Chocolate: A sweet method for stroke prevention in men?

Eating a moderate amount of chocolate each week may be associated with a lower risk of stroke in men, according to a new study published in the August 29, 2012, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"While other studies have looked at how chocolate may help cardiovascular health, this is the first of its kind study to find that chocolate, may be beneficial for reducing stroke in men," said study author Susanna C. Larsson, PhD, with the Karolinska Institute in Stockholm, Sweden.

For the study, 37,103 Swedish men ages 49 to 75 were given a food questionnaire that assessed how often they consumed various foods and drinks and were asked how often they had chocolate. Researchers then identified stroke cases through a hospital discharge registry. Over 10 years, there were 1,995 cases of first stroke.

Men in the study who ate the largest amount of chocolate, about one-third of a cup of chocolate chips (63 grams), had a lower risk of stroke compared to those who did not consume any chocolate. Those eating the highest amount of chocolate had a 17-percent lower risk of stroke, or 12 fewer strokes per 100,000 person-years compared to those who ate no chocolate. Person-years is the total number of years that each participant was under observation.

In a larger analysis of five studies that included 4,260 stroke cases, the risk of stroke for individuals in the highest category of chocolate consumption was 19 percent lower compared to non-chocolate consumers. For every increase in chocolate consumption of 50 grams per week, or about a quarter cup of chocolate chips, the risk of stroke decreased by about 14 percent.

"The beneficial effect of chocolate consumption on stroke may be related to the flavonoids in chocolate. Flavonoids appear to be protective against cardiovascular disease through antioxidant, anti-clotting and anti-inflammatory properties. It's also possible that flavonoids in chocolate may decrease blood concentrations of bad cholesterol and reduce blood pressure," said Larsson.

"Interestingly, dark chocolate has previously been associated with heart health benefits, but about 90 percent of the chocolate intake in Sweden, including what was consumed during our study, is milk chocolate," Larsson added.

Daily Aspirin May Help Fight Prostate Cancer, But Not Breast Cancer

Two new studies paint a complex portrait of aspirin's impact on cancer risk and mortality, with one suggesting the drug may lower the risk of dying from prostate cancer and the other seeing no significant drop in the risk for developing breast cancer.

"These were different types of studies," explained Dr. Stanley Liauw, author of the prostate cancer study and an associate professor in the department of radiation and cellular oncology at the University of Chicago Medical Center. "The breast cancer group was looking at how aspirin might affect new formations of cancer, while we looked at how it might inhibit cancer progression."

"And we're also talking about different disease sites," he added, "which may involve different pathways. So, it's possible that aspirin might affect these pathways differently."

"But there is some rationale, based on previous research, for why we might expect to see an aspirin benefit," Liauw added. "And for our study looking at prostate cancer death we actually saw a pretty dramatic effect."

Both findings are published online Aug. 27 in the Journal of Clinical Oncology.

The breast cancer research team, led by Dr. Xuehong Zhang, an instructor in medicine at Brigham and Women's Hospital in Boston, pointed out that the disease is the most frequently diagnosed cancer among American women.

With previous research suggesting that routine aspirin and/or nonsteroidal anti-inflammatory drug (NSAID) use reduced the risk for colon cancer (some of which was conducted by Zhang's team), the Harvard researchers set out to see whether either might have a similar impact on breast cancer.

Between 1980 and 2008, the team tracked nearly 85,000 postmenopausal women, all of whom were working as registered nurses when the study first launched.

Nearly every two years, the women completed questionnaires on their medical histories and lifestyle. All were asked about their routine use of aspirin and/or other NSAIDS.

Over the course of three decades, more than 4,700 of the women developed some form of invasive breast cancer. Yet, Zhang's team found that neither regular aspirin nor other NSAIDs had any significant impact on overall breast cancer risk, regardless of how much they were used.

Meanwhile, Liauw and his team explored the potential benefit of aspirin use among nearly 6,000 men diagnosed with, and undergoing treatment for, prostate cancer.

The men were drawn from 41 different health centers across the United States, and all had undergone either surgery (radical prostatectomy) or radiotherapy.

The team noted that 37 percent of the patients were already taking some type of anticoagulant (aspirin, warfarin (Coumadin), clopidogrel (Plavix), and/or enoxaparin). No aspirin or other anticoagulant was prescribed once the study began.

After more than 10 years of follow-up, the team found that among those taking some type of anticoagulant, the risk of dying from prostate cancer was significantly lower than it was among those not taking one.

Further analysis revealed that most of the benefit came from aspirin use, which Liauw said was responsible for a 57 percent reduction in the risk of prostate cancer death.

Because dosage information was not collected, no conclusions could be drawn about exactly how much aspirin was most beneficial. However, the team noted that the protective effect was strongest among patients with particularly "high-risk" disease.

Both study teams said that more research is needed to confirm their respective findings. And neither study proved a cause-and-effect relationship between aspirin use and its effect on cancer.

"So, at this point, this is just hypothesis-generating," Liauw said. "It may be true, but it needs to be tested more formally."

Zhang added that although aspirin showed little benefit with respect to breast cancer risk, he doesn't see any cancer-related downside to their long-term use. However, for women seeking to reduce their breast cancer risk, "the best strategies remain to maintain an ideal weight, exercise, avoid long-term use of postmenopausal hormones, and minimize alcohol intake," he noted.

Two experts who wrote an accompanying editorial in the journal suggested that aspirin might make a difference among very specific subgroups of people.

"When looking at aspirin's impact on breast cancer risk, looking at all-comers and including all sorts of people who take anti-inflammatory drugs for all sorts of reasons might miss the kernel," said editorial lead author Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center, in New York City. "That is to say that there may very well be a subset of people for whom taking aspirin can be of protective benefit "

"But," he added, "the answer always is and remains that you should talk to your doctor about this before deciding to take or not take anything, including aspirin, because none of these studies prove anything definitively one way or another."

Editorial co-author Dr. Andrew Dannenberg, director of the Weill Cornell Cancer Center, agreed.

"It continues to seem to me that aspirin does have a use for reducing the risk for certain cancers," he said. "However, aspirin also has side effects -- peptic ulcer disease and hemorrhagic stroke, which are real diseases. And therefore I'm still reluctant at this time to make specific recommendations that people take aspirin for the prevention for cancer. And I believe that prospective trials that better define dose and duration are required before anyone should make definitive recommendations for the use of aspirin in this context."

Sudden death less likely in exercise related cardiac arrests

People who have a cardiac arrest during or shortly after exercise are three times more likely to survive than those who have a cardiac arrest that is not exercise related, according to research presented at the ESC Congress 2012 today, August 26. The findings from the Amsterdam Resuscitation Study (ARREST) were presented by Dr Arend Mosterd from the Netherlands.

"Although physical activity is the best way to promote cardiovascular health, exercise can also trigger an acute cardiac event leading to death," said Dr Mosterd. "These dramatic and often high profile events, for example in soccer players, invariably lead to concerns and cast a shadow over the overwhelmingly positive effects of regular exercise."

The ARREST research group maintains a prospective database of all resuscitation efforts in the greater Amsterdam area (i.e. the Dutch province of North Holland, covering approximately 2671 km2 and a population of 2.4 million). In case of a medical emergency in the Netherlands, one dials the national emergency number (112), where an operator connects the call to a regional ambulance dispatch center. If a cardiac arrest is suspected, the dispatcher sends out two ambulances of a single tier. The standard Emergency Medical System consists of ambulances manned by a team equipped with a manual defibrillator (a). Also, the dispatcher sends out a first responder – fire fighters or police officers – equipped with an automated external defibrillator (AED) (b). Many public areas like supermarkets, sport centers and office buildings have an AED onsite. Trained lay rescuers can attach this AED prior to arrival of the dispatched first responders or ambulance team.

The researchers used data from ARREST to determine the occurrence and prognosis of exercise related out of hospital cardiac arrests (OHCA) in the greater Amsterdam area from 2006 to 2009. The number of exercise related OHCAs was low at just 48 per year, which equated to 5.8% of all OHCAs.

During the 3 year study period, 145 of the 2,517 OHCAs were in people who were exercising during or within 1 hour before the arrest, predominantly bicycling (n = 49), tennis (n = 22), workouts at the gym (n = 16) and swimming (n = 13). Only 10 of the 145 exercise related OHCAs were in women. Just 7 (including 1 woman) exercise related OHCAs occurred in subjects aged 35 years or younger.

Almost half (65) of the 145 patients who had an exercise related OHCA survived the event. Patients suffering an exercise related OHCA had a much better prognosis better prognosis (45% survival) than cardiac arrests that were not exercise related (15% survival) (see table 1).

"Patients persons suffering an exercise related OHCA are three times more likely to survive the event than persons whose arrest is not exercise related," said Dr Mosterd. "None of the survivors of exercise related OHCA suffered serious neurologic damage, which was not the case for those surviving a non exercise related OHCA."

Patients who had an exercise related OHCA were younger (mean age 58.8 ± 13.6 vs 65.5 ± 15.8) and more likely to be male (93.1% vs 71.9%) than those whose arrest was not exercise related. In addition, exercise related OHCAs occurred more frequently in public places (99.3% vs 25.3%), were more frequently witnessed (89.0% vs 75.7%) and had higher rates of bystander cardiopulmonary resuscitation (CPR) (86.2% vs 64.4%) and AED (35.2% vs 22.2%) use.

Dr Mosterd said: "The remarkably good survival of victims of exercise related out of hospital cardiac arrest can partially be ascribed to the fact that they are younger and more likely to suffer the arrest in a public location, leading to bystander cardiopulmonary resuscitation, often with the use of an automated external defibrillator. Taking these factors into account exercise per se also contributes to a better outcome."

The only other prospective study of sports related OHCA and sudden death in the general population to date was conducted in France (1). "The survival rate to hospital discharge of exercise related OHCA victims was three times higher in our study group than was observed in the French study (45% vs 16%)," said Dr Mosterd. "As most exercise related events are bystander witnessed (89% in the Netherlands vs 93% in France) the most likely explanation for the remarkably better survival in the Netherlands relates to the high rate of initiation of bystander CPR (86%) compared to 31% in France. It is of note that the highest survival rates (around 50%) in France are found in two regions where bystanders initiated CPR in 90% of cases (compared to 86% in our population)."

Dr Mosterd continued: "More research is needed to determine why, after taking into account favourable factors such as age, location of the event and initiation of CPR, persons who exercise during or shortly before having a cardiac arrest still have a better prognosis than people who have a cardiac arrest that is unrelated to exercise."

He added: "The number of exercise related out of hospital cardiac arrests in the general population is low, particularly in women and in those aged 35 years or younger. We demonstrated for the first time that cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis (45% survival) than cardiac arrests that are not exercise related (15% survival)."

Dr Mosterd concluded: "Prompt bystander initiation of CPR with the use of an AED is likely to be the key to improving outcome, an observation that should have direct implications for public health programmes aimed at preventing exercise related sudden death."

Midlife fitness staves off chronic disease at end of life, UT Southwestern researchers report

Being physically fit during your 30s, 40s, and 50s not only helps extend lifespan, but it also increases the chances of aging healthily, free from chronic illness, investigators at UT Southwestern Medical Center and The Cooper Institute have found.

For decades, research has shown that higher cardiorespiratory fitness levels lessen the risk of death, but it previously had been unknown just how much fitness might affect the burden of chronic disease in the most senior years – a concept known as morbidity compression.

"We've determined that being fit is not just delaying the inevitable, but it is actually lowering the onset of chronic disease in the final years of life," said Dr. Jarett Berry, assistant professor of internal medicine and senior author of the study available online in the Archives of Internal Medicine.

Researchers examined the patient data of 18,670 participants in the Cooper Center Longitudinal Study, research that contains more than 250,000 medical records maintained over a 40-year span. These data were linked with the patients' Medicare claims filed later in life from ages 70 to 85. Analyses during the latest study showed that when patients increased fitness levels by 20 percent in their midlife years, they decreased their chances of developing chronic diseases – congestive heart failure, Alzheimer's disease, and colon cancer – decades later by 20 percent.

"What sets this study apart is that it focuses on the relationship between midlife fitness and quality of life in later years. Fitter individuals aged well with fewer chronic illnesses to impact their quality of life," said Dr. Benjamin Willis of The Cooper Institute, first author on the study.

This positive effect continued until the end of life, with more-fit individuals living their final five years of life with fewer chronic diseases. The effects were the same in both men and women.

These data suggest that aerobic activities such as walking, jogging, or running translates not only into more years of life but also into higher quality years, compressing the burden of chronic illness into a shorter amount of time at the end of life, Dr. Berry said.

According to the National Heart, Lung, and Blood Institute (NHLBI), adults should get at least 2 _ hours of moderate to intense aerobic activity each week to ensure major heart and overall health benefits.

Nutrition tied to improved sperm DNA quality in older men

A new study led by scientists from the U.S. Department of Energy's Lawrence Berkeley National Laboratory (Berkeley Lab) found that a healthy intake of micronutrients is strongly associated with improved sperm DNA quality in older men. In younger men, however, a higher intake of micronutrients didn't improve their sperm DNA.

In an analysis of 80 healthy male volunteers between 22 and 80 years of age, the scientists found that men older than 44 who consumed the most vitamin C had 20 percent less sperm DNA damage compared to men older than 44 who consumed the least vitamin C. The same was true for vitamin E, zinc, and folate.

"It appears that consuming more micronutrients such as vitamin C, E, folate and zinc helps turn back the clock for older men. We found that men 44 and older who consumed at least the recommended dietary allowance of certain micronutrients had sperm with a similar amount of DNA damage as the sperm of younger men," says Andy Wyrobek of Berkeley Lab's Life Sciences Division.

"This means that men who are at increased risk of sperm DNA damage because of advancing age can do something about it. They can make sure they get enough vitamins and micronutrients in their diets or through supplements," adds Wyrobek.

Wyrobek conducted the research with a team of researchers that includes Brenda Eskenazi of the University of California at Berkeley's School of Public Health and scientists from the University of Bradford in the United Kingdom. They report their findings in the August 27 online issue of the journal Fertility and Sterility.

Their research comes as more men over 35 have children, which raises public health concerns. Previous research conducted in Wyrobek's lab found that the older a man is, the more he's likely to have increased sperm DNA fragmentation, chromosomal rearrangements, and DNA strand damage. Older men are also more likely to have increased frequencies of sperm carrying certain gene mutations, such as those leading to dwarfism. These findings help explain why aging men are less fertile and are predicted to have more chromosomally defective pregnancies and a higher proportion of offspring with genetic defects.

But until now, researchers haven't understood whether diet can protect against the detrimental effects of aging on the sperm genome.

The scientists studied a group of about 80 men between 20 and 80 years old with an average age of 44. They were recruited several years ago as part of the California Age and Genetic Effects on Sperm Study when Wyrobek was at Lawrence Livermore National Laboratory. Each man who participated in the study filled out a 100-item questionnaire that estimated their average daily vitamin intake, both from food and supplements.

In addition, their sperm DNA quality was assessed via a lab analysis in which a voltage gradient pulls broken DNA strands from intact strands within the sperm nucleus.

Each volunteer's intake of a micronutrient was classified as low, moderate, or high based on how they compared to other participants. The median daily intake, both from diet and supplements, was 162 milligrams for vitamin C, 23.7 milligrams for vitamin E, 2,586 micrograms for _-carotene, 475 grams for folate, and 12.3 milligrams for zinc. Many participants, even those who reported to be healthy, consumed much less than the recommended dietary allowance for many of the micronutrients.

The scientists analyzed the data several ways and came up with the same result each time: A diet high in antioxidants and micronutrients may decrease the risk of producing sperm with DNA damage, especially in older men.

Why this is so isn't a mystery. Antioxidants scavenge reactive molecules that cause oxidative damage to cells. Studies have shown that dietary supplementation with antioxidants and increased consumption of antioxidant-rich fruits and vegetables can decrease the amount of oxidative DNA damage.

Based on their results, the scientists believe this same protective mechanism may also be at work in the reproductive tract of older men.

"The different response of the old and young men presents new opportunities for health care, especially for older men planning families," says Wyrobek.

More research is needed, however. Although the scientists found a clear link between higher vitamin intake and improved sperm DNA quality in older men, they don't know whether this link extends to male fertility and the health of offspring.

"Our research points to a need for future studies to determine whether increased antioxidant intake in older fathers will improve fertility, reduce risks of genetically defective pregnancies, and result in healthier children," says Wyrobek. "The research also raises a broader question beyond sperm DNA: How might lifestyle factors, including higher intakes of antioxidants and micronutrients, protect somatic as well as germ cells against age-related genomic damage?"

Healthy lifestyle reduces the risk of hypertension by two thirds

Healthy behaviours regarding alcohol, physical activity, vegetable intake and body weight reduce the risk of hypertension by two thirds, according to research presented at the ESC Congress today. The findings were presented by Professor Pekka Jousilahti from National Institute for Health and Welfare.

According to the World Health Organization, hypertension is the leading cause of mortality in the world, contributing annually to over 7 million deaths (about 15% of all deaths). Therefore, prevention of hypertension is essential to improving health and preventing morbidity and mortality, both in developing and developed countries.

The purpose of this study was to examine whether five major cardiovascular disease related lifestyle factors – smoking, alcohol consumption, physical activity, obesity and consumption of vegetables – predict the future increase of blood pressure and development of clinical hypertension, and need for antihypertensive drug treatment.

This large prospective population-based cohort study included 9,637 Finnish men and 11,430 women who were 25 to 74 years of age and free of hypertension during the baseline measurements (1982-2002). Healthy lifestyle factors were defined as: (1) not smoking, (2) alcohol consumption less than 50g per week, (3) leisure time physical activity at least 3 times per week, (4) daily consumption of vegetables, and (5) normal weight (BMI<25kg/m2).

Data on the development of hypertension during the follow-up period were obtained from the Social Insurance Institution of Finland register of people entitled to special reimbursement for antihypertensive drugs. During a mean follow-up of 16 years, 709 men and 890 women developed hypertension.

Smoking was omitted from the final analysis. Professor Jousilahti said: "Even though smoking is a major risk factor for cardiovascular disease, it was not associated with the development of hypertension in our analyses, which is in accordance with previous studies."

The four remaining healthy lifestyle factors were included in the analysis. Hazard ratios for hypertension associated with adherence to 0 (the reference group), 1, 2, 3, and 4 healthy lifestyle factors were calculated after adjusting for age, year of entering the study, education, and smoking.

The hazard ratios for hypertension associated with adherence to 0, 1, 2, 3, and 4 healthy lifestyle factors were 1.00, 0.74, 0.51, 0.34, and 0.33 for men, and 1.00, 0.89, 0.68, 0.41, and 0.37 for women. "The risk of hypertension was only one third among those having all four healthy lifestyle factors compared to those having none," said Professor Jousilahti. "Even having one to three healthy lifestyle factors reduced the risk of hypertension remarkably. For example having two healthy lifestyle factors reduced the risk of hypertension by nearly 50% in men and by more than 30% in women."

"Our analysis suggests that adherence to healthy lifestyle factors may have more of an impact on risk of hypertension in men than women," he added. "This could be because of the stronger association of obesity and alcohol consumption with the risk of hypertension in men than in women."

"Four modifiable lifestyle factors: alcohol consumption, physical activity, consumption of vegetables and keeping normal weight have a remarkable effect on the development of hypertension," said Professor Jousilahti. "Lifestyle modification has a huge public health potential to prevent hypertension. While our research suggests that lifestyle modification may produce greater reductions in hypertension in men than women, it also shows large benefits in women, and adherence to all four healthy lifestyle factors had a nearly similar effect in both sexes. Both men and women should take steps towards a healthier lifestyle to decrease their risk of hypertension."

He concluded: "Our study was focused on prevention of hypertension and therefore included subjects who did not have hypertension at baseline. But the results should apply to the treatment of patients with hypertension, who can reduce their blood pressure by modifying the four lifestyle factors alone, or by making these modifications while taking blood pressure lowering medication.

People of Normal Weight With Belly Fat at Highest Death Risk

People who are of normal weight but have fat concentrated in their bellies have a higher death risk than those who are obese, according to Mayo Clinic research presented today at the European Society of Cardiology Congress in Munich. Those studied who had a normal body mass index but central obesity — a high waist-to-hip ratio — had the highest cardiovascular death risk and the highest death risk from all causes, the analysis found.

"We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight," says senior author Francisco Lopez-Jimenez, M.D., a cardiologist at Mayo Clinic in Rochester. "This group has the highest death rate, even higher than those who are considered obese based on body mass index. From a public health perspective, this is a significant finding."

The study included 12,785 people 18 and older from the Third National Health and Nutrition Examination Survey, a representative sample of the U.S. population. The survey recorded body measurements such as height, weight, waist circumference and hip circumference, as well as socioeconomic status, comorbidities, and physiological and laboratory measurements. Baseline data were matched to the National Death Index to assess deaths at follow-up.

Those studied were divided by body mass index into three categories (normal: 18.5–24.9 kg/m2; overweight: 25.0–29.9 kg/m2; and obese: >30 kg/m2) and two categories of waist-to-hip ratio (normal: <0.85 in women and <0.90 in men; and high: e0.85 in women and e0.90 in men). Analyses were adjusted for age, sex, race, smoking, hypertension, diabetes, dyslipidemia and baseline body mass index. People with chronic obstructive pulmonary disease and cancer were excluded.

The mean age was 44; 47.4 percent were men. The median follow-up period was 14.3 years. There were 2,562 deaths, of which 1,138 were cardiovascular related.

The risk of cardiovascular death was 2.75 times higher, and the risk of death from all causes was 2.08 times higher, in people of normal weight with central obesity, compared with those with a normal body mass index and waist-to-hip ratio.

"The high risk of death may be related to a higher visceral fat accumulation in this group, which is associated with insulin resistance and other risk factors, the limited amount of fat located on the hips and legs, which is fat with presumed protective effects, and to the relatively limited amount of muscle mass," says Karine Sahakyan, M.D., Ph.D., a cardiovascular research fellow at Mayo Clinic in Rochester.

Many people know their body mass index these days; it's also important for them to know that a normal one doesn't mean their heart disease risk is low, adds Dr. Lopez-Jimenez. Where their fat is distributed on their body can mean a lot, and that can be determined easily by getting a waist-to-hip measurement, even if their body weight is within normal limits, he says.

Lack of sleep found to be a new risk factor for aggressive breast cancers

Lack of sleep is linked to more aggressive breast cancers, according to new findings published in the August issue of Breast Cancer Research and Treatment by physician-scientists from University Hospitals Case Medical Center's Seidman Cancer Center and Case Comprehensive Cancer Center at Case Western Reserve University.

Led by Cheryl Thompson, PhD, the study is the first-of-its-kind to show an association between insufficient sleep and biologically more aggressive tumors as well as likelihood of cancer recurrence. The research team analyzed medical records and survey responses from 412 post-menopausal breast cancer patients treated at UH Case Medical Center with Oncotype DX, a widely utilized test to guide treatment in early stage breast cancer by predicting likelihood of recurrence.

All patients were recruited at diagnosis and asked about the average sleep duration in the last two years. Researchers found that women who reported six hours or less of sleep per night on average before breast cancer diagnosis had higher Oncotype DX tumor recurrence scores. The Oncotype DX test assigns a tumor a recurrence score based on the expression level of a combination of 21 genes.

"This is the first study to suggest that women who routinely sleep fewer hours may develop more aggressive breast cancers compared with women who sleep longer hours," said Dr. Thompson, who is Assistant Professor at Case Western Reserve University School of Medicine and lead author. "We found a strong correlation between fewer hours of sleep per night and worse recurrence scores, specifically in post-menopausal breast cancer patients. This suggests that lack of sufficient sleep may cause more aggressive tumors, but more research will need to be done to verify this finding and understand the causes of this association."

The authors point out that while the correlation of sleep duration and recurrence score was strong in post-menopausal women, there was no correlation in pre-menopausal women. It is well known that there are different mechanisms underlying pre-menopausal and post-menopausal breast cancers. The data suggest that sleep may affect carcinogenic pathway(s) specifically involved in the development of post-menopausal breast cancer, but not pre-menopausal cancer.

"Short sleep duration is a public health hazard leading not only to obesity, diabetes and heart disease, but also cancer," said Li Li, MD, PhD, a study co-author and family medicine physician in the Department of Family Medicine at UH Case Medical Center and Associate Professor of Family Medicine, Epidemiology and Biostatistics at Case Western Reserve University School of Medicine. "Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for reducing the risk of developing more aggressive breast cancers and recurrence."

Dark Chocolate, Cocoa Compounds, May Reduce Blood Pressure

Compounds in cocoa may help to reduce blood pressure, according to a new systematic review in The Cochrane Library. The researchers reviewed evidence from short-term trials in which participants were given dark chocolate or cocoa powder daily and found that their blood pressure dropped slightly compared to a control group.

Cocoa contains compounds called flavanols, thought to be responsible for the formation of nitric oxide in the body. Nitric oxide causes blood vessel walls to relax and open wider, thereby reducing blood pressure. The link between cocoa and blood pressure stems from the discovery that the indigenous people of San Blas Island in Central American, who drink flavanol-rich cocoa drinks every day, have normal blood pressure regardless of age. However, flavanol concentrations in cocoa and chocolate products vary according to cocoa processing procedures and types of chocolate, so it is difficult to establish the optimal dosage for an effect.

To investigate the effect of flavanols on blood pressure, the researchers reviewed data from trials in which people consumed dark chocolate or cocoa powder containing between 30-1080 mg of flavanols in 3-100 g of chocolate each day. Altogether, 856 people were involved in 20 trials lasting 2-8 weeks, or in one case, 18 weeks. Flavanol-rich chocolate or cocoa powder reduced blood pressure on average by 2-3 mm Hg.

“Although we don’t yet have evidence for any sustained decrease in blood pressure, the small reduction we saw over the short term might complement other treatment options and might contribute to reducing the risk of cardiovascular disease,” said lead researcher Karin Ried of the National Institute of Integrative Medicine in Melbourne, Australia, who worked with colleagues at the University of Adelaide.

In a subset of trials, when chocolate or cocoa powder was compared to flavanol-free-products as controls, the beneficial effects were more pronounced (3-4 mm Hg), whereas the researchers found no significant effect on blood pressure in the second subset with low-flavanol products as control. It is possible that low-flavanol products also have a small effect on blood pressure, so that it was harder to observe differences between high and low-flavanol products in these trials. However, results of these subsets of trials may have been influenced by trial length and blinding of participants, as trials using flavanol-free control products tended to be of shorter duration with participants knowing their allocated group.

“We’ll also need to see long term trials, including effects on the risk of stroke and cardiovascular disease, before we can come to conclusions regarding clinical outcomes and potential side effects of long-term consumption,” said Ried. “These trials should use flavanol-free products in the control groups to eliminate any potential effects of low-dose flavanol on blood pressure.”

Statin Use Tied to Possible Boost in Cataract Risk

The millions of adults who currently use prescription statins to control their cholesterol levels may be inadvertently increasing their risk for developing age-related cataracts, new research suggests.

The bump in cataract risk linked to statin use appears comparable to the elevated risk already known to exist among people with type 2 diabetes, the study team observed.

That said, the study authors cautioned that more research is needed before being able to definitively say there is a cause-and-effect relationship between statins and cataract risk.

"The bottom line is that there appears to be an increased risk among people taking statins as far as getting cataracts," said study lead author Elizabeth Irving, research chairwoman in the School of Optometry and Vision Science at the University of Waterloo in Ontario, Canada. "That was actually a surprise, because most of the previous literature had suggested the opposite. However, it doesn't mean that one is causing the other."

"I would also say we are not now suggesting that statin patients do anything except follow their doctor's advice with respect to statins," Irving added. "They're taking statins for a reason. If you're going to have a heart attack or get cataracts, what would you choose?"

Irving and her colleagues discuss their findings in the August issue of the journal Optometry and Vision Science.

The authors noted that previous animal research has already pointed to a possible link between high-dosage statin use and a bump in the risk for cataracts, which are characterized by a significant clouding of the eyes' lenses.

To explore the potential link between statins and eye health in humans, the investigators focused on nearly 6,400 cataract patients who were being treated at the University of Waterloo between 2007 and 2008.

Of those patients, more than 450 had type 2 diabetes, and both diabetes status and statin use were looked at possible risk factors for cataracts.

After accounting for factors such as gender, cigarette use and high blood pressure, the team found that statin use was associated with a 57 percent increased risk for developing cataracts.

Statin users were more likely to develop cataracts at a younger age, the study found. For patients without diabetes, the average age for which the odds of developing cataracts were at least 50 percent was 57.3 years for those not using statins compared with 54.9 years for those taking statins. Patients with diabetes had the same cataract risk at 55.1 years if not using statins and 51.7 years if taking them.

Some overlap existed between diabetes and statin use, the team noted, with 56 percent of the diabetic cataract patients regularly taking statins. The authors pointed out that patients with diabetes who also took statins were found to have developed cataracts a full 5.6 years earlier than those who neither had diabetes nor took statins.

Yet the team nevertheless determined that statin use appeared to be, by itself, an independent risk factor for cataracts.

"Again, we don't think these findings should turn the world upside down," Irving stressed. "However, we do think that it once again shows that it's good to think about what drugs do to the people who take them, and that the people who make drugs might want to consider making better drugs than statins, given the possibility that they do raise the risk for cataracts."

Dr. Alfred Sommer, professor of ophthalmology and dean emeritus of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, strongly suggested that statin users should "not be alarmed" by the current findings.

"It's not to put down this kind of exploratory study, but this simply doesn't prove anything. This only suggests that there may be some association between the two," he noted. "For now, statins are really the most important way we have to prevent heart attacks. We don't have any alternatives at this point, so this is really just a teaser for more research. Nobody should change what they're doing."

Prostate Cancer: Six Things Men Should Know About Tomatoes, Fish Oil, Vitamin Supplements, Testosterone, PSA Tests

When it comes to prostate cancer, there's a lot of confusion about how to prevent it, find it early and the best way -- or even whether -- to treat it. Below are six common prostate cancer myths along with research-based information from scientists at Fred Hutchinson Cancer Research Center to help men separate fact from fiction.

Myth 1 -- Eating tomato-based products such as ketchup and red pasta sauce prevents prostate cancer. "The vast majority of studies show no association," said Alan Kristal, Dr.Ph., associate director of the Hutchinson Center's Cancer Prevention Program and a national expert in prostate cancer prevention. Kristal and colleagues last year published results of the largest study to date that aimed to determine whether foods that contain lycopene -- the nutrient that puts the red in tomatoes -- actually protect against prostate cancer.

After examining blood levels of lycopene in nearly 3,500 men nationwide they found no association. "Scientists and the public should understand that early studies supporting an association of dietary lycopene with reduced prostate cancer risk have not been replicated in studies using serum biomarkers of lycopene intake," the authors reported in Cancer Epidemiology, Biomarkers & Prevention. "Recommendations of professional societies to the public should be modified to reflect the likelihood that increasing lycopene intake will not affect prostate cancer risk."

Myth 2 -- High testosterone levels increase the risk of prostate cancer. "This is a lovely hypothesis based on a very simplistic understanding of testosterone metabolism and its effect on prostate cancer. It is simply wrong," Kristal said. Unlike estrogen and breast cancer, where there is a very strong relationship, testosterone levels have no association with prostate cancer risk, he said. A study published in 2008 in the Journal of the National Cancer Institute, which combined data from 18 large studies, found no association between blood testosterone concentration and prostate cancer risk, and more recent studies have confirmed this conclusion.

Myth 3 -- Fish oil (omega-3 fatty acids) decrease prostate cancer risk. "This sounds reasonable, based on an association of inflammation with prostate cancer and the anti-inflammatory effects of omega-3 fatty acids," Kristal said. However, two large, well-designed studies -- including one led by Kristal that was published last year in the American Journal of Epidemiology -- have shown that high blood levels of omega-3 fatty acids increase the odds of developing high-risk prostate cancer.

Analyzing data from a nationwide study of nearly 3,500 men, they found that those with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels. "This very sobering finding suggests that our understanding of the effects of omega-3 fatty acids is incomplete," Kristal said.

Myth 4 -- Dietary supplements can prevent prostate cancer. Several large, randomized trials that have looked at the impact of dietary supplements on the risk of various cancers, including prostate, have shown either no effect or, much more troubling, they have shown significantly increased risk. "The more we look at the effects of taking supplements, the more hazardous they appear when it comes to cancer risk," Kristal said. For example, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest prostate cancer prevention study to date, was stopped early because it found neither selenium nor vitamin E supplements alone or combined reduced the risk of prostate cancer. A SELECT follow-up study published last year in JAMA found that vitamin E actually increased the risk of prostate cancer among healthy men. The Hutchinson Center oversaw statistical analysis for the study, which involved nearly 35,000 men in the U.S., Canada and Puerto Rico.

Myth 5 -- We don't know which prostate cancers detected by PSA (prostate-specific antigen) screening need to be treated and which ones can be left alone. "Actually, we have a very good sense of which cancers have a very low risk of progression and which ones are highly likely to spread if left untreated," said biostatistician Ruth Etzioni, Ph.D., a member of the Hutchinson Center's Public Health Sciences Division.

In addition to blood levels of PSA, indicators of aggressive disease include tumor volume (the number of biopsy samples that contain cancer) and Gleason score (predicting the aggressiveness of cancer by how the biopsy samples look under a microscope). Gleason scores range from 2-5 (low risk) and 6-7 (medium risk) to 8-10 (high risk).

"Men with a low PSA level, a biopsy Gleason score of 6 or lower and very few biopsy samples with cancer are generally considered to be very low risk," Etzioni said. Such newly diagnosed men increasingly are being offered active surveillance -- a watchful waiting approach -- rather than therapy for their disease, particularly if they are older or have a short life expectancy.

"The chance that these men will die of their disease if they are not treated is very low, around 3 percent," she said. Similarly, such men who opt for treatment have a mortality rate of about 2 percent. "For the majority of newly diagnosed cases of prostate cancer, giving initial clinical and biopsy information, we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment."

Myth 6 -- Only one in 50 men diagnosed with PSA screening benefits from treatment. "This number, which was released as a preliminary result from the European Randomized Study of Prostate Cancer Screening, is simply incorrect," Etzioni said. "It suggests a very unfavorable harm-benefit ratio for PSA screening. It implies that for every man whose life is saved by PSA screening, almost 50 are overdiagnosed and overtreated."

"Overdiagnosis" is diagnosing a disease that will never cause symptoms or death in the patient's lifetime. "Overtreatment" is treating a disease that will never progress to become symptomatic or life-threatening.

The 50-to-one ratio is based on short-term follow-up and "grossly underestimates" the lives likely to be saved by screening over the long term and overestimates the number who are overdiagnosed. "The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one," she said.