk of cardiovascular disease was indeed lowered for people who achieved all seven objectives. Unfortunately, very few people actually met all seven; indeed, many people only managed three or four of them.

That raises questions about how best to present multiple strands of health advice.

Their study found something else that was interesting. Although the seven objectives were all about reducing the risk of heart disease, people who adopted all seven seem to have been protected from other diseases as well. There were fewer deaths from all causes in those people. This strengthens the view that many, seemingly unrelated diseases have common underlying factors related to our modern Western life-style.

Link to study

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

 

An interesting new study* provides evidence that it’s better to get up and move around every so often rather than sit still for long periods.

If you work all day sat at a desk or workbench, or spend your evenings sitting in front of a TV, computer or book, this could be an important result.

The study looked at overweight people in the period following a meal. It showed that walking around for a couple of minutes every 20 minutes improved the level of glucose and insulin in their blood, compared with simply sitting still.

The importance of this is that high levels of glucose and insulin over many years can be associated with heart disease, cancer and other diseases. In the shorter term, they make it more likely you will put on body fat, and they make it
harder to lose weight. Ideally, you want them both to return to normal levels as soon as possible after a meal.

It would seem wise for everyone not to sit still for long periods, especially in the hours after a meal. Get up and move around every so often.

An earlier study** has already shown the long-term dangers of sitting still for long periods. It found that people who watch many hours of television a week – and so are sitting still for a long time – are more likely to suffer heart disease and diabetes. The recent study could go some way towards explaining this.

The study really brings home the importance of physical activity for your body. It shows that even occasional light activity such as a two-minute walk can have a positive effect on important processes going on inside you.

Greater amounts of physical activity bring greater benefits, of course. It has long been known that regular physical activity helps prevent heart and blood vessel disease, counter diabetes, reduce the risk of many common cancers and lose body
fat. And that’s just a few amongst many other benefits.

Inactive people could start with ordinary everyday things like walking that bit extra every day, taking the stairs rather than the lift, and asking whether you really need to use the car for short trips. From there, we recommend building
up your exercise to even higher levels – an hour a day in total if you can manage it. This should bring significant benefits to your long-term health.

But, as this study shows, every little helps – and more than you might think!

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life

* The study about getting up and moving: http://care.diabetesjournals.org/content/early/2012/02/22/dc11-1931

** The study about sitting in front of TV for long periods: http://jama.ama-assn.org/content/305/23/2448.short

 

 

 

Heart attack deaths in England fell by 50 per cent between 2002 and 2010*.

In a study published in January, researchers analysed the records of over 800,000 men and women admitted to hospital with a heart attack. This showed a truly remarkable decline in the number of deaths.

It’s great news. Until a decade ago, numbers were increasing. So what is behind this dramatic change?

The researchers concluded that roughly half the decrease was due to improvements in treatment which kept people from dying, while the rest was due to fewer people having heart attacks in the first place.

It seems more people may now be aware of the underlying causes of heart disease and are changing their lifestyle. They are smoking less, eating more healthily, being more active, watching their weight and their blood pressure, and taking steps to avoid diabetes. (Click here for an overview of the causes of heart attacks.)

At the same time, highly effective medicines and new treatment options for heart attacks have been developed. These break up the blood clots and blockages in arteries that cause the heart attacks.

But there’s no room for complacency. Even with this improvement, heart attacks – and related heart disease not covered by this study – are still one of the main causes of death in the UK. Often heart disease hits in middle life when many men and women are at their peak of earning or responsibility.

And those who have a heart attack but do not die from it can end up with a less than full life. Prevention is still better than cure.

On the other hand, this study and similar trends in the United States show that present efforts are on the right track.

But one troubling finding in the study was that the smallest improvement was in people aged 30 to 54. Could increasing levels of obesity and the earlier onset of diabetes in this group be the reason?

The precursors to the process that blocks arteries are known to start in childhood. Although it is never too late for individuals to take steps to reduce their risk of having a heart attack, the best time to start is when young.

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.



|Smolina K, Wright FL, Rayner M, Goldacre MJ

Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study.

BMJ 2012;344:d8059 doi: 10.1136/bmj.d8059

 

 

These days, when you have a book to sell you need a website. But when we were building our site, we realised it could be much more than a boring old marketing tool.

So what we’ve done is put together a site full of information we hope will be of value to everyone, whether or not you buy our book How to Live to 110. It outlines what to do now to keep yourself healthy, so you live longer and end up in great shape throughout your later years.

We’ve given an overview of all the main diseases covered in the book – heart disease, cancer, high blood pressure, diabetes, lung disease, infections, dementia and so on – and suggested some of the steps you can take to avoid these. We also give advice and suggestions on physical activity, burning calories, foods that help protect you from disease, avoiding hunger, losing weight permanently and giving up smoking.

People are living longer these days. Everyone really should be taking steps to make sure their old age is rewarding and healthy rather than years of illness and frailty. The website can’t go into depth on this, like our book does, but we hope it will still prove helpful. And, unlike some websites, all the suggestions we make are based on scientific studies

Of course, we’d love it if people buy our book. After all, we spent two hard years researching and putting it together, and we’re really proud of how it turned out! But if our website gets some people thinking about their future health – and perhaps contributes to a reduction in the diseases caused by modern living – then that’s great too.

(Our website is www.how-to-live-to-110.com – or click on the tab at the top of the blog.)

 

Professor Brian Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

© 2012 How to Live to 110 Suffusion theme by Sayontan Sinha