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Talking therapies could cut risk of heart disease

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Using talking therapies to help deal with depression may cut the risk of suffering a heart attack or stroke in later life, a new University College London study suggests.

Previous research has advocated that those affected by depression and anxiety are more likely to suffer from cardiovascular problems.

Now this latest study published in the European Health Journal, has found that using psychological or talking therapy to treat depression in adults over the age of 45 may be linked to reduced rates of cardiovascular disease – including stroke and heart disorders – as well as help the brain.

The research included 636,955 adults over the age of 45 with depression who had completed a course of psychological therapy and didn’t have cardiovascular disease or dementia. 

It found that depression improvement was linked with a 15% fall in the risk of cardiovascular disease in the 45-60 age group compared to no improvement.

The equivalent figure for those 60 years and over was 6%.

In addition, 45 to 60-year-olds with improved depression had a 22% decreased likelihood of death during follow-up compared to not improving. Those 60-plus had a 15% reduction.

Study author, Céline El Baou, a PhD student at University College London, said: “This study is the first to establish a link between psychological therapy outcomes and future risk of cardiovascular disease.

“The findings are important as they suggest that the benefits of psychological therapy may extend beyond mental health outcomes and to long-term physical health.”

She added that the study emphasises the need to ensure that psychological treatments are more widely available and accessible as a means of tackling mental and physical health problems.

This is especially relevant for certain groups who face barriers to accessing psychological therapies and are at greater risk of cardiovascular disease. Collaborative care systems where specialists from both disciplines work together could be one way to make treatment more accessible and obtain better outcomes overall.”

There are  a number of different talking therapies available to help people deal with stress, anxiety and depression. They include cognitive behavioural therapy (CBT), the aim of which is to help patients explore and change how they think about their life, and free them from unhelpful patterns of behaviour.

Guided self help is another form of treatment where a person works through a CBT-based workbook or online course with the help of a therapist. Other types of talking therapy include counselling, and behavioural activation that aims to help people to take simple and practical steps to deal with depression and enjoy life again.

Cardiovascular diseases are the leading cause of death worldwide. An estimated 18.6 million people died from this cause globally in 2019.

Previous studies have shown that the risk of cardiovascular disease is approximately 72% higher among people with major depressive disorders compared to their healthy peers.

The University College London study is the first to look at whether reducing depression symptoms with psychological therapy is associated with a lower likelihood of future cardiovascular disease.

The average age of those who took part was 55 years, and 66% were women. 

Information on psychological treatment, incidence of cardiovascular disease and death was obtained from national electronic health record databases in England and linked at the individual level.

Depression level was assessed before and after therapy using the Patient Health Questionnaire-9, which gives a score of 0 (not at all) to 3 (nearly every day) for nine items.

These included:

  • Little interest or pleasure in doing things
  • Feeling down, depressed, or hopeless
  • Trouble falling or staying asleep, or sleeping too much
  • Feeling tired or having little energy
  • Poor appetite or overeating
  • Feeling you are a failure or have let yourself or your family down
  • Trouble concentrating on things
  • Moving or speaking slowly or being fidgety or restless
  • Thoughts that you would be better off dead, or of hurting yourself in some way. 

Depression was defined as a score of 10 or more.

Improvement in depression was defined as a reduction of six points or more in the PHQ-9 score and no worsening of anxiety between the start and end of treatment. 

Anxiety was included in the definition so that the outcome of therapy was not considered good if depression improved but anxiety worsened.

Patients were followed for new onset all-cause cardiovascular disease, coronary heart disease, stroke and all-cause mortality. 

The follow-up began 365 days after the last therapy session. Those with a cardiovascular event during this period were excluded to reduce the likelihood that previously undiagnosed disease was the cause of depression.

During a median follow up of 3.1 years, depression symptoms improved in 373,623 (59%) participants and didn’t in 263,332 (41%). 

There were 49,803 cardiovascular events and 14,125 participants died. 

Improvement of depression was associated with 12%, 11%, 12% and 19% lower risks of any cardiovascular disease, coronary heart disease, stroke and all-cause mortality, respectively, compared to no improvement. 

The analyses were adjusted for characteristics that could influence the relationships such as age, ethnicity, gender, socioeconomic deprivation and other health conditions.

Ms El Baou said: “The findings are consistent with previous research suggesting that interventions to modify risk factors for cardiovascular disease are more effective at a younger age. This highlights the value of receiving help early to gain the most benefit.”

The study’s authors noted that the results do not definitively prove that reductions in cardiovascular disease were caused by relief of depression. 

In addition, data was missing on lifestyle behaviours such as smoking and inactivity which could raise susceptibility to cardiovascular disease and limit the effect of psychological treatment.

Despite this, the study has been welcomed by cardiology experts.  Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation, commented: “This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes

“While observational, it provides further evidence that brain and heart health are connected, and that treating depression may have other significant benefits beyond improving mental health.”

He added a word of caution, however. “More research is needed to demonstrate whether the therapy is actually causing the reduction in heart and circulatory conditions, and if so, how,” he said.

Dr Camilla Nord, Group Leader at the University of Cambridge’s MRC Cognition and Brain Sciences Unit, said the study provided “robust support” for a link between improved mental health following psychological therapy and a reduction in the future risk of cardiovascular disease. 

“The sample is large and very comprehensive, including all the IAPT services in England. This study provides an important piece of the puzzle in understanding the well-established comorbidity between cardiovascular disease and depression, which could help reduce the risk of morbidity and mortality in mental health conditions.”

Bur she also commented: “There are two notable limitations. At present, we do not know the causality of the association: other factors could have driven the finding, for example, psychological therapy might be less effective for depression in patients who already have a high risk of cardiovascular disease. 

“We also do not know what could be driving this effect—for example, could a reduction in depression following therapy cause lifestyle changes (such as increased exercise) that reduce cardiovascular risk? 

“If other types of research, such as randomised controlled trials, discover this relationship is causal, psychological therapies could one day be recommended for patients with depression to improve long-term physical health, not just mental health.”

 

Research

Ageing fight revealed in new ‘muscle map’

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The first comprehensive cell atlas of ageing human muscle reveals the intricate genetic and cellular processes behind muscle deterioration and mechanisms to counteract it.

How muscle changes with ageing, and tries to fight its effects, is now better understood at the cellular and molecular level with the first comprehensive atlas of ageing muscles in humans.

Researchers from the Wellcome Sanger Institute and their collaborators at Sun Yat-sen University, China applied single-cell technologies and advanced imaging to analyse human skeletal muscle samples from 17 individuals across the adult lifespan. By comparing the results, they shed new light on the many complex processes underlying age-related muscle changes.

The atlas uncovers new cell populations that may explain why some muscle fibres age faster than others. It also identifies compensatory mechanisms the muscles employ to combat ageing.

The findings offer avenues for future therapies and interventions to improve muscle health and quality of life as we age.

This study is part of the international Human Cell Atlas initiative to map every cell type in the human body, to transform understanding of health and disease.

As we age, our muscles progressively weaken. This can affect our ability to perform everyday activities like standing up and walking. For some people, muscle loss worsens, leading to falls, immobility, a loss of autonomy and a condition called sarcopenia. The reasons why our muscles weaken over time have remained poorly understood.

In this new study, scientists from the Wellcome Sanger Institute and Sun Yat-sen University, China used both single-cell and single-nucleus sequencing techniques along with advanced imaging to analyse human muscle samples from 17 individuals aged 20 to 75.

The team discovered that genes controlling ribosomes, responsible for producing proteins, were less active in muscle stem cells from aged samples. This impairs the cells’ ability to repair and regenerate muscle fibres as we age. Further, non-muscle cell populations within these skeletal muscle samples produced more of a pro-inflammatory molecule called CCL2, attracting immune cells to the muscle and exacerbating age-related muscle deterioration.

Age-related loss of a specific fast-twitch muscle fibre subtype, key for explosive muscle performance, was also observed. However, they discovered for the first time several compensatory mechanisms from the muscles appearing to make up for the loss. These included a shift in slow-twitch muscle fibres to express genes characteristic of the lost fast-twitch subtype, and increased regeneration of remaining fast-twitch fibre subtypes.

The team also identified specialised nuclei populations within the muscle fibres that help rebuild the connections between nerves and muscles that decline with age. Knockout experiments in lab-grown human muscle cells by the team confirmed the importance of these nuclei in maintaining muscle function.

Veronika Kedlian, first author of the study from the Wellcome Sanger Institute, said: “Our unbiased, multifaceted approach to studying muscle ageing, combining different types of sequencing, imaging and investigation reveals previously unknown cellular mechanisms of ageing and highlights areas for further study.”

Professor Hongbo Zhang, senior author of the study from Sun Yat-sen University, Guangzhou, China, said: “In China, the UK and other countries, we have ageing populations, but our understanding of the ageing process itself is limited. We now have a detailed view into how muscles strive to maintain function for as long as possible, despite the effects of ageing.”

Dr Sarah Teichmann, senior author of the study from the Wellcome Sanger Institute, and co-founder of the Human Cell Atlas, said: “Through the Human Cell Atlas, we are learning about the body in unprecedented detail, from the earliest stages of human development through to old age.With these new insights into healthy skeletal muscle ageing, researchers all over the world can now explore ways to combat inflammation, boost muscle regeneration, preserve nerve connectivity, and more. Discoveries from research like this have huge potential for developing therapeutic strategies that promote healthier ageing for future generations.”

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UK body calls for more ageing research backing

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The British Society for Research on Ageing (BSRA) is calling for more public backing in the UK for research to help people stay healthier for longer, as an alternative to charities that support research on diseases.

The greatest risk factor for disease is ageing, but we have very little charitable support for research into how to slow ageing, the organisation warns.

Many diseases such as cancers and heart disease tragically shorten lives far too early, or like Alzheimer’s and arthritis, destroy quality of life for patients and carers. There is understandably huge public charitable support for more research. However, the greatest risk factor for those diseases, and even infectious diseases like COVID, is ageing.

Yet in comparison there is currently very little support for research to understand how we can slow ageing to prevent disease. This approach may be more productive in the long term to fight disease. Furthermore, keeping people healthier for longer, or avoiding chronic diseases all together, would be the most favourable outcome.

The UK population is ageing fast, putting pressure on the NHS and the economy. Despite this pressing problem all around us, there is no accessible way for people to support research into ageing in the UK. The BSRA aims to change that.

With a very small budget and almost completely run by volunteers, the BSRA has successfully funded several small research projects but progress needs to be accelerated. More funding is needed because it takes years to see the effects of ageing, so studies are long. Also ageing affects individuals in different ways, meaning that large numbers of people must be studied to make firm conclusions.

Therefore, there is an urgency to get studies funded and the BSRA has decided to launch an ambitious fundraising campaign to boost research into ageing. Initially, the Society aims to fund a series of one year research projects at the Masters degree level at universities across the UK and with plans to raise much more in the future to support longer and more ambitious projects that will impact the lives of the general public.

Chair of the BSRA, Prof David Weinkove from Durham University, says “The time is now to really get behind research into the biology of ageing. We have fantastic researchers across the country, but they are held back by a lack of funding. Evidence-based research is needed to understand how we people can stay healthier for longer, and to then we must make that knowledge available to as many people as possible”.

Dr Jed Lye says “This is a great opportunity for the public to help, for corporations to contribute, or philanthropists wanting a large impact with a relatively small donation; every £20,000 we raise can fund an entire year of research into ageing and longevity, and gets a budding scientist their research qualification.”

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More action needed to prevent arthritis, say researchers

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MSU researchers have concluded that little is being done to address the prevalence of early knee osteoarthritis (OA) symptoms faced by patients after anterior cruciate ligament (ACL) reconstruction, calling for more action.

Scholars from Michigan State University’s Department of Kinesiology have published a new study in the Journal of Athletic Training in January showing these OA symptoms persist throughout the first year following surgery and need to be addressed with early intervention.

“We’re trying to change the narrative,” said Assistant Professor Matthew Harkey, who authored the study. “We see fairly young, active individuals experiencing extensive symptoms, but these symptoms are not interpreted by clinicians as something that may be related to osteoarthritis.

“Ignoring these symptoms might be setting them up to experience long term decline and function.”

ACL reconstruction is an arthroscopic surgical procedure that replaces torn anterior cruciate ligament in the knee with a graft. According to the National Institutes of Health, approximately 400,000 procedures are completed each year in the United States.

A 2017 study showed that approximately 14 million individuals in the United States alone suffer from symptomatic early knee OA.

The research team examined a data set of 82 individuals who underwent ACL reconstruction, each of whom completed a survey regarding their knee pain and symptoms following surgery. The results showed nearly one-in-four participants reported persistent early arthritis symptoms from 6 to 12 months after knee surgery.

In April 2024, Harkey will head to Austria and present similar research at the Osteoarthritis Research Society International Conference. This time, he used data from 3,200 individuals supplied by the New Zealand ACL Registry and found that close to one-in-three had early knee OA symptoms up to 24 months after ACL reconstruction.

The importance of intervention

Not addressing these symptoms in a timely manner places patients at risk for long-term structural decline, says Harkey. Although the study doesn’t show that patients experiencing symptoms will develop early OA, it heightens athletic trainers’ awareness of the possibility of symptoms, which could be addressed with intervention.

“It’s a bit complex – we can’t outright say arthritis is developing, but there’s a large group of patients whose symptoms linger long after surgery,” Harkey pointed out. “Often, clinicians assume that these post-operative symptoms will naturally improve as patients reengage with their usual activities. However, what we’re seeing suggests these symptoms persist and likely require a targeted approach to manage or improve them.”

According to Harkey, intervention could include exercise or physical therapy to help maintain strength and movement. He added that the healthcare infrastructure remains a barrier for patients, who often are limited to a low number of physical therapy visits through their healthcare plans.

The co-authors of the study with MSU affiliations include Ashley Triplett, assistant professor in the College of Education; Sheeba Joseph, associate professor, Colleges of Human and Osteopathic Medicine; Francesca Genoese, doctoral student in the Department of Kinesiology; Michael Shingles and Andrew Schorfhaar of Sparrow Hospital, alums of the College of Osteopathic Medicine.

Moving forward, Harkey aims to demonstrate how early knee OA after ACL reconstruction may lead to structural joint damage over time.

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