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Anabolic steroid use linked to long-lasting heart problems

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Anabolic steroids can continue causing serious side effects years after users stop taking them, two new studies suggest.

The synthetic derivatives of testosterone have become popular among athletes and bodybuilders who want to improve their performance and develop a more muscular physique.

In most countries, they are only available legally for personal use on prescription from a registered pharmacist. But there has in recent years been an explosion of the black market for illegal anabolic steroids as their use has extended out into the general population, especially among body-conscious young men looking to improve their appearance.

Men in their 40s, 50s, and even into their 60s and 70s are also increasingly turning to steroids that mimic the naturally-occurring sex hormone testosterone, in a bid to fight the signs of ageing and boost their libido.

Anabolic steroid use is known to cause a host of severe health problems, however, from early heart attacks to kidney and liver failure, strokes, and psychiatric issues, as well as lower testosterone levels, erectile dysfunction, breast growth, and hair loss.

Not much has been known about their effect on users years after they stop taking them, though.

But according to the two studies presented at the 25th European Congress of Endocrinology in Istanbul, steroids could be linked to long-lasting heart disease and a worse quality of life.

These studies were carried out by researchers from the Copenhagen University Hospital Rigshospitalet who investigated the impact of anabolic steroids in former users.

In one study, the researchers examined 64 healthy men aged between 18 and 50, who did recreational strength training in Denmark.

Of these men, 28 were using anabolic steroids, 22 were former users, and 14 had never taken the manufactured drugs, first synthesised in Germany in 1935 and initially utilised by the medical profession to treat depression, before professional Russian weightlifters began misusing them in the early 1950s.

The researchers assessed how much blood flowed to their heart muscle when resting and exercising, using a Positron Emission Tomography-Computed Tomography (PET-CT) scan with the radioactive tracer Rubidium-82. They found both former and current users had a poor blood flow to the heart.

The findings indicate that former steroid users are more likely to develop heart disease when compared to those who have never used them.

Lead author Dr Yeliz Bulut, a Phd student at the Rigshospitalet, said: “Previous studies have shown that the heart function almost normalises after anabolic steroids are discontinued, but our study suggests that former anabolic steroid users are at an increased risk of heart disease years after stopping as cardiac microcirculation – the blood flow through the smallest vessels in the circulatory system – seems persistently impaired.

“The previous use of anabolic steroids could be a new risk factor for developing cardiovascular disease.”

In another study, Dr Bulut and colleagues collected questionnaires and blood samples to measure testosterone levels from three groups of men, aged 18-50 years. The group included 89 current anabolic steroid users, 61 former, and 30 men who had never used the drugs before.

They found that former users of anabolic steroids reported a worse quality of life on their physical and mental health, such as fatigue, social functioning and emotional well-being, despite stopping years earlier.

Additionally, the same group had lower testosterone levels compared to those who had never used steroids.

Previous studies have shown that men experience withdrawal symptoms, such as depression and decreased motivation, and have lower levels of testosterone, immediately after they stop using steroids.

“Our study adds to the growing body of literature that an impaired quality of life in previous anabolic steroid users seems to persist years following cessation and could be caused by both withdrawal and/or hypogonadal symptoms due to a sudden drop in testosterone levels in the blood,” Dr Bulut explained.

“Sadly, a reported worse quality of life could be a reason for former users to start reusing these steroids again.”

Both studies included a small number of anabolic steroid users, former users and non-users.

Dr Bulut and her team now plan to recruit more men to the studies to assess both of these links with former steroid abuse on a larger scale.

“Our initial findings show that previous anabolic steroid users are likely to develop heart disease and have a decreased quality of life but we need to confirm these results with larger studies and investigate how the risk changes in relation to the years of usage and/ or cessation.

“Steroid side effects among former users seem to persist for a much longer period than we have known until now. We hope our results on these long-term health risks will prevent men from using anabolic androgenic-steroids.”

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Air pollution linked to increased hospital admission for heart and lung diseases

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Exposure to fine particulate matter (PM2.5) air pollution is linked to an increased risk of hospital admission for major heart and lung diseases, find two large US studies, published by The BMJ.

Together, the results suggest that no safe threshold exists for heart and lung health.

According to the Global Burden of Disease study, exposure to PM2.5 accounts for an estimated 7.6% of total global mortality and 4.2% of global disability adjusted life years (a measure of years lived in good health).

In light of this extensive evidence, the World Health Organization (WHO) updated the air quality guidelines in 2021, recommending that an annual average PM2.5 levels should not exceed 5 μg/m3 and 24 hour average PM2.5 levels should not exceed 15 μg/m3 on more than 3-4 days each year.

In the first study, researchers linked average daily PM2.5 levels to residential zip codes for nearly 60 million US adults (84 per cent white, 55 per cent women) aged 65 and over from 2000 to 2016. They then used Medicare insurance data to track hospital admissions over an average of eight years.

After accounting for a range of economic, health and social factors, average PM2.5 exposure over three years was associated with increased risks of first hospital admissions for seven major types of cardiovascular disease – ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, arrhythmia, valvular heart disease, and thoracic and abdominal aortic aneurysms.

Compared with exposures of 5 μg/m3 or less (the WHO air quality guideline for annual PM2.5), exposures between 9 and 10 μg/m3, which encompassed the US national average of 9.7 μg/m3 during the study period, were associated with a 29% increased risk of hospital admission for cardiovascular disease.

On an absolute scale, the risk of hospital admission for cardiovascular disease increased from 2.59% with exposures of 5 μg/m3 or less to 3.35% at exposures between 9 and 10 μg/m3.

“This means that if we were able to manage to reduce annual PM2.5 below 5 µg/m3, we could avoid 23% in hospital admissions for cardiovascular disease,” say the researchers.*

These cardiovascular effects persisted for at least three years after exposure to PM2.5, and susceptibility varied by age, education, access to healthcare services, and area deprivation level.

The researchers say their findings suggest that no safe threshold exists for the chronic effect of PM2.5 on overall cardiovascular health, and that substantial benefits could be attained through adherence to the WHO air quality guideline.

“On February 7, 2024, the US Environmental Protection Agency (EPA) updated the national air quality standard for annual PM2.5 level, setting a stricter limit at no more than 9 µg/m3. This is the first update since 2012. However, it is still considerably higher than the 5 µg/m3 set by WHO. Obviously, the newly published national standard was not sufficient for the protection of public health,” they add.*

In the second study, researchers used county-level daily PM2.5 concentrations and medical claims data to track hospital admissions and emergency department visits for natural causes, cardiovascular disease, and respiratory disease for 50 million US adults aged 18 and over from 2010 to 2016.

During the study period, more than 10 million hospital admissions and 24 million emergency department visits were recorded.

They found that short term exposure to PM2.5, even at concentrations below the new WHO air quality guideline limit, was statistically significantly associated with higher rates of hospital admissions for natural causes, cardiovascular disease and respiratory disease, as well as emergency department visits for respiratory disease.

For example, on days when daily PM2.5 levels were below the new WHO air quality guideline limit of 15 μg/m3, an increase of 10 μg/m3 in PM2.5 was associated with 1.87 extra hospital admissions per million adults aged 18 and over per day.

The researchers say their findings constitute an important contribution to the debate about the revision of air quality limits, guidelines, and standards.

Both research teams acknowledge several limitations such as possible misclassification of exposure and point out that other unmeasured factors may have affected their results. What’s more, the findings may not apply to individuals without medical insurance, children and adolescents, and those living outside the US.

However, taken together, these new results provide valuable reference for future national air pollution standards.

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Home health care linked to increased hospice use at end-of-life – study

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Patients who had previously received home health care had a higher likelihood of accessing hospice care at the end of their life, according to a new study.

Researchers, whose findings are published in the Journal of Palliative Medicine, examined the home health care and hospice care experiences of more than two million people.

Using Medicare data, researchers found when individuals received home health care before the last year of their life, they had higher odds of using hospice care than those who had never received home health care.

Researchers said this association underscores the potential benefits of receiving end-of-life care in the comfort of one’s home.

As the aged population increases, the findings also show the need for more resources in the health care sector and staff training in end-of-life care.

Home health care services including skilled nursing, therapy, social work and aide services are used to maintain functioning or slow decline in health. Hospice care provides similar services but is intended for those with life expectancies of six months or less and is focused on pain relief, minimising hospital visits and providing comfort and support. Both services provide patients the opportunity to receive more personalised care in their home.

Researchers say home-based care also encourages greater involvement of family caregivers in the caregiving process.

Olga Jarrín, senior author of the study, the Hunterdon Professor of Nursing Research at the Rutgers School of Nursing and director of the Community Health and Aging Outcomes Laboratory within the Rutgers Institute for Health, Health Care Policy and Aging Research, commented: “In addition to benefits for the patient, hospice care also provides resources and support to help family caregivers cope with the physical, emotional and practical challenges of caring for a loved one at the end of life.”

Hyosin (Dawn) Kim, research assistant professor at Oregon State University and first author of the study, added: “By providing personalised care, reducing hospitalisations, fostering family involvement and support, and improving symptom management, home-based care can enhance the quality of end-of-life experiences for patients with terminal illnesses and their families.”

 

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Sleep programme shows promise in those with memory problems – study

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A new study has shown promising results in improving sleep and quality of life in individuals living with memory problems.

A group of researchers from Penn Nursing, Penn Medicine, Rutgers School of Nursing, and Drexel University’s College of Nursing and Health Professions, have delved into the efficacy of a non-pharmacological approach in a trial known as the Healthy Patterns Sleep Program.

The study involved 209 pairings of community-residing individuals with memory problems and their care partners. Participants were assigned to either the Healthy Patterns Sleep Program, which consisted of one-hour home activity sessions administered over four weeks, or a control group that received sleep hygiene training, plus education on home safety and health promotion.

The Healthy Patterns Sleep Program trained care partners in timed daily activities such as reminiscence in the morning, exercise in the afternoon and sensory activities in the evening that can decrease daytime sleepiness and improve nighttime sleep quality.

Nancy Hodgson, PhD, RN, FAAN, the Claire M. Fagin Leadership Professor in Nursing and Chair of Department of Biobehavioral Health Sciences, who led the study, said: “The results from this study provide fundamental new knowledge regarding the effects of timing activity participation and can lead to structured, replicable treatment protocols to address sleep disturbances. Overall, the Healthy Patterns program resulted in improved QOL compared to an attention-control group.”

The findings also indicate that, compared to a control group, the four-week Healthy Patterns program improved sleep quality among persons living with memory issues who had depressive symptoms or poor sleep quality.  The study indicates the Healthy Patterns Intervention might need a longer dose to induce improvements in other sleep-wake activity metrics.

The study’s significance lies in its confirmation of the effectiveness of behavioural interventions in not only improving quality of life and addressing sleep quality issues in this population, but also potentially reducing care partner burden and overall care costs for persons living at home with memory problems.

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