December 2, 2011
NIH Podcast Episode #0148
Balintfy: Welcome to episode 148 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode: a pair of reports on the dangers of smoking: how it’s implicated in bladder cancer, and how nicotine could be a gateway drug. Also, news for older adults: the risk factors that can lead to cognitive problems, and a campaign to focus on reducing risk with fitness. And, details on jaw pain. But first, this news update. Here’s Craig Fritz.
Fritz: In 1980, there were 720,000 people aged 90 and older in the United States. In 2010, there were 1.9 million, and by 2050, the ranks of people 90 and older may reach 9 million, according to a report from the U.S. Census Bureau, commissioned by the National Institutes of Health. The report details the demographic, health and economic status of America’s oldest adults. It found that a majority of the 90-plus population are widowed white women who live alone or in a nursing home. Most of them are high school graduates. Social security provides almost half of their personal income, and almost all of them have health insurance coverage through Medicare or Medicaid. The vast majority say they have one or more types of disability. Scientists note that with the aging boom it is critical to develop demographic data providing as detailed a picture as possible of our oldest population. The information on a variety of factors — income, health status, disabilities and living arrangements — will be particularly useful to researchers, planners and policymakers.
Toddlers receiving anti-HIV drugs have higher cholesterol levels, on average, than children who do not have HIV, according to researchers at the national institutes of health. Scientists found that cholesterol levels tended to be highest among children who received a certain type of drugs —known as protease inhibitors. The average cholesterol readings for this group was higher compared to children on other HIV drugs and to children who did not have HIV. In contrast, HIV -positive children who were not on medication had relatively low cholesterol levels. In addition, 10.8 percent of HIV -positive toddlers had cholesterol levels considered borderline high risk for developing heart disease, twice the proportion of toddlers without HIV. The findings correspond with previous studies showing that adults and older children taking protease inhibitors also develop high cholesterol levels. However, the current study is the first to look at children between 12 to 23 months of age. It's likely that these children will be taking antiretroviral drugs for a lifetime. Researchers note that their findings suggest that it would be a good idea for young children taking protease inhibitors to have their cholesterol monitored to determine if they face any increased risk of heart disease as they grow older.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Later in the program, stroke risk and cognitive decline, the Go4Life campaign, a jaw disorder’s link to chronic pain, and two features on the dangers of smoking; that’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Cigarette smoking implicated in half of bladder cancers in women
Balintfy: In this first of two reports on the dangers of smoking, we learn how new data is showing that half of bladder cancer cases in women are caused by smoking. Wally Akinso reports that this puts their risk on par with men.
Akinso: Cigarette smokers have a higher risk of bladder cancer than previously reported, and the proportion of smoking-related bladder cancer in women is now comparable to that in men.
Freedman: Current-smoking women had four times risk of bladder cancer as never-smoking women.
Akinso: Dr. Neal Freedman, at the NIH, is the author of a recent study.
Freedman: And this compares to previous studies where as current-smoking women have three times risk of bladder cancer as never-smoking women.
Akinso: This latest study uses data from over 450,000 participants in the NIH-AARP Diet and Health Study, a questionnaire-based study that was started in 1995, and included follow-up through the end of 2006. Dr. Freedman explains the differences between the current and the older data.
Freedman: We also found that 50 percent of bladder cancer could be attributed to cigarette smoking where as in previous studies in women it was about 20-30 percent. Previous studies were performed in populations where women didn't smoke as much. But in the US, women and men smoke similar amounts and we think this is why in our study the amount of bladder cancer attributed to smoking was higher.
Akinso: In the current study, former smokers were twice as likely to develop bladder cancer as never-smokers, and current smokers were four times more likely than those who never smoked. Dr. Freedman describes the risk for both groups.
Freedman: So it's less than current smokers but at the same time, there’s still a higher risk among former smokers than never-smokers.
Akinso: In 2011, approximately over 69,000 people will be diagnosed with bladder cancer in the United States, and close to 15,000 will die from the disease. For more information on this study and bladder cancer, visit www.cancer.gov. This is Wally Akinso at the NIH, Bethesda, Maryland.
NIH study examines nicotine as a gateway drug
Balintfy: In this next report NIH-funded research in mice shows that nicotine has an effect on the brain that basically primes it for cocaine. Here again is Wally Akinso.
Akinso: A ground breaking study in mice has identified a biological mechanism that could help explain how tobacco products could act as gateway drugs. Dr. Nora Volkow an institute director at the NIH explains how this new research follows evidence from studies looking at large numbers of illicit drug users.
Volkow: The epidemiological studies have shown that the first drug that most people take is either cigarette smoking or alcohol. And following these they go into other drugs like marijuana and subsequently into drugs like cocaine, or heroin, or methamphetamine.
Akinso: The idea or model of gateway drugs where a person's likelihood of abusing cocaine and perhaps other drugs in the future has been controversial. Dr. Volkow says this study looked at a biological mechanism showing that nicotine had a priming effect in the brains of mice.
Volkow: Investigators looked at different models of the effects of cocaine from the behavior. And so when they pretreated with nicotine the animals conditioned much faster than the animals that had only been given cocaine. And conditioning is a process that we know is indispensible in the process of addiction. The person that's addicted gets conditioned to the drug and that drives wanting to take the drug.
Akinso: To examine whether the results from this study paralleled findings in humans, the researchers reexamined statistics from the 2003 National Epidemiological Study of Alcohol Related Consequences to explore the relationship between onset of nicotine use and degree of cocaine dependence.
Volkow: No one had really studied this in humans. And clearly this is why this study is remarkable. It's identifying basic changes that bring to light the question whether something like this will be happening adolescence that get exposed to nicotine that when they are taking nicotine and then they take cocaine in simultaneous they're going to be much more likely to become addicted to cocaine.
Akinso: Dr. Volkow adds that now that they have a mouse model of actions of nicotine as a gateway drug this will allow them to explore the molecular mechanisms by which alcohol and marijuana might act as gateway drugs. For more information on this finding, visit www.drugabuse.gov. This is Wally Akinso at the NIH, Bethesda, Maryland.
NIH study finds stroke risk factors may lead to cognitive problems
Balintfy: If those two stories weren’t convincing enough about the dangers of cigarette smoking, it also increases the risk for stroke. Strokes, which affect some 795,000 Americans each year, can be deadly, and can cause a host of cognitive problems, including effects on memory, speech and language, and everyday problem solving.
Koroshetz: There are a couple of different forms of stroke.
Balintfy: Dr. Walter Koroshetz is deputy director at the NIH institute researching the brain and nervous system.
Koroshetz: A way to think about it is two major classes. One is bleeding into the brain and the other one is blockage of blood vessels which cause what we call ischemic strokes.
Balintfy: Dr. Koroshetz explains that these ischemic strokes are more common, tend to accumulate as people age, and have been associated with cognitive decline in the elderly.
Koroshetz: We are talking about cognitive decline as people losing their edge, having trouble doing things that are important to their work or their lifestyle.
Balintfy: Now new findings from an NIH-funded study, which has followed more than 30,000 people, show the same risk factors for stroke also increase the risk for cognitive decline.
Koroshetz: Well in this study, the major risk factor was hypertension, and in terms of stroke, hypertension is the major risk factor for stroke; and again here, it's the major risk factor affecting cognitive impairment.
Balintfy: Dr. Koroshetz points out that hypertension, or high blood pressure is manageable.
Koroshetz: The way to manage hypertension is to take blood pressure medicines, to reduce your weight, and to get exercise.
Balintfy: He hopes this study will be a motivating factor for people to reduce their risk.
Koroshetz: So we can control our blood pressure; we can control our weight; we can get exercise; and those things are usually what people associate with better cardiac health and preventing heart attacks. The message here is that it actually promotes brain health.
Balintfy: Another key message from this recent study, published in the Journal Neurology, is that African Americans are at higher risk.
Koroshetz: This study, REGARDS study, is funded to look at a large population, particularly African Americans and Caucasians to compare the risks and trying to understand why African Americans have the highest risk.
Balintfy: And the researchers have made other interesting findings:
Koroshetz: They found that some of the increased risk is related to more high blood pressure, more diabetes, slightly increased weight called body mass index; and those were things that now are kind of out there in the open to get controlled. However, there does seem to be a significant percentage of the risk which is unexplained.
Balintfy: Dr. Koroshetz says another intriguing piece of the study is that the risk of stroke is also dependent on where people grow up. He notes stroke rates are highest in what’s call the “Stroke Belt” in the Southwestern United States. That includes North Carolina, South Carolina, Tennessee, Kentucky, Mississippi, Arkansas and Alabama.
Koroshetz: So if you grew up in the Stroke Belt and then moved in your 20s or 30s, you seem to carry the risk that you had that people in the Stroke Belt had. So it almost suggests there's something going on earlier in life with regard to these risks for stroke.
Balintfy: There may also be a cumulative effect of “silent strokes” adding up to cognitive decline.
Koroshetz: MRI scans are incredibly sensitive to any type of structural changes in the brain. So, one can see now strokes in the brain that occurred in areas that didn't give symptoms and those are called silent strokes. We've known about them for a long time but it's only recently that people have been able to do MRIs on populations to show what the incidence is, and it's strikingly high and it goes up exponentially to the point where if you're 90 years old, you have a 40% chance of having had a silent stroke. Most people with silent strokes have more than one as well.
Balintfy: Dr. Koroshetz says that there’s potentially a silent epidemic going on where there’s injury to the brain due to very small strokes that go unnoticed by people and their physicians but may cause the cognitive impairment.
Koroshetz: Those changes in the MRI now give us a potential window into identifying people who are at the highest risk of developing this kind of vascular cognitive impairment and that I think is exciting as we go forward. It's also a little daunting because of the expense of MRI scans and the idea of everyone having an MRI scan to look for this. I think it's not a crazy idea that this will be something important in the future.
Balintfy: But Dr. Koroshetz adds, prevention is key: managing high blood pressure, maintaining a healthy weight, and keeping physically active help not only heart health, but reduce stroke risk and reduce cognitive decline. For more information on stroke research and this study, visit www.ninds.nih.gov.
New Go4Life campaign focuses on fitness of older adults
Balintfy: So how exactly can we be physically active, maintaining health and independence and reduce risk for stroke and cognitive decline? A new federal campaign for people 50 and older is designed to help people get active and keep going. Dr. Richard Hodes, an institute director at the NIH says the initiative contains research- and evidence-based recommendations and guidance for older men and women.
Hodes: For some time we’ve been telling people that research shows that various aspects of physical activity do have advantages; now we can go a step beyond for those who are interested in taking advantage of what we know and provide a means and a vehicle and help to initiate and sustain that activity.
Balintfy: The Go4Life campaign encourages sedentary older adults to reap health benefits by making physical activity a part of their daily lives. Only 25 percent of people aged 65-74 say they engage in regular physical activity.
Dutta: We recognize that motivation is a problem at any age.
Balintfy: Dr. Chhanda Dutta is a physical activity and exercise expert at the NIH.
Dutta: You have to make exercise a priority in your life. In this fast pace, moving world we live hectic lives and we’re often making tradeoffs. However, I think it’s really important, it’s an investment in yourself; if you make exercise a priority, you’ll be functionally and healthier in the long run.
Balintfy: Experts point out that exercise has specific benefits, including improving heart health, reducing pain from osteoarthritis, and preventing diabetes. U.S. Surgeon General, Dr. Regina Benjamin adds that getting started can be easy.
Benjamin: You don’t have to do strenuous exercise. You don’t have to go to the gym, you can just do it right in your home, right where you are in your seat. It’s easier if you have your friends and someone with you to start doing something, and you’re just going for life. That’s why it’s Go4Life, just to get yourself going, anything to get moving.
Balintfy: Dr. Benjamin says that while she herself is setting an example with Surgeon General’s walks around the country, physical activity is also a priority for the whole nation.
Benjamin: And this fits right into our overall health and wellness and Go4Life is part of that.
Balintfy: Go4Life resources center on a colorful, interactive website. It’s targeted towards individuals, groups, and health care professionals. The site features specific exercises, success stories, and free materials to motivate a growing number of older people. Dr. Dutta explains that Go4Life also recommends four categories of exercise.
Dutta: You have to work on aerobic exercises, good for your heart. You have to work on your strength, so there’s resistance training. You have to work on your balance and I cannot stress enough the importance of working on your balance especially at any age. And the fourth category is flexibility. And we strongly encourage people to incorporate exercises from each of these four categories into developing their own personal routine.
Balintfy: The Go4Life site also offers online virtual coaches to help motivate participants. For more information on the Go4Life initiative, and to get started and stay active, visit www.nia.nih.gov/Go4Life.
Coming up next, preliminary results of a large, seven-year study on a jaw disorder are revealing risk factors for chronic pain.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Research study finds risk factors for TMJD
Balintfy: Welcome back to NIH Research Radio. Thousands of Americans this year will be diagnosed with a common disorder of the jaw area.
Kusiak: There looks to be about maybe 10 million people in the United States that have the disorder.
Balintfy: Dr. John Kusiak, a program director at the NIH says the condition is called temporomandibular joint disorder, or TMJD.
Kusiak: It's a series of complex disorders that affect the jaw, the muscles, the joint, the tissues, and cartilage surrounding the joint. It usually involves pain in that area either upon touching it or with function; that is when you open the jaw you will have pain.
Balintfy: Even the act of smiling, he says, can be painful. Because TMJD is complex, healthcare providers have no way to determine whether patients will get better with little or no treatment, or end up battling chronic TMJD.
Maixner: The condition has been largely unexplored from a mechanistic point of view
Balintfy: Dr. William Maixner is the Director of the Center for Neurosensory Disorders at the University of North Carolina. He’s also a principal investigator of an NIH-funded study designed to tease apart the underlying biological, psychological and genetic factors that contribute to both the development of this condition and the persistence of it in the population.
Maixner: I know of no other really large study of this type where we've really done a very detailed assessment of patient populations in clinic and then have followed them longitudinally.
Balintfy: The study, called OPPERA, is a longitudinal study.
Kusiak: That is a study over observing subjects over a long period of time
Balintfy: Again Dr. Kusiak. He says OPPERA is looking for factors that are related to the beginnings or risks of TMJD.
Kusiak: It's important to know that because if you know what the risk factors might be, then there's a much better opportunity to intervene through therapies whether it's pharmacological, behavioral, or other means. It's probably much easier to treat early on rather than later.
Balintfy: Current treatments can include anti-inflammatory drugs, or heat or cold packs. Researchers are also concerned with chronic TMJD that can involve not only pain and poor function but also psychological effects that may lead to depression and anxiety. Dr. Kusiak adds that TMDJ can coexist with other chronic pain conditions.
Kusiak: There are, we believe anyway, a fair number of subjects that not only have just TMJD but also other chronic pain conditions like fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and it would be really important to try to identify the specific risk factors for those individuals as well.
Balintfy: Dr. Maixner adds there is no single risk factor for TMJD.
Maixner: The notion that we are dealing with just the head and neck oral-facial condition I think now is being laid to rest.
Balintfy: He says it is becoming clearer and clearer through research that TMJD should be looked at with a global view.
Maixner: This is a really a condition associated with a constellation of conditions that impact almost every region of the body in one way or another.
Balintfy: Initial results from the OPPERA study show that in women, the risk for TMJD increases between the ages of 18 and 44; that unlike other chronic pain conditions, TMJD does not appear connected to socio-economic status; and that genetic variability does contribute to chronic TMJD – researchers have found that chronic TMJD patients had alterations in several genes, including some known to influence stress response, psychological well-being and inflammation. For more information on the OPPERA study and TMJD, visit www.nidcr.nih.gov.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us next time when we’ll hear about stem cells:
“This paradigm that we have found for intestinal stem cells could very well apply to other tissues as well.”
Our next edition will be available on Friday, December 16. In the mean time, if you have any questions or comments about this program, or have a topic you’d like to hear about next time, please let me know by email, my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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