Impact of Social Isolation on Neuroplasticity in Adults Post-Neurological Injury

 Well, the solution to this is 100% recovery before you lose the first two groups of friends as described by Aristotle.  Your doctor's responsibility.

Aristotle believes that there are three different kinds of friendship; that of utility, friendship of pleasure, and virtuous friendship. 

The latest here:

 Impact of Social Isolation on Neuroplasticity in Adults Post-Neurological Injury

Description

During the year 2020, a worldwide quarantine was set in place as a preventative strategy to combat the COVID-19 pandemic. According to the Michigan Health Lab in June of 2020, 56% of people over the age of 50 said they sometimes or often felt isolated from others. In comparison, this statistic increased by over 100% from the original 27% reported back in 2018 (Gavin, 2020). Social isolation (SI) has been recognized as a major risk factor for morbidity and mortality in humans and animals for more than a quarter century (CacSo the solution to this os 100% recovery, then you won'y lose the first two groups of friends as decioppo et al., 2014). Neuroplasticity is the brain’s ability to modify, change, and adapt both structure and function throughout life and in response to experience (Voss et al, 2017). This presentation will review social isolation and its impact on neuroplasticity in adults post-neurological injury. This poster will also review strategies that can be incorporated to maintain neuroplasticity during social isolation.

Participants will be able to:

1. Describe the relationship between neuroplasticity and social isolation.

2. Explain the importance of socialization and how it impacts brain development/growth.

3. List strategies to aid in brain plasticity after a neurological injury while being socially isolated.

References

Cacioppo, S., Capitanio, J. P., & Cacioppo, J. T. (2014). Toward a neurology of loneliness. Psychological Bulletin, 140(6), 1464–1504. https://doi.org/10.1037/a0037618

Davim, André, et al. “Environmental Enrichment as a Strategy to Confront Social Isolation under the COVID-19 Pandemic.” Frontiers in Behavioral Neuroscience, vol. 14, 21 Jan. 2021, https://doi.org/10.3389/fnbeh.2020.564184.

Gavin, Kara. “Loneliness Doubled for Older Adults in First Months of COVID-19.” Www.michiganmedicine.org, 14 Sept. 2020, www.michiganmedicine.org/health-lab/loneliness-doubled-older-adults-first-months-covid-1 9. Accessed 8 Mar. 2023.

Lee, Paul S. N., et al. “Internet Communication versus Face-To-Face Interaction in Quality of Life.” Social Indicators Research, vol. 100, no. 3, 31 Oct. 2010, pp. 375–389, https://doi.org/10.1007/s11205-010-9618-3.

Liu, Jia, et al. “Impaired Adult Myelination in the Prefrontal Cortex of Socially Isolated Mice.” Nature Neuroscience, vol. 15, no. 12, 11 Nov. 2012, pp. 1621–1623, www.ncbi.nlm.nih.gov/pmc/articles/PMC3729624/, https://doi.org/10.1038/nn.3263.

National Institute for the Clinical Application of Behavioral Medicine. “How Does Neuroplasticity Work? [Infographic].” NICABM, 17 Aug. 2016, www.nicabm.com/brain-how-does-neuroplasticity-work/. University at Buffalo. (2012, November 11). New form of brain plasticity: How social isolation disrupts myelin production. ScienceDaily. Retrieved March 6, 2023 from www.sciencedaily.com/releases/2012/11/121111153935.htm

Voss, Patrice, et al. “Dynamic Brains and the Changing Rules of Neuroplasticity: Implications for Learning and Recovery.” Frontiers in Psychology, vol. 8, no. 1657, 4 Oct. 2017, https://doi.org/10.3389/fpsyg.2017.01657

Presentation Type

Poster Presentation

College

College of Education and Allied Health

Department

Communication Disorders and Deaf Education

Disciplines

Communication Sciences and Disorders | Speech and Hearing Science | Speech Pathology and Audiology

Degree Name

Master of Science (MS)

Degree Program

Speech-Language Pathology

Publication Date

Spring 2023

Publisher

Fontbonne University Archives

City

St. Louis, MO

Recommended Citation

Long, Harriett, "Impact of Social Isolation on Neuroplasticity in Adults Post-Neurological Injury" (2023). 2023 SLP Posters. 31.
https://griffinshare.fontbonne.edu/slp-posters-2023/31

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Enriched environment-Induced Neuroplasticity in Ischemic stroke and its underlying mechanisms

If your doctor and hospital hasn't created protocols on environmental enrichment since the

enriched environment talked about by Dr. Dale Corbett in 2011.

You don't have a functioning stroke hospital or doctor. Why the fuck do they consider themselves a stroke hospital? Run away!

Enriched environment-Induced Neuroplasticity in Ischemic stroke and its underlying mechanisms 

Xia Bi^1*, Ping-Ping Han¹, Yu Han¹, Zhen-Kun Gao² and Xin-Ya Shen²

• ¹Zhoupu Hospital, Shanghai University of Medicine and Health Sciences, China
• ²Shanghai University of Traditional Chinese Medicine, China

The final, formatted version of the article will be published soon.

Stroke is a common cerebrovascular disease that can interrupt local blood flow in the brain, causing neuronal damage or even death, resulting in varying degrees of neurological dysfunction. Neuroplasticity is an important neurological function that helps neurons reorganize and regain function after injury. After cerebral ischemia, neuroplasticity changes are critical factors for restoring brain function. An enriched environment promotes increased neuroplasticity, thereby aiding stroke recovery. In this review, we discuss the positive effects of the enriched environment on neuroplasticity after cerebral ischemia, including synaptic plasticity, neurogenesis, and angiogenesis. In addition, we also introduce some studies on the clinical application of enriched environments in the rehabilitation of post-stroke patients, hoping that they can provide some inspiration for doctors and therapists looking for new approaches to stroke rehabilitation.

Stroke survivors' perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study

You managed to miss all these drugs for stroke recovery. Don't you read the literature?

• DMT (8 posts to November 2020)

• ecstasy (19 posts to November 2012)

• LSD (5 posts to September 2018)

  • CerAxon (5 posts to January 2012)

  • citicoline (15 posts to October 2011)

   

• magic mushrooms (10 posts to October 2014) 

  psilocybin (14 posts to May 2014)

  My 13 reasons for marijuana use post-stroke.  

  Don't follow me, I'm not medically trained and I don't have a Dr. in front of my name.

   

 

Stroke survivors' perspectives on decision-making about rehabilitation and the prospect of taking recovery-promoting drugs: A qualitative study

Author links open overlay panel

, , , ,

https://doi.org/10.1016/j.rcsop.2023.100297Get rights and content

Under a Creative Commons license

open access

Abstract

Objectives

To investigate factors which influence stroke survivors' decision-making about their rehabilitation and the prospect of taking recovery-promoting drugs, to enhance their recovery.

Methods

Seventeen stroke survivors who had undertaken stroke rehabilitation, and three spouses, participated in focus groups and individual interviews in northern Queensland, Australia. Inductive thematic analysis of the interview data was conducted in accordance with Braun and Clarke's six-phase process.

Results

Two specific, pivotal decision points during participants' stroke recovery process were identified: 1) overall, when deciding what rehabilitation they would undertake and hypothetically what recovery-promoting drugs they would take, and 2) on a daily basis, when deciding whether to participate in rehabilitation and take recovery-promoting drug on any given day. Six themes which described factors influencing their decision-making were: ‘My options for rehabilitation and recovery-promoting drugs’; ‘The costs of rehabilitation and recovery-promoting drugs’; ‘My recovery goals’; ‘What I can deal with today’; ‘The people my rehabilitation and recovery-promoting drugs affect’; and ‘Fitting rehabilitation and recovery-promoting drugs into my life.’ These themes were applicable at either one or both of the identified decision points.

Conclusion

Factors that influence stroke survivors' decision-making, overall and on a day-to-day basis, need to be considered to ensure they can make the best decisions for themselves to achieve their full recovery potential. Understanding the conditions under which a stroke survivor would take a recovery-promoting drug will contribute to the development of dosing protocols to which stroke survivors could adhere.

Keywords

Stroke

Rehabilitation

Recovery

Pharmacotherapy

Medication

Drug

1. Introduction

Stroke survivor preferences with regard to the costs, risks and inconveniences associated with rehabilitation interventions to improve their recovery play an important role in whether they choose to adhere to the intervention.1., 2., 3. For example, the cost of transport to the rehabilitation clinic, the risk of falling while transiting and the inconvenience of waiting to be collected after an appointment are all factors which may affect adherence. Such factors must be considered with the advent of recovery-promoting drugs (RPDs), defined as medications that promote motor recovery post-stroke.^4,5 To date, drugs investigated for recovery-promoting potential have included amphetamine, cerebrolysin, citalopram, fluoxetine, lithium and selegilene.⁸ The conditions under which stroke survivors would commit to taking RPDs as prescribed are largely unknown. Understanding their preferences, and the factors that underpin them, is necessary if clinicians are to support stroke survivors to make informed decisions about RPDs that they would take precisely as prescribed to maximise their recovery.³ Furthermore, accommodating stroke survivors' preferences for physical and behavioural rehabilitation interventions (referred to as rehabilitation hereafter) and RPDs, alone or in combination, has potential to improve trial fidelity and translation into real-world practice.⁹ This knowledge could contribute to the development of robust clinical guidelines for RPD use to promote stroke recovery.

Stroke survivor preferences are influenced by many and varied factors, each of which hold varying importance to each individual .^1,3 Discrete choice experiments allow investigation into the interplay of such factors that may influence a person's preference by examining the trade-offs respondents are willing to make between different key attributes in decision-making.¹⁰ While several DCEs have been undertaken to investigate stroke survivors' preferences for rehabilitation and for medications to reduce stroke risk,^3,11., 12., 13., 14. none have been conducted to explore stroke survivors' decision-making about their rehabilitation and prospect of taking recovery-promoting drugs. When developing a robust discrete choice experiment, the key factors influencing decision-making must be known.¹⁵ Because RPDs have only been used in clinical trials, finding stroke survivors with experience taking them is near impossible. Until such time as RPDs are routinely available or prescribed, exploring how stroke survivors make decisions about their participation in rehabilitation will provide important insight into these factors. By posing the hypothetical question of whether they would take RPDs, and under what circumstances, stroke survivors can draw on their lived experience of making decisions to promote their recovery and provide their best estimation of which factors would influence their decision-making. Therefore, the aim of this study was to investigate factors which would influence stroke survivors' decision-making about their rehabilitation, and the prospect of taking RPDs, to enhance their recovery.

More at link.

A Concentrated Fruit Juice That Lowers Blood Pressure

FYI, don't do this yet, not totally proven.

A Concentrated Fruit Juice That Lowers Blood Pressure

Drinking this uncommon juice can lower blood pressure.

The lingonberry is a tiny red berry similar to a cranberry, but powerful enough to improve blood vessel function, research finds.

Drinking lingonberry juice in the long-term will lower blood pressure by widening the blood vessels and relaxing the smooth muscle cells within the arteries.

Many people experience elevated blood pressure and many are at risk of vascular disease caused by disturbances in blood vessel function.

Nutrition, in addition to medicatio, plays an essential role in managing hypertension and related disorders, like heart disease.

An experimental study found that an eight-week treatment with concentrated lingonberry juice reduced blood pressure in hypertensive rats.

Berries, tea, cocoa, vegetables and fruits rich in polyphenol, an antioxidant, have been shown to improve cardiovascular health.

Nordic berries such as lingonberry, blackcurrant, cranberry and bilberry are excellent sources of polyphenols, including flavonoids, anthocyanidins and proanthocyanidins.

Lingonberry juice given to genetically hypertensive rats stopped the expression of genes causing inflammation in the aorta but other berry juices were not as effective.

It is possible that lingonberry juice has an anti-inflammatory effect by reducing the serum levels of certain hormones that are responsible for increasing blood pressure.

It also enhances nitric oxide production which in turn makes blood vessels widen and improves vascular function.

Ms Anne Kivimäki, the study’s author, said:

“‘These experimental findings need evidence from comparative clinical studies on healthy individuals with slightly elevated blood pressure who, at this point, have been given nutritional and lifestyle guidance instead of drug therapy.

Lingonberry juice is no substitute for medication, but it is a good dietary supplement.

The study was accessed through E-thesis service Helsingin yliopisto (Kivimäki et al., 2019).

These Fruits And Veg Reduce Cognitive Decline Risk The Most

 Now ask your doctor for specific daily amounts needed, that will require further research since just is just an association, not a proven cause.

These Fruits And Veg Reduce Cognitive Decline Risk The Most

The fruits and vegetables that provide the highest protection against cognitive decline.

Certain fruits and vegetables that contain antioxidant flavonols appear to protect against cognitive decline.

Flavanols, which are a type of flavonoid, are found in nearly all fruits and vegetables, as well as in tea.

Consuming around one cup of dark leafy greens each day is linked to retaining stronger cognitive abilities with age.

Kaempferol and myricetin

A flavanol called kaempferol was linked to the highest level of protection by the research.

Typical foods that contain high levels of kaempferol include beans, tea, kale, spinach and broccoli.

Another flavanol called myricetin was also protective, although not quite to the same extent as kaempferol.

Typical foods that contain high levels of myricetin include wine, tea, kale, oranges and tomatoes.

Quercetin, which is found in tea, apples, kale and tomatoes was also protective, but at a still lower level.

Dr Thomas M. Holland, the study’s first author, said:

“It’s exciting that our study shows making specific diet choices may lead to a slower rate of cognitive decline.

Something as simple as eating more fruits and vegetables and drinking more tea is an easy way for people to take an active role in maintaining their brain health.”

Slowing cognitive decline

For the study, almost 1,000 people were divided into groups based on the amount of flavanols in their diet.

The group consuming the most flavanols got 15 mg a day — the amount that would come from a single cup of dark leafy greens.

Study participants were tracked over an average of 7 years and given regular cognitive tests.

These revealed that people who consumed the highest levels of flavanols experienced the slowest decline in their cognitive abilities.

The study’s authors explained:

“Results suggest dietary intakes of total flavonols and several flavonol constituents may be associated with slower decline in global cognition and multiple cognitive abilities with older age.”

As with any correlational research like this one, the study cannot prove that there is a link, merely that there is an association.

Upfront Diagnostics develops ‘world-first’ stroke test

But 15 minutes is way too slow.

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery. CAN YOU DO THAT? Since no one can do that, what are the followup procedures that will still deliver 100% recovery?

Don't allow your hospital to use the tyranny of low expectations to drive their goals for stroke recovery. The only goal in stroke is 100% recovery. You may need to scream at your stroke medical 'professionals' to get them to understand that. 

Electrical 'storms' and 'flash floods' drown the brain after a stroke

The latest here:

Upfront Diagnostics develops ‘world-first’ stroke test

Upfront Diagnostics, a healthcare company looking to revolutionise stroke diagnosis, has announced a seed funding round of £1.6 million. 

The startup – previously known as Pockit – was founded in 2017 by University of Cambridge students Gonzalo Ladreda, Dr Edoardo Gaude, Marcos Ladreda and Dr Joshua Bernstock, and has been backed by Cambridge Enterprise since 2019. 

It has developed LVOne, a point-of-care rapid test for identifying patients suffering an acute ischaemic stroke caused by large vessel occlusion.

Globally, there are more than 20 million strokes annually. LVOs account for 30% of strokes but are responsible for 95% of disabilities and deaths. Traditional stroke diagnosis methods often involve time-consuming and costly imaging techniques, causing delays in treatment initiation. 

By identifying Upfront Diagnostics biomarkers with a handheld blood test, paramedics are said to be able to recognise LVO stroke cases within 15 minutes and take patients directly to a comprehensive stroke centre for treatment. 

The startup says this saves more than 1 hour and 30 minutes over the current clinical pathway, billions in medical treatment costs, helps avoid disabilities and saves lives.

The investment was led by APEX Ventures’ Medical Fund, following grant funding from SBRI Healthcare in partnership with the Stroke Association.

“With this significant funding, we are poised to transform stroke diagnosis worldwide and make a tangible impact on patient care,” said co-founder Gonzalo Ladreda.

“Our rapid blood test has the potential to revolutionise stroke management by providing paramedics and physicians with actionable insights in a matter of minutes, enabling them to make informed treatment decisions swiftly.

“This time-saving difference in early diagnosis could mean a 20% reduction in disabilities from LVO strokes. For every 15 minutes of earlier treatment, there is a cost-saving of over $60,000 per patient. Ultimately faster diagnosis leads to better outcomes for all.”

LVOne was validated on 270 patients at the Royal Victoria Infirmary Hospital in Newcastle, and it is designed to identify LVO strokes in the ambulance so that patients can be fast-tracked to a thrombectomy-specialised hospital for treatment. Within 15 minutes, the test allows paramedics to identify an LVO anywhere with very high accuracy.

The test has been developed with the support of Innovate UK, Newcastle University, Academic Health Science Network, National Institute for Health and Care Research (NIHR), SBRI Healthcare, Stroke Association and NHS Foundation Trust.

The seed funding will be used to scale up the technology and its accuracy for identifying large artery strokes on real-world patients. Upfront Diagnostics will also expand its team and prepare for clinical approval. 

Dr Pooja Sikka, general practitioner in the UK and venture partner at APEX Ventures Medical Fund, commented: “I am delighted to back the Upfront Diagnostics team who started their journey in Cambridge. 

“LVOne could revolutionise the stroke care pathway globally, getting patients rapidly into stroke centres and access to interventional radiology services quickly, generating positive clinical outcomes rapidly. It can be a rare find in health tech to find an investment where you change outcomes so definitively, but this is one of them. 

“The impact on the healthcare workforce, the social care system and the broader economic benefits of this solution will also be felt. Stroke is a preventable disease, but growing. We need better diagnostics and optimised care pathways. Effective point-of-care testing is fundamental to achieving that.”

DAPT noninferior to alteplase in minor nondisabling acute ischemic stroke

So both pretty much failed at 100% recovery but your writeup failed to acknowledge that, for that lie I'd fire you all. The only goal in stroke is 100% recovery, when will you get that thru your thick skulls?

DAPT noninferior to alteplase in minor nondisabling acute ischemic stroke

Key takeaways:

• At 90 days after minor nondisabling acute ischemic stroke, there was no difference in functional outcomes between treatment with DAPT or alteplase.
• Safety outcomes were slightly better with DAPT.

In patients with minor nondisabling acute ischemic stroke, treatment with dual antiplatelet therapy was noninferior to treatment with IV alteplase, according to the results of the ARAMIS trial.

The researchers randomly assigned 760 patients (median age, 64 years; 31% women) with minor nondisabling acute ischemic stroke — defined as NIH Stroke Scale score of 5 or less, plus 1 point or less on single-item scores such as vision, language, neglect or single limb weakness, and a score of 0 in the consciousness item — to DAPT or IV alteplase. The patients, who were treated at 38 hospitals in China, underwent randomization within 4.5 hours of symptom onset and had a median NIH Stroke Scale score of 2.

At 90 days after minor nondisabling acute ischemic stroke, there was no difference in functional outcomes between treatment with DAPT or alteplase.
Data were derived from Chen HS, et al. JAMA. 2023;doi:10.1001/jama.2023.7827.

The DAPT group received clopidogrel 300 mg and aspirin 100 mg on the first day followed by clopidogrel 75 mg and aspirin 100 mg for 12 days, and then guideline-based antiplatelet therapy until 90 days. The alteplase group received IV alteplase 0.9 mg/kg up to 90 mg on the first day followed by guideline-based antiplatelet therapy starting 24 hours after the alteplase dose.

The primary endpoint was excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1, at 90 days.(1 is not excellent according to survivors, you can't let your stroke medical 'professionals' use the tyranny of low expectations on you!)

At 90 days, 93.8% of patients in the DAPT group and 91.4% of those in the alteplase group had excellent functional outcome (risk difference, 2.3%; 95% CI, –1.5 to 6.2; crude RR = 1.38; 95% CI, 0.81-2.32), Hui-Sheng Chen, MD, from the department of neurology, General Hospital of Northern Theatre Command in Shenyang, China, and colleagues wrote.

The unadjusted lower limit of the 97.5% CI was –1.5%, beating the noninferiority margin of –4.5% (P for noninferiority < .001), according to the researchers.

Symptomatic intracranial hemorrhage at 90 days occurred in one patient (0.3%) from the DAPT group and in three patients (0.9%) from the alteplase group, the researchers wrote.

Various sensitivity analyses did not change the results.

“This finding, along with better safety outcomes, provides robust evidence for the effectiveness of DAPT being noninferior to intravenous alteplase in patients with minor nondisabling acute ischemic stroke,” Chen and colleagues wrote.

Vitamin D for Cardiovascular Prevention Runs Into Another Wall

Well the previous post on this is here:

The Importance of Vitamin D for Older Adults: A Key to Healthy Aging

 

You can ask your doctor what is the correct interpretation.

Vitamin D for Cardiovascular Prevention Runs Into Another Wall

But D-Health Trial investigators hold out hope supplements may still help selected patients

by Nicole Lou, Senior Staff Writer, MedPage Today June 28, 2023

Monthly super-sized vitamin D supplements failed to significantly reduce major cardiovascular events in older adults, the Australian D-Health Trial found.

Over up to 5 years of treatment, incident myocardial infarction (MI), stroke, and coronary revascularization turned up in 6% of the vitamin D group and 6.6% of the placebo group (HR 0.91, 95% CI 0.81-1.01), and that hazard ratio didn't budge over time.

There was no effect modification by age, sex, or body mass index, reported Rachel Neale, PhD, of Queensland Institute of Medical Research's Berghofer Medical Research Institute in Herston, Australia, and colleagues in The BMJopens in a new tab or window.

However, some individual components of the primary outcome appeared more indicative of a clinical benefit for the monthly 60,000 IU dose of vitamin D supplementation:

• Myocardial infarction (HR 0.81, 95% CI 0.67-0.98)
• Coronary revascularisation (HR 0.89, 95% CI 0.78-1.01)
• Stroke (HR 0.99, 95% CI 0.80-1.23)

Also potentially redeeming was a signal that there was better reduction in cardiovascular events in vitamin D users who had been taking statins or other cardiovascular medications at baseline (HR 0.84, 95% CI 0.74-0.97), though the P-value for interaction was not significant.

"Vitamin D supplementation might reduce the incidence of major cardiovascular events, although the absolute risk difference was small and the confidence interval was consistent with a null finding. These findings could prompt further evaluation of the role of vitamin D supplementation, particularly in people taking drugs for prevention or treatment of cardiovascular disease," Neale and colleagues concluded.

Their findings are consistent with prior randomized trials -- ViDAopens in a new tab or window and VITALopens in a new tab or window, for instance -- showing vitamin D supplementation does not prevent cardiovascular events. The D-Health investigators themselves previously reported that vitamin D3 supplements did not reduce all-cause nor cardiovascular disease mortalityopens in a new tab or window in the Australian cohort.

Yet for them, the signal of benefit in certain vitamin D recipients in the present report, along with an overall estimated number needed to treat to avoid one major cardiovascular event of 172, merits further investigation into the potential protective effects of vitamin D supplementation. Subgroup analyses in other large trials might be helpful, Neale's group said.

"In the meantime, these findings suggest that conclusions that vitamin D supplementation does not alter risk of cardiovascular disease are premature," they argued.

In current practice, clinicians may choose not to measure vitamin D levels, instead prescribing a higher supplement dose for selected patients at increased risk for vitamin D deficiency. The U.S. Preventive Services Task Force still deems the evidence insufficient to supportopens in a new tab or window broad screening for vitamin D deficiency in adults, partly because it is unclear what level of vitamin D is too low for a given individual.

D-Health participants were unscreened adults ages 60 to 84 years recruited from 2014 to 2015, having been selected randomly from a population register. Their cardiovascular outcomes were followed through multiple population-based databases.

Individuals were randomized to 60,000 IU/month vitamin D3 (n=10,662) or placebo (n=10,653). Blinded, all received 12 study tablets each year and were instructed to take one tablet at the beginning of each month. People were supposed to minimize the use of off-trial vitamin D supplements, with a maximum 2,000 IU per day outside the trial still acceptable to the investigators.

Study authors noted the relatively good health of D-Health participants, who were less likely to be current smokers than the general population.

Average serum 25(OH)D concentration reached 77 nmol/L in the placebo group and 115 nmol/L in the vitamin D group.

Annual self-reports and random blood sampling suggested that four out of five participants ultimately took 80% of study tablets, indicating "extremely high retention and adherence," Neale's group reported.

The incidence of adverse events was similar between groups.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The D-Health Trial was funded by project grants from the National Health and Medical Research Council, with additional fellowship support.

Neale disclosed funding from Viatris for an unrelated study of pancreatic cancer.

Primary Source

The BMJ

Source Reference: opens in a new tab or windowThompson B, et al "Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial" BMJ 2023; DOI: 10.1136/bmj-2023-075230.

Trial of vitamin D supplementation raises questions about CV effects on older adults

Well the previous post on this is here:

The Importance of Vitamin D for Older Adults: A Key to Healthy Aging

 

You can ask your doctor what is the correct interpretation.

Trial of vitamin D supplementation raises questions about CV effects on older adults

Key takeaways:

• In older adults, vitamin D supplementation trended toward reducing risk for major cardiovascular events.
• The findings are inconsistent with previous trials of the CV effects of vitamin D supplementation.

In a trial of more than 20,000 older adults, vitamin D supplementation trended toward reducing risk for major CV events in older adults compared with placebo, a finding differing from previous studies.

Bridie Thompson, PhD, MPH, BSc, postdoctoral researcher in the Population Health Program, QIMR Berghofer Medical Research Institute in Herston, Queensland, Australia, and colleagues published an analysis the D-Health Trial to determine whether vitamin D supplementation reduced risk for major CV events in 21,315 participants aged 60 to 84 years compared with placebo.

In older adults, vitamin D supplementation trended toward reducing risk for major cardiovascular events.
Data were derived from Thompson B, et al. BMJ. 2023;doi:10.1136/bmj-2023-075230.

In the main results from the D-Health Trial published in The Lancet in January 2022, there was no difference between the groups in all-cause mortality, CVD mortality, cancer mortality or other causes of mortality.

Participants were assigned 60,000 IU per month of vitamin D or placebo taken orally for up to 5 years. At 5 years, follow-up was completed by 80.2% of the vitamin D group and 77.6% of the placebo group, and 84% of the vitamin D group and 82% of the placebo group reported taking at least 80% of the study tablets.

At 5 years, a major CV event, defined as MI, stroke or coronary revascularization, occurred in 6.6% of the placebo group and 6% of the vitamin D group (HR = 0.91; 95% CI, 0.81-1.01), Thompson and colleagues found.

The treatment effect was more pronounced but was not significantly greater in participants who were also taking CV drugs at baseline (HR = 0.84; 95% CI, 0.74-0.97; P for interaction = .12), according to the researchers.

“There was high concurrent use of statins and other cardiovascular drugs, and the interaction could reflect an effect in people who are already at high risk of experiencing a cardiovascular event, rather than a synergistic effect between vitamin D and a particular drug,” Thompson and colleagues wrote. “However, the exploratory analysis by self-reported history of major cardiovascular events was inconsistent with this hypothesis, and it is plausible that there is an interaction between vitamin D and the drugs examined.”

The difference in standardized cause-specific cumulative incidence of major CV events at 5 years was –5.8 events per 1,000 participants (95% CI, –12.2 to 0.5), which translated to a number needed to treat of 172 to avoid one major CV event, Thompson and colleagues wrote.

Compared with the placebo group, the vitamin D group had lower rates of MI (HR = 0.81; 95% CI, 0.67-0.98) and coronary revascularization (HR = 0.89; 95% CI, 0.78-1.01) but not stroke (HR = 0.99; 95% CI, 0.8-1.23), according to the researchers.

The findings differ from the VITAL, ViDA and several other large trials of vitamin D, which found no CV benefit associated with vitamin D supplementation.

“If the effect on myocardial infarction observed in the D-Health Trial is a true effect, and not due to chance, the reasons for the lack of consistency across studies are unclear,” Thompson and colleagues wrote. “The discrepancy with VITAL might partly be caused by differences in study design and adherence.”

The researchers concluded that “these findings indicate that vitamin D supplementation might reduce the incidence of major cardiovascular events, particularly myocardial infarction and coronary revascularization. This protective effect could be more marked in those taking statins or other cardiovascular drugs at baseline. Subgroup analyses in other large trials might help to clarify this issue. In the meantime, these findings suggest that conclusions that vitamin D supplementation does not alter risk of cardiovascular disease are premature.”

References:

• Manson JE, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1809944.
• Neale RE, et al. Lancet. 2022;doi:10.1016/S1040-6736(21)00345-4.
• Scragg R, et al. JAMA Cardiol. 2017;doi:10.1001/jamacardio.2017.0175.

Perspective

Back to Top

JoAnn E. Manson, MD, DrPH, MACP, FAHA

These are likely chance findings when considered in the context of the totality of the evidence. The findings are neither convincing nor persuasive. We need to consider that the analyses in this report are secondary or subgroup findings, most of which are not statistically significant or would not hold up after multiple-comparison testing. The main D-Health Trial was designed to assess vitamin D for reducing mortality, and the primary results for all-cause and cause-specific mortality were null. Moreover, some concern was raised by a signal of increased risk for cancer mortality from vitamin D supplementation in this trial. The trial tested bolus dosing (60,000 IU monthly), which is not considered to be as physiological as daily dosing.

The evidence has been quite compelling from multiple clinical trials that vitamin D supplementation does not reduce risk for CV events, especially in populations not preselected for vitamin D deficiency. Our group performed a meta-analysis (Barbarawi M, et al. JAMA Cardiol. 2019;doi:10.1001/jamacardio.2019.1870) of 21 randomized clinical trials with more than 83,000 participants, and not a single one showed a benefit of vitamin D supplementation for preventing CVD. The overall meta-analysis RR was 1.0, completely null. Even in subgroups looked at by age, sex, CVD risk factors and blood levels of 25-hydroxyvitamin D, no clear benefits were seen.

This doesn’t mean that vitamin D has no role in maintaining CV health. There’s no question that we need at least a small to moderate amount of vitamin D to achieve optimal CV health, as well as for bone health, cognition and prevention of many chronic diseases. However, ‘more is not necessarily better’ when it comes to vitamin D or other nutrients or supplements. In a generally replete population not preselected for profound vitamin D deficiency, supplementation with vitamin D does not appear to confer additional CV benefits in most randomized trials. And high-dose bolus vitamin D has even been linked to an increased risk for falls and fractures in several other trials. It’s important to avoid thinking that any supplement will be a magic bullet for good health. That can be a distraction from more important strategies for prevention of CVD, such as lifestyle modifications, including physical activity and eating a heart-healthy diet, cholesterol-lowering therapies and controlling blood pressure. Although additional large-scale trials of vitamin D and CVD are unlikely to be helpful, more could be done with individual participant-level meta-analyses of existing randomized trials to look at those with specific CV diagnoses or use of certain medications; this could shed further light on the effects of vitamin D supplementation among those at high CV risk.

JoAnn E. Manson, MD, DrPH, MACP, FAHA

Chief, Division of Preventive Medicine

Brigham and Women's Hospital

Professor of Medicine

Michael and Lee Bell Professor of Women's Health

Harvard Medical School

Disclosures: Manson reports serving as principal investigator of the VITAL trial, which was funded by the NIH.

The Importance of Vitamin D for Older Adults: A Key to Healthy Aging

FYI, but other voices are not so conclusive:

The Importance of Vitamin D for Older Adults: A Key to Healthy Aging

un 28, 2023 - McMaster University -

Our bodies undergo numerous changes as we age, and maintaining good health becomes increasingly important. One crucial element in this pursuit is ensuring an adequate intake of essential nutrients, and vitamin D is a standout player on this stage. Known as the "sunshine vitamin," vitamin D is especially vital for older adults, as it offers many benefits to support their overall health and well-being. We explore some of those important aspects below.

 

What role does Vitamin D play?

Vitamin D is a unique nutrient that acts as a hormone in the body. Its primary function is to facilitate the absorption of calcium and phosphorus, two minerals that are vital for maintaining bone health. Adequate vitamin D levels are essential for building and preserving strong bones, which is particularly critical for older adults who are more susceptible to osteoporosis and fractures.

 

Vitamin D has been found to play a crucial role in other bodily functions beyond bone health. It supports the immune system, promotes muscle strength and coordination, and contributes to cardiovascular health.

 

Key sources of Vitamin D:

The most natural source of vitamin D is sunlight. When exposed to sunlight, the skin synthesizes vitamin D from cholesterol. While sunlight is an excellent source of vitamin D, it is crucial to balance sun exposure with sun safety.

 

We can also get Vitamin D from the foods we eat. Dietary sources of vitamin D include fatty fish like salmon and mackerel, fortified dairy products, fortified cereals, and egg yolks. However, obtaining sufficient vitamin D through diet alone can be challenging, especially for older adults with specific dietary restrictions or reduced appetites. In such cases, vitamin D supplements are often recommended to ensure optimal levels.

 

How do I know if I am getting enough Vitamin D?

To determine whether you have adequate vitamin D levels, it is essential to consult with your healthcare provider. They can perform a blood test to measure your serum 25-hydroxyvitamin D levels, which is the most accurate way to assess your vitamin D status. Based on the results, your healthcare provider can guide you on the appropriate dosage of vitamin D supplementation or provide lifestyle recommendations.

 

Vitamin D plays a vital role in promoting healthy aging for older adults. From supporting bone health to strengthening the immune system and reducing the risk of various diseases, this sunshine vitamin is a true asset. Read more about it in our resources below.

Featured Resources

• Video Post: Supplementing with vitamin D? What you should know
• Video Post: Vitamin D: Should I be taking a supplement?
• Blog Post: Are you getting enough vitamin D?
• Blog Post: Preventing type 2 diabetes with the “sunshine” vitamin?
• Blog Post: Vitamin D: A possible ally in the fight against diabetes
• Blog Post: Vitamin D and calcium: A dynamic duo in the maintenance of strong bones
• Blog Post: Be "sun smart" to avoid skin cancer

Neuro Rehab and Spasticity Management | HealthCasts Season 5, Episode 13

Notice it's spasticity 'management' NOT CURE! 20 minutes long so didn't watch.

Neuro Rehab and Spasticity Management | HealthCasts Season 5, Episode 13

Neuro rehabilitation specifically helps patients who have suffered from an event like a stroke or other neurological injury. First Physicians Group Physiatrist Ryan Hafner, MD specializes in spasticity management, and explains why seeking Neuro rehab early can help patients get back to their lives. Check out other interviews with SMH experts at smh.com/podcast, and subscribe on your favorite streaming app so you never miss an episode.

An electrical stimulation intervention protocol to prevent disuse atrophy and muscle strength decline: an experimental study in rat

Well your doctor should have been doing something like this from May 2017 already to prevent your muscle atrophy. Has your doctor initiated human research?

'Exercise-in-a-pill' boosts athletic endurance by 70 percent May 2017 

Or this?

A replacement for exercise? January 2020

The latest here:

An electrical stimulation intervention protocol to prevent disuse atrophy and muscle strength decline: an experimental study in rat

• Haiwang Shi,
• Fan Li,
• Fulong Zhang,
• Xiaobei Wei,
• Chengyi Liu &
• Rui Duan 

Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 84 (2023) Cite this article

• Metrics details

Abstract

Background

Skeletal muscle is negatively impacted by conditions such as spaceflight or prolonged bed rest, resulting in a dramatic decline in muscle mass, maximum contractile force, and muscular endurance. Electrical stimulation (ES) is an essential tool in neurophysiotherapy and an effective means of preventing skeletal muscle atrophy and dysfunction. Historically, ES treatment protocols have used either low or high frequency electrical stimulation (LFES/HFES). However, our study tests the use of a combination of different frequencies in a single electrical stimulation intervention in order to determine a more effective protocol for improving both skeletal muscle strength and endurance.

Methods

An adult male SD rat model of muscle atrophy was established through 4 weeks of tail suspension (TS). To investigate the effects of different frequency combinations, the experimental animals were treated with low (20 Hz) or high (100 Hz) frequency before TS for 6 weeks, and during TS for 4weeks. The maximum contraction force and fatigue resistance of skeletal muscle were then assessed before the animals were sacrificed. The muscle mass, fiber cross-sectional area (CSA), fiber type and related protein expression were examined and analyzed to gain insights into the mechanisms by which the ES intervention protocol used in this study regulates muscle strength and endurance.

Results

After 4 weeks of unloading, the soleus muscle mass and fiber CSA decreased by 39% and 58% respectively, while the number of glycolytic muscle fibers increased by 21%. The gastrocnemius muscle fibers showed a 51% decrease in CSA, with a 44% decrease in single contractility and a 39% decrease in fatigue resistance. The number of glycolytic muscle fibers in the gastrocnemius also increased by 29%. However, the application of HFES either prior to or during unloading showed an improvement in muscle mass, fiber CSA, and oxidative muscle fibers. In the pre-unloading group, the soleus muscle mass increased by 62%, while the number of oxidative muscle fibers increased by 18%. In the during unloading group, the soleus muscle mass increased by 29% and the number of oxidative muscle fibers increased by 15%. In the gastrocnemius, the pre-unloading group showed a 38% increase in single contractile force and a 19% increase in fatigue resistance, while in the during unloading group, a 21% increase in single contractile force and a 29% increase in fatigue resistance was observed, along with a 37% and 26% increase in the number of oxidative muscle fibers, respectively. The combination of HFES before unloading and LFES during unloading resulted in a significant elevation of the soleus mass by 49% and CSA by 90%, with a 40% increase in the number of oxidative muscle fibers in the gastrocnemius. This combination also resulted in a 66% increase in single contractility and a 38% increase in fatigue resistance.

Conclusion

Our results indicated that using HFES before unloading can reduce the harmful effects of muscle unloading on the soleus and gastrocnemius muscles. Furthermore, we found that combining HFES before unloading with LFES during unloading was more effective in preventing muscle atrophy in the soleus and preserving the contractile function of the gastrocnemius muscle.

Background

Skeletal muscle atrophy is commonly associated with aging, malnutrition, fasting and disuse conditions such as bed rest, inactivity, and microgravity [1, 2], resulting in a decrease in muscle mass and fiber cross-sectional area (CSA). Muscle atrophy is also frequently accompanied by changes in muscle fiber type and declining contractile function [3,4,5], leading to impaired mobility and inconvenience [6], increased risk of injury, and slower recovery [7, 8]. The imbalance between skeletal muscle protein synthesis and degradation, and the shift in muscle fiber types are the main causes of skeletal muscle atrophy [9,10,11,12,13]. Exercise is a proven and effective method of treating skeletal muscle atrophy by promoting protein synthesis through the PI3K/AKT/mTOR pathway and reducing protein degradation through the downregulation of MuRF1 expression [14,15,16,17,18]. However, exercise may not be feasible for individuals with trauma or post-surgery, making alternative methods of muscle contraction necessary.

In the 1960s, the field of physical medicine introduced physiological electrical stimulation (ES), a technique that simulates muscle contraction. This led to the development of a functional electrical stimulation system for clinical use, designed to trigger useful muscle contraction and maintain muscle quality and function [19, 20]. Today, ES is not only used as a rehabilitation treatment [21,22,23], but also as an effective training tool for people with physical weakness and for the general population to improve their sports performance [24]. Studies have shown that different electrical stimulation frequencies have varying effects on skeletal muscles. High frequency electrical stimulation (HFES, > 40 Hz in general) mimics resistance training to promote skeletal muscle protein synthesis and increase muscle mass, helping to prevent the decline of muscle mass and contractility that often occurs with aging and denervation [25,26,27]. Low frequency electrical stimulation (LFES, 5 to 30 Hz in general) mimics aerobic exercise and promotes the biological activity of mitochondria [23, 28,29,30,31]. Noteworthy, frequencies under 16 Hz were not strong enough to produce a significant contraction [32]. Although the contraction force generated by LFES (10-30 Hz) is low, the duration of the contraction force can last 24 h or longer, an effect not seen with higher frequency stimulation [19]. Despite the extensive research on the effects of single-frequency electrical stimulation on skeletal muscles, there have been relatively fewer studies exploring the impact of combining high and low frequency electrical stimulation on skeletal muscle mass and contractile function. This remains an area of active research, as researchers aim to better integrate electrical stimulation protocols with specific treatment goals and develop effective stimulation treatment plans to improve the contractility and fatigue resistance of skeletal muscles.

In this study, various treatment regiments combining high frequency or low frequency electrical stimulation at different stages of muscle atrophy were used to evaluate their effects. The maximum contractile and fatigue resistance of skeletal muscle, skeletal muscle weight, fiber CSA were measured to determine the most effective treatment regimen. Our results showed that a pretreatment with HFES can mitigate the negative impact of muscle unloading on the soleus and gastrocnemius muscles. Additionally, LFES treatment during unloading, following HFES pretreatment, was found to be more effective in resisting soleus muscle atrophy and preventing a decline in the contractile function of gastrocnemius muscle. The protein expression of nuclear factor of activated T cell (NFAT) and calcium/calmodulin-dependent phosphatase calcineurin (CaN), which can impact the fiber type of skeletal muscle [33, 34], were also detected using Western Blot analysis.

More at link.