A New View of Traumatic Brain Injury

People with Traumatic Brain Injury (TBI) may continue to improve or decline years after their injury, making it a more chronic illness, according to a study published in the June 21, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Our results dispute the notion that TBI is a one-time event with a stagnant outcome after a short period of recovery,” said study author Benjamin L. Brett, PhD, of the Medical College of Wisconsin in Milwaukee. “Rather, people with TBI continue to show improvement and decline across a range of areas including their ability to function and their thinking skills.”

The study involved people at 18 level 1 trauma center hospitals with an average age of 41. A total of 917 people had mild TBI and 193 people had moderate to severe TBI. They were matched to 154 people with orthopedic injuries but no head injuries. Participants were followed for up to seven years.

The participants took three tests on thinking, memory, mental health and ability to function with daily activities annually from two to seven years post-injury. They also completed an interview on their abilities and symptoms, including headache, fatigue, and sleep disturbances.

When researchers looked at all test scores combined, 21% of people with mild TBI experienced decline, compared to 26% of people with moderate to severe TBI and 15% of people with orthopedic injuries with no head injury, according to Neurology.

Among the three tests, researchers saw the most decline over the years in the ability to function with daily activities. On average, over the course of 2 to 7 years post-injury, a total of 29% of those with mild TBI declined in their abilities and 23% of those with moderate to severe TBI.

Yet some people showed improvement in the same area, with 22% of those with mild TBI improving over time and 36% of those with moderate to severe TBI.

“These findings point out the need to recognize TBI as a chronic condition in order to establish adequate care that supports the evolving needs of people with this condition,” Brett said. “This type of care should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline.”

A limitation of the study was that all participants were seen at a level 1 trauma center hospital within 24 hours of their injury, so the findings may not apply to other groups of people.

Enjoy Fireworks Season Safely

Fireworks produce loud, explosive noises that can reach dangerous decibel levels, often exceeding 150 decibels (dB). To put this into perspective, normal conversation typically measures around 60 dB, while prolonged exposure to sounds above 85 dB can lead to permanent hearing loss.

“Fireworks’ high decibel levels pose a significant risk, especially for children, individuals with pre-existing hearing conditions, and those in close proximity to the detonation,” says Sara Lerner, Assistant Director of Clinical Audiology with ENT and Allergy Associates (ENTA), the largest ear, nose, throat, allergy, and audiology practice in the country. “It’s important to recognize that the harm caused by fireworks is not limited to a single instance. Frequent exposure to loud noises, even for short durations, can accumulate over time and result in irreversible hearing damage.”

People who frequently engage in or are regularly exposed to fireworks displays are particularly susceptible to long-term hearing impairments, ENTA says in a news release.. While the 4th of July and the summer season, are times of excitement and festivities, it’s crucial to remember the potential risks fireworks pose to your hearing health. Here are some valuable tips to help you safeguard your hearing during this holiday:

Maintain a Safe Distance: When attending fireworks displays, try to position yourself at a safe distance from the launch site. As a general rule, staying at least 500 feet away can significantly reduce the intensity of the sound waves reaching your ears.

Use Hearing Protection: Invest in high-quality earplugs or earmuffs specifically designed for noise reduction. These protective devices create a barrier against loud noises and help to mitigate the risk of hearing damage. Ensure that they fit snugly and effectively block out excessive sound.

Limit Exposure Time: Prolonged exposure to loud noises increases the likelihood of hearing damage. If you’re planning to enjoy fireworks for an extended period, take regular breaks in quieter areas to give your ears a chance to recover. This break allows your auditory system to rest and reduces the cumulative impact of noise exposure.

Create a Quiet Zone: If you’re hosting a 4th of July gathering, designate a quiet area where individuals can retreat and escape the noise of fireworks. Provide comfortable seating and encourage guests to take breaks in this zone to protect their hearing and overall well-being. Look after pets, who are often upset by loud noises. Keep them inside at a safe distance from hearing the noise.

Be Mindful of Children: Children’s ears are particularly sensitive to loud noises. If you’re celebrating with young ones, closely supervise their exposure to fireworks and ensure they wear appropriate hearing protection. Explain the importance of safeguarding their hearing and lead by example. Remember, protecting your hearing is a lifelong commitment,” says Lerner. “By implementing these tips, you can enjoy your 4th of July and summer celebrations while taking proactive steps to preserve your hearing health for years to come.”

Maternal Mental Health And Its Effect on Children

According to the National Institute of Mental Health (NIMH), an estimated 40% to 50% of people experience adversity during childhood, which can increase the risk for physical and emotional challenges when they grow up.

Studies show that parents who faced difficult situations in their childhood may pass on some of those risks to their children.

In a recent study funded by the NIMH, Jessica Uy, Ph.D., of the University of California Los Angeles, and colleagues analyzed the transmission of trauma from one generation to the next. They discovered that when mothers experience adversity in their childhood, it can negatively impact their mental health during and after pregnancy, which in turn, can affect their children’s mental health.

For the study, the researchers followed 541 mother-child pairs who participated in the Growing Up Singapore Toward Health Outcomes (GUSTO) study. Mothers in the study reported their levels of anxiety and depression at 26 weeks of pregnancy and at 3 months, 12 months, 24 months, 36 months, 4.5 years, and 6 years after the birth of their child. When their children were 4.5 years of age, mothers reported their recollections of childhood abuse or neglect.

The researchers asked the mothers and their children to fill out surveys when the children were between 7 and 8 years old to find out if the children were feeling anxious, depressed, or withdrawn. Additionally, the researchers collected functional magnetic resonance imaging (fMRI) data from a subset of 89 children in the study when they were 6 years old.

The study showed that maternal experiences of childhood neglect were associated with worse mental health (reflecting higher levels of anxiety and depression symptoms) both during pregnancy and after birth.

Worse maternal mental health, in turn, was linked to children having more feelings of anxiety and depression and being more socially withdrawn when they were 7.5 years old. Maternal experiences of childhood neglect were also associated with their children reporting more anxiety-related performance fears, physical symptoms, and restlessness.

Maternal experiences of childhood abuse were associated with worse mental health among mothers after birth, which in turn was linked to their children feeling more anxious, depressed, and withdrawn at 7.5 years of age.

The researchers also found a link between maternal mental health and their children’s brain activity. Children of mothers who experienced worse mental health after birth showed weaker connectivity between two parts of the brain (the amygdala and prefrontal cortex)—a connection critical for the regulation and processing of emotion.

The study had several limitations, the researchers said. The mothers who participated were from the general population, which meant most had lower levels of trauma, anxiety, and depression than would be found in a population in treatment. In addition, not all children had fMRI data, and having fMRI data from a larger sample of children would lend greater weight to the findings.

But the study results indicate that when a mother experiences difficult times during her own childhood, it can affect her mental health when she is an adult, during critical life stages such as during pregnancy and after giving birth. This, in turn, can increase the risk of mental health challenges in her children.

The authors suggest one way to break the transmission of risk may be to focus on providing intervention and support to women during these critical time periods.

Brain Health and Multivitamins

A new Harvard study, COSMOS 2, published in the American Journal of Clinical Nutrition, has shown that taking a multivitamin for one year was associated with improved memory and cognition equivalent to reversing age-related memory loss by three years.

The randomized clinical trial, which included 3,500 participants aged 60 and over, was the second COSMOS study to show that multivitamins significantly improved brain function—with the “vitamin group” far surpassing the placebo group.

“The benefits of taking a multivitamin were maintained throughout the three years of the study,” says board certified internist Jacob Teitelbaum, MD, who advocates nutritional supplementation as a complement to the standard American diet and standard medical therapies. “This confirms numerous earlier studies showing that folate (simple folic acid) dramatically lowers dementia risk.” In addition to a daily multivitamin, he recommends supplementing with a good B complex, folate, vitamin D, and magnesium—all with proven efficacy.

Teitelbaum is one of the world’s leading researchers on effective treatment for chronic fatigue syndrome (CFS) and fibromyalgia. His landmark double-blind, placebo-controlled study published in the Journal of Chronic Fatigue Syndrome (8:2, 2001) showed profound benefits from nutrition as well as sleep, hormones, treating hidden infections/inflammation, and exercising as able.

“The reason doctors have traditionally been slow to recommend multivitamins is because their training has been pharmaceutical-focused and sorely deficient in nutritional education, he says. “This new COSMOS study is an important step towards setting the record straight—and represents a wakeup call to clinicians, researchers, and media that cover latest medical findings.”

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Planting And Enjoying A Hummingbird Garden

Whether you are making some late additions to your gardens or planning for the future, include some hummingbird-favorite plants. Select plants and create combinations to attract and support them with a season-long supply of nectar.

Hummingbirds consume an average of two to three times their weight in nectar each day. Providing feeders and an abundance of flowers throughout the season will support the hummingbirds and help attract them to your gardens. Keep this in mind as you add plants to your landscape.

Shrubs like azalea, lilac, weigela, buttonbush, and Rose-of-Sharon provide shelter for birds and nectar-filled flowers for hummingbirds and other pollinators to enjoy. The North American native honeysuckle vine adds vertical interest and hummingbird appeal even in small spaces.  Major Wheeler is a variant of the native honeysuckle vine that blooms all summer and is more resistant to powdery mildew.  Watch as the hummingbirds munch on any aphids that attack this plant.  They are great pest managers to have in the garden.

Another native vine, the trumpet vine, is a vigorous grower that can be trained into a small tree or onto a trellis.  This plant will send out suckers requiring some regular maintenance. Be patient as it can take several years for this vine to begin flowering. Avoid overfertilization which results in an even bigger plant and no flowers.

Garden phlox and bee balm are both hummingbird favorites that add color and nectar to the summer garden. Look for powdery mildew-resistant varieties or plant them among other tall plants to hide any discolored foliage that may occur. North American native anise hyssop and liatris are two more favorites you may want to include.

Fill vacant spots in the garden, containers, or hanging baskets with annuals known to attract hummingbirds. Fuchsias, begonias, and impatiens are perfect for shady locations.  Cupheas are often sold under the common names, tiny mice and cigar plant, and prefer a sunnier location. The taller blue horizon ageratum, geranium, bidens, tall verbena, and petunias grow well in gardens and containers.

Both perennial and annual salvias attract hummingbirds.  Place a pot or two of Black and Blue, Black and Bloom, and Wendy’s Wish near your windows, so you can enjoy the frequent visits of your resident hummingbirds.

Add one or more feeders to your landscape. Provide space between the feeders as hummingbirds are territorial. Make sure there is cover within 10 to 15 feet. Fill the container with a 1-part sugar to 4-part water solution. Replace the mixture and clean the feeders every few days. This provides additional food for

It may take a couple of years for the hummingbirds to find your nectar-filled garden. In the meantime, you will enjoy the flowers and other pollinators that stop by to dine.

Some Foods May Extend Life of ALS Patients

People with amyotrophic lateral sclerosis (ALS) who eat more foods high in certain omega-3 fatty acids like flaxseed oil, walnuts, canola oil and pumpkin seeds may have a slower physical decline from the disease and may have a slightly extended survival.

The study, which looked at the survival of people with ALS over the course of 18 months, was published in the June 21, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Researchers also found an omega-6 fatty acid may be beneficial. The omega-omega-6 fatty acid called linoleic acid that is found in vegetable oils, nuts, meats, seeds and eggs was associated with a lower risk of death during the study. The study does not prove that these omega fatty acids slow decline of ALS or extend survival; it only shows an association.

ALS is a rare, progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. People with ALS lose the ability to initiate and control muscle movement, which often leads to total paralysis and death. The average life span after diagnosis is two to five years.

“The link our study found between diet and ALS is intriguing and suggests, but does not prove, that people with ALS may benefit from incorporating more omega-3 fatty acids into their diet,” said Kjetil Bjornevik, MD, PhD, of Harvard University and member of the American Academy of Neurology. “It will now be important to conduct additional research looking specifically at the plant-based omega-3 fatty acid alpha-linolenic acid in people with ALS to further explore this possibility.”

The study involved 449 people who had ALS with an average age of 58, who were followed over 18 months. Of the total participants, 126 or 28%, died by the end of the study.

Researchers looked at levels of omega-3 fatty acids in participants’ blood. They divided them into four groups based on lowest to highest amounts.

Participants took a test to assess their disease progression and severity of symptoms. The test measured 12 aspects of physical function including swallowing, speaking, chewing, and the ability to use muscles in the hands, arms, legs and torso, as well as respiratory function. Each category was scored from zero, meaning no ability, to four, meaning normal ability. Total scores ranged between zero to 48, with higher scores indicating better function and less severe symptoms.

Researchers found an omega-3 fatty acid called alpha-linolenic acid was the most beneficial. This acid is found in many seeds and oils, including flaxseed, walnuts, chia, hemp, and many common vegetable oils.

The people with the highest amount of alpha-linolenic acid had an average score of 38.3 at the start of the study, while the people with the lowest amount had an average score of 37.6.

A lower number of people from the group with the most alpha-linolenic acid died during the study, with 21 deaths, or 19%, compared to people in the lowest group, with 37 deaths or 33%.

After adjusting for age, sex and ethnicity, people with the highest amounts of alpha-linolenic acid had a 50% lower risk of death during the study compared to people with the lowest amount.

Higher levels of a specific omega-3 fatty acid called eicosapentaenoic acid that is found in fatty fish and fish oil supplements was also associated with a lower risk of death during the study.

A limitation of the study is the lack of access to data on the overall diet of the participants, including other nutrients and supplements as well as total caloric intake, which could all be associated with survival time in ALS.

The study was supported by the ALS Association.

A limitation of the study is the lack of access to data on the overall diet of the participants, including other nutrients and supplements as well as total caloric intake, which could all be associated with survival time in ALS.

Learn more about ALS at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health.

A New Hope for Breast Cancer Survivors

Most women diagnosed with early stage breast cancer today can expect to become long term cancer survivors, according to a study published in June in the British Medical Journal (BMJ). finds a study

The findings, by a group of British and Canadian researchers, show that the average risk of dying from breast cancer in the five years after a diagnosis has fallen from 14% to 5% since the 1990s. For those diagnosed during 2010-15, more than six in 10 women had a five year risk of 3% or less.

The researchers say their findings can be used to reassure most women treated for early breast cancer that they are likely to become long term cancer survivors. The findings can also help identify those for whom the risk of dying from breast cancer remains substantial.

Worldwide, more than 2 million women receive a diagnosis of early breast cancer each year. While the risk of dying from breast cancer in these women has decreased over the past few decades, the extent of this decrease was previously unknown. Also, it was not known whether this decrease applied to groups of women with certain characteristics or whether it applied to all groups.

To address this uncertainty, researchers used data from the National Cancer Registration and Analysis Service to investigate the long term risks of dying from breast cancer after a diagnosis of early breast cancer.

They included all 512,447 women who were registered in England with early breast cancer (i.e. cancer confined to the breast and possibly the axillary lymph nodes) as their first cancer from January 1993 to December 2015, and who were treated initially with surgery.

Annual breast cancer death rates and cumulative five year risks were estimated, taking account of time since diagnosis, calendar period of diagnosis, and characteristics such as age, whether the cancer was detected by screening, involvement of lymph nodes, and tumor size and grade. All women were followed until December 2020.

The results show that for women with a diagnosis made within each of the calendar periods 1993-99, 2000-04, 2005-09, and 2010-15, the annual breast cancer mortality rate was highest during the five years after diagnosis and then declined.

Cumulative five year breast cancer mortality risk was on average 14.4% for women with a diagnosis made during 1993-99 but only 4.9% for women with a diagnosis made during 2010-15.

Considering just the 156,338 women with a diagnosis during 2010-15, cumulative five year breast cancer mortality risk varied substantially between women with different characteristics. It varied according to patient age, whether the cancer was detected by screening, whether it had certain receptors, and according to cancer size, grade and the number of lymph nodes involved. It was less than 3% for 62.8% of women but more than 20% for 4.6% of women.

The researchers acknowledge that these observational findings can’t determine the specific causes of these reductions in mortality and point to several other limitations. For example, data on cancer recurrence was not available. The study focused on women who were initially treated with surgery. It did not include women who received treatment to reduce the size of their cancer before surgery, women whose cancer had already spread, or women diagnosed with more than one cancer.

However, this study provides a detailed and accurate picture of breast cancer mortality in a complete population of women with early breast cancer for up to 20 years.

As such, they say these analyses “provide patients with early breast cancer, and the clinicians who treat them, with estimates of their likely prognosis based on up-to-date data.”

They add: “Our study is good news for the great majority of women diagnosed with early breast cancer today because their prognosis has improved so much. Most of them can expect to become long-term cancer survivors.”

Anemia And Low-Dose Aspirin

Recent follow-up analysis of data from an international clinical trial funded by the National Institutes of Health (NIH) suggests that daily low-dose aspirin increases the risk of anemia in people aged 65 years and older by approximately 20%.

Given these findings, older adults on low-dose aspirin and their care providers may want to consider periodic monitoring of red blood cells or hemoglobin, the NIH said in a news release. Anemia in older adults is associated with functional decline, increased fatigue, disabilities, depressive symptoms, and cognition problems.

The study was published in the Annals of Internal Medicine.

Scientists from the Aspirin in Reducing Events in the Elderly (ASPREE) study examined the effect of long-term low-dose aspirin use on incident anemia and the effect of aspirin on changes in hemoglobin concentration, as well as ferritin levels, as an indicator of iron deficiency.

The researchers found that low-dose aspirin led to increased incident anemia in otherwise healthy older adults at enrollment, independent of major bleeding.

Previous ASPREE data analyses suggested daily low-dose aspirin does not decrease risk for dementia and cognitive decline; and that daily low-dose aspirin had no effect on healthy lifespan in older people.

ASPREE, a joint U.S. and Australian research project aimed at determining the effect of low-dose aspirin on survival without dementia or disability, began in 2010 and completed recruitment in 2014. It was a randomized, double-blind, placebo-controlled, primary prevention trial of daily 100 mg of aspirin in a population of healthy older people in the U.S. and Australia with a period of treatment averaging 4.5 years. The trial involving 19,114 people age 65 and older was distinctive for its size, methodological rigor, and high participant retention rate in both countries.

Equalizing Health Care

Hypertension, or high blood pressure, affects almost half of all people in the U.S. and can lead to serious health issues, including heart attack, stroke and kidney problems. Monitoring your blood pressure levels regularly is a key part of managing it, and the American Heart Association (AHA), with support from Elevance Health Foundation, is working to ensure more people have access to the tools needed to check their blood pressure at home.

“As high blood pressure disproportionately affects Black, Hispanic and Indigenous populations in the U.S., the American Heart Association continues its commitment to improve health equity nationwide, we strive to ensure that everyone has access to resources for a healthier life,” said AHA volunteer president Michelle A. Albert, M.D., M.P.H., FAHA, the Walter A. Haas-Lucie Stern endowed chair in cardiology, professor of medicine and admissions dean at University of California San Francisco School of Medicine. “We appreciate the support from Elevance Health Foundation, which enables us to work in the communities where the need is greatest.”

Acccording to an AHA news release, a recent poll by the Association was designed to evaluate patient perceptions and barriers to blood pressure management in the home setting. The survey participants—patients with high blood pressure at clinics in under-resourced areas throughout the U.S.—were provided with blood pressure kits to monitor their blood pressure at home as part of the Building Healthier, Safer Communities Together initiative supported by Elevance .More than three quarters (88%) of the participants said that they planned to check their blood pressure levels at least once daily, and over half of the respondents (64%) said they believe that monitoring their blood pressure at home will help to improve their overall health.

The program is a community-based initiative focused on blood pressure control in medically under-resourced communities and is one component of a nationwide project with Federally Qualified Health Centers (FQHCs) and other community clinics to facilitate and provide health education, guidance and resources to patients.

“Nearly half of all Americans have high blood pressure, which is why implementing interventions that target health measures – such as increased awareness and management of blood pressure – are crucial to not only improving the health of people living in historically under-resourced communities, but advancing equity for all,” said Shantanu Agrawal, M.D., chief health officer at Elevance Health. “Through this initiative, more than 3,500 patient care kits are in the hands of people at the highest risk, allowing them to monitor their blood pressure at home.”

According to research, community health workers can make a difference in improving patients’ access to care and treatment for health concerns such as high blood pressure. Community health workers can aid their patients and communities in various roles beyond just patient medical care, including providing health education, linking people with social services, and improving overall patient-health professional communication.

Communication is important, according to many of the survey responses. When patients were asked what could help them monitor their blood pressure at home, 38% replied that regular in-person consultations with a doctor or a nurse would be helpful, and 26% responded that more opportunities for education on blood pressure and hypertension would be helpful.

Adult patients from 11 clinics in nine markets throughout the U.S. who were diagnosed with high blood pressure and received a self-monitoring blood pressure kit were invited to participate in the survey. The survey was planned to identify gaps in knowledge of patients encouraged to regularly monitor their blood pressure at home, and is part of the Building Healthier, Safer Communities Together (BHSCT) program. Through the BHSCT initiative, the American Heart Association provided primary healthcare professionals with 350 patient care kits in 16 under-resourced target communities, Baton Rouge, La., New Orleans, La., Houston, Atlanta, Ga., Des Moines, Nashville, Tenn., Newport, Tenn., Los Angeles, Calif., Seattle, Wash., St. Louis, Mo., New York, N.Y., Indianapolis, Ind., Miami, Fla. and Cincinnati, Ohio, to distribute to their high-risk patients in support of remote blood pressure monitoring. The purpose of this evaluation is to use survey-based data collection to assess participant characteristics, perceptions and barriers to blood pressure management. This evaluation will inform the program for the next two years.

The program is a community-based initiative focused on blood pressure control in medically under-resourced communities and is supported by Elevance. Surveys were provided in both English and Spanish, and participants had the option to complete the 18-question survey in electronic form on a tablet during a clinic visit, or in a paper format. Data was collected between August 2021 and June 2022 and analyzed by the Evaluation Team in the Qualtrics system on behalf of the AHA. A total of 317 participants attempted the survey, 80% of whom were age 45 and older. Most of the responses received were from the electronic version of the survey (64%).[7] The majority of respondents identified as female (55%), aged 45-64 (59%), and as being of Hispanic, Latino, or Spanish origin (58%).

The Guilty Way We Pay

“Will you be paying with cash or card?”

It’s a question that’s been asked of consumers for decades. And despite the increasing popularity of digital payment methods, cash and card remain the most popular choices worldwide. In 2021, 65 percent of all point-of-sale transactions globally were made using cash or card, according to Fidelity National Information Services. 

Past research shows that 90 percent of households use multiple payment methods, but new research from the University of Notre Dame takes a first look into how consumers choose between them. The study finds that the justifiability of a purchase affects how consumers choose to pay.

“Purchase Justifiability Drives Payment Choice: Consumers Pay With Card To Remember And Cash To Forget” is forthcoming in the Journal of the Association for Consumer Research from Christopher Bechler, assistant professor of marketing in Notre Dame’s Mendoza College of Business, along with Szu-chi Huang from Stanford University and Joshua Morris, data science manager for Nike.

“When a purchase is difficult to justify — like buying an overpriced bottle of water at the airport, cigarettes or candy — consumers pay with less-trackable methods, like cash, so they can eliminate the paper or electronic trail and ‘forget’ this guilty purchase,” said Bechler, who specializes in consumer behavior and social psychology with an emphasis on attitudes, persuasion and financial decision-making. “When a purchase is easy to justify, consumers have no problem paying with trackable methods like credit cards that create paper or electronic trails.”

Despite the vast amount of research on financial decision-making in behavioral economics, consumer behavior and social psychology, this is the first study to take an in-depth look at how consumers choose to pay.

The team analyzed real transaction data from 118,042 purchases and manipulated the justifiability of purchases consumers imagined making in six experiments on more than 5,000 individuals. They hoped to capture the causal effect of hard-to-justify purchases on consumers’ intentions to use cash vs. a credit or debit card.

“I think a lot of consumers — particularly those who diligently track their card expenses — recognize that they use cash so they don’t have to think about certain purchases again,” Bechler said. “In fact, this strategy of using cash to hide purchases from ourselves if we feel bad about them is something my co-authors and I admitted to doing ourselves.”

The findings show merchants it’s a good idea to be strategic with the types of payment methods they allow.

“A doughnut shop could benefit from letting its customers pay with cash because they may want to forget their unhealthy purchase,” Bechler said. “A salad shop might not see the same benefit.”

And as the world turns to cryptocurrencies and new payment methods, the study underscores implications for both merchants and financial institutions designing payment methods of the future. Bechler said understanding the factors that affect how consumers choose to pay could be important for predicting which new methods will succeed.

Make Gardening with Kids Enjoyable

Gardening is good for the mind, body, and spirit. It is also good for the youngsters in our lives. Research shows gardening helps relieve stress, improve focus, positively impacts mood and psychological well-being, builds a sense of confidence, and more.

Look for creative ways to get children involved in gardening. Tap into other interests or skills like art, reading, writing, insects, and birds, if you need to persuade reluctant participants into growing plants.

Include lots of colors and unique plants that kids will love. Crested celosia resembles brains, making it a good choice for the zombie fans in the group.  Eyeball plant (Acmella oleracea), balloon plant (Gomphocarpus physocarpus) with its hairy inflated seedpods, snake plant, and kangaroo paws (Anigozanthos favidus) are a few to consider.  Gardeners of all ages will appreciate the popcorn plant (Senna didymobotrya) with its buttered popcorn-scented leaves or bat-faced cuphea and the hummingbirds it will attract.

Consider adding features that make the garden a fun space to visit.  There is a reason that bean teepees, sunflower houses, and tunnels in the garden have remained popular with kids of all ages for decades. Or grow a garden shaped like a slice of pizza planted with all the key ingredients or a salsa garden. Everyone will benefit when using freshly harvested ingredients to create these dishes.

A pot or flat of grass makes a nice field for superheroes and a lawn for dolls.  A bare patch of soil is perfect for digging, driving cars and trucks, or sculpting hills and valleys. All these build skills that can be applied to future gardening efforts.

Plant some salad radishes that are ready to harvest in 25 to 30 days. This will help keep the kids interested in the garden when waiting for the tomatoes, beans, and other vegetables to ripen. Call it harvesting when you are thinning the radish planting. Use these greens as a snack or in a salad. Harvesting and eating is more fun for all of us than just thinning the excess plants.

Use rainy days to create plant labels from paint sticks or stones. Paint individual words on some of the stones and place them in the garden. Let children leave messages for each other or write poetry. Or repurpose pickle jars into garden treasure jars. Have children decorate the jars. Then you fill the jars with messages or treasures before hiding them in the garden.

Explore ways to reuse and recycle landscape trimmings. Put twigs to use creating small-scale wattle fences for a fairy, gnome, or zombie garden. This is great practice for building a larger-scale wattle fence for the garden.

Go on a bug hunt to see who is living in your garden, yard, or neighborhood. Look for good bugs like lady beetles that eat plant-damaging aphids and bees that pollinate our flowers.  Then log what you find in a backyard journal.

Gentle guidance, realistic expectations, and age-appropriate activities will help get kids excited about gardening. The gardens they create and the plants they grow are often amazing but more important, it is the experience of growing together that makes it worthwhile.

Exercise and Chronic Conditions

According to the National Institute on Aging (NIA), almost anyone, at any age, can do some type of physical activity. You can still exercise even if you have a health condition like heart disease, arthritis, chronic pain, high blood pressure, or diabetes. In fact, physical activity may help.

For most older adults, physical activities like brisk walking, riding a bike, swimming, weightlifting, and gardening are safe, especially if you build up slowly. As always, check with your doctor before beginning any exercise routine. Here are some suggestions for exercising with some specific conditions.

Arthritis

For people with arthritis, exercise can reduce joint pain and stiffness. It can also help with losing weight, which reduces stress on the joints.

Flexibility exercises such as upper- and lower-body stretching and tai chi can help keep joints moving, relieve stiffness, and give you more freedom of movement for everyday activities.

Strengthening exercises, such as overhead arm raises, will help you maintain or add to your muscle strength to support and protect your joints.

Endurance exercises make the heart and arteries healthier and may lessen swelling in some joints. Try activities that don’t require a lot of weight on your joints, such as swimming and biking.

If you have arthritis, you may need to avoid some types of activity when joints are swollen or inflamed. If you have pain in a specific joint area, for example, you may need to focus on another area for a day or two.

COPD (Chronic Obstructive Pulmonary Disease)

If you have COPD, talk with your healthcare provider or a pulmonary therapist to learn what he or she recommends. You may be able to learn some exercises to help your arms and legs get stronger and/or breathing exercises that strengthen the muscles needed for breathing.

Pulmonary rehabilitation is a program that helps you learn to exercise and manage your disease with physical activity and counseling. It can help you stay active and carry out your day-to-day tasks.

Type 2  Diabetes

For people with diabetes, exercise and physical activity can help manage the disease and help you stay healthy longer. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be more active most days of the week, and create a plan for being physically active that fits into your life and that you can follow. Your healthcare team can help.

A few easy steps to be more active:

Stretch during TV commercial breaks.

Walk around when you talk on the phone.

Take more steps by parking farther away from stores, movie theaters, or your office.

Weight Issues

If you are overweight, don’t let that stop you from doing physical activities, including all four types of exercises. If you have difficulty bending or moving easily or feel self-conscious, try different activities, like walking, water exercises, dancing, or weightlifting, to see what works best for you. Anything that gets you moving—even for only a few minutes a day in the beginning—is a healthy start.

Heart Health

Your heart keeps your body running. As you grow older, some changes in the heart and blood vessels are normal, but others are caused by disease. Choices you might make every day, such as eating healthy, maintaining a healthy weight, and aiming to be more physically active, can contribute to heart health. Inactive people are nearly twice as likely to develop heart disease as those who are active. A lack of physical activity can worsen other heart disease risk factors as well, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity. Being physically active is one of the most important things you can do to keep your heart healthy. Aim for at least 150 minutes of moderate-intensity aerobic activity a week.

Osteoporosis

Weight-bearing exercises, which force you to work against gravity, such as walking, jogging, or dancing three to four times a week, are best for building muscle and strengthening bones. Try some strengthening and balance exercises, too, to help avoid falls, which could cause a broken bone. Doing these exercises is good for bone health for people with osteoporosis and those who want to prevent it.

Chronic pain

Most people living with chronic pain can exercise safely, and it can assist with pain management. In fact, being inactive can sometimes lead to a cycle of more pain and loss of function. Talk to your doctor about what exercises/activities might be right for you. Each type of exercise—endurance, strength, balance, and flexibility—has its own benefits, so a combination may be best.

Exercise can help you maintain a healthy body weight, which may relieve knee or hip pain. Putting on extra weight can slow healing and make some pain worse. Remember to listen to your body when exercising and participating in physical activities. Avoid over-exercising on “good days.” If you have pain, swelling, or inflammation in a specific joint area, you may need to focus on another area for a day or two. If something doesn’t feel right or hurts, seek medical advice right away.

For more information on senior health issues, click here to visit the NIA website.

Hormones and Hypertension

Women ages 45 years and older taking estrogen hormone therapy in pill form were more likely to develop high blood pressure than those using transdermal (topical, applied to the skin) or vaginal formulations, according to new research published today in June 2023 in Hypertension, a peer-reviewed American Heart Association journal.

A woman’s body produces less estrogen and progesterone after menopause, changes that may increase the risk for cardiovascular diseases including heart failure, according to the American Heart Association.

Hormone therapy may be prescribed to relieve symptoms of menopause, in gender-affirming care and in contraception, and previous studies have found that some hormone therapies may reduce cardiovascular disease risk in menopausal women under 60 years of age or for whom it has been fewer than 10 years since menopause. The authors of this study noted that while high blood pressure is a modifiable risk factor for cardiovascular disease, the potential effects of different types of hormone therapy on blood pressure in menopausal women remain uncertain.

“It’s really important to have greater knowledge on safe and effective hormonal treatments for women during menopause. At the end of the day, it’s an individualized decision about what is best for the person going through menopause and should include open dialogue with their physician or health care team,” Ahmed said. “We need large, randomized studies factoring in all the complexities of hormone therapy around this important transition period in the female lifecycle.”

“We know estrogens ingested orally are metabolized through the liver, and this is associated with an increase in factors that can lead to higher blood pressure,” said lead study author Cindy Kalenga, an M.D./Ph.D.-candidate at the University of Calgary in Alberta, Canada.

“We know that post-menopausal women have increased risk of high blood pressure when compared to pre-menopausal women. Fthermore, previous studies have shown that specific types of hormone therapy have been associated with higher rates of heart disease,” Kalenga said. “We chose to dive deeper into factors associated with hormone therapy, such as the route of administration (oral vs. non-oral) and type of estrogen, and how they may affect blood pressure.”

This study involved a large group of over 112,000 women, ages 45 years and older, who filled at least two consecutive prescriptions (a six-month cycle) for estrogen-only hormone therapy, as identified from health administrative data in Alberta, Canada between 2008 and 2019. The main outcome of high blood pressure (hypertension) was identified via health records.T

First, researchers investigated the relationship between route of estrogen-only hormone therapy administration and risk of developing high blood pressure at least one year after starting the treatment. The 3 different routes of hormone therapy administration were oral (by mouth), transdermal and vaginal application. Additionally, researchers evaluated the formulation of estrogen used and the risk of developing high blood pressure. For this study, the researchers reviewed medical records of individuals taking estrogen-only hormone therapy. The two most common forms of estrogen used by study participants were estradiol — a synthetic form of estrogen that most closely mimics what is naturally produced in women’s bodies in the premenopausal years — and conjugated equine estrogen, an animal-derived form of estrogen and the oldest type of estrogen therapy.

The analysis found:

Women taking oral estrogen therapy had a 14% higher risk of developing high blood pressure compared to those using transdermal estrogen and a 19% higher risk of developing high blood pressure compared to those using vaginal estrogen creams or suppositories.

After accounting for age, a stronger association was seen among women younger than 70 years of age compared to women older than 70.

Compared to estradiol, conjugated equine estrogen was associated with an 8% increased risk of developing high blood pressure.

Taking estrogen for a longer period of time or taking a higher dose was associated with greater risk of high blood pressure, the authors noted. According to Kalenga, the study’s findings suggest that if menopausal woman take hormone therapy, there are different types of estrogen that may have lower cardiovascular risks.

“These may include low-dose, non-oral estrogen — like estradiol, in transdermal or vaginal forms — for the shortest possible time period, based on individual symptoms and the risk–benefit ratio, Kalenga said. “These may also be associated with the lowest risk of hypertension. Of course, this must be balanced with the important benefits of hormone therapy, which include treatment of common menopausal symptoms.”

The average age of natural menopause among women worldwide is about 50 years of age. Current evidence supports that initiating menopausal hormone therapy in the early stages may have cardiovascular benefits, though not in the late stages of menopause, according to the American Heart Association’s 2020 Statement on Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention. Previous studies have found that menopausal hormone therapy may help relieve symptoms of menopause, including hot flashes, night sweats, mood changes or sleep disturbances.

“Over a quarter of the world’s population of women are currently older than the age of 50. By 2025, it’s estimated that there will be one billion menopausal individuals on the planet,” said study co-author Sofia B. Ahmed, M.D., M.M.Sc., a professor of medicine at the University of Calgary, Alberta, Canada. “Approximately 80% of people going through menopause have symptoms, and for some it lasts up to seven years. While menopause is a normal part of the aging process, it has huge implications for quality of life, economic impact, work productivity and social relationships. We need to give people the information they need to choose the most effective and safe hormonal treatments for menopause.”

The study had several limitations. The impact of different forms of hormone therapy on high blood pressure outcomes were based only on medical records. The study did not include women younger than the age of 45 and did not collect data about hysterectomies or menopausal status; however, the researchers used initiation of estrogen therapy in women over the age of 45 to indicate postmenopausal status. The researchers included estrogen-only therapy in this study, which is most often prescribed for women who have had a hysterectomy (surgical removal of the uterus), whereas women with an intact uterus may receive a combination of estrogen and progestin, another type of hormone. This means these findings may only be considered for women taking estrogen-only hormone therapy, the authors noted. Additionally, the study’s findings cannot offer definitive insights on other populations who may benefit from estrogen hormone therapy, including women who have an intact uterus or women who experience premature or early menopause.

The research study reviewed women in Canada, which may present differences. However, current guidelines in Canada align with U.S. guidelines from the American College of Obstetricians and Gynecologists. Both recommend the use of hormone therapy in women with appropriate indications and note that hormone therapy should not be considered as prevention or treatment of hypertension or heart disease.

No difference in health outcomes, care costs for patients treated by traditional MDs or osteopaths

New UCLA-led research suggests that patient mortality rates, readmissions, length of stay, and health care spending were virtually identical for elderly hospitalized patients who were treated by physicians with Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degrees.

While both traditional, or allopathic, medical schools and osteopathic medical schools provide the same rigorous health education, osteopathic training adds a more holistic, hands-on component involving manipulation of the musculoskeletal system – for instance, the use of stretching and massage to reduce pain or improve mobility.

“These findings offer reassurance to patients by demonstrating that they can expect high-quality care regardless of whether their physicians received their training from allopathic or osteopathic medical schools,” said senior author Dr. Yusuke Tsugawa, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and associate professor of health policy and management at the UCLA Fielding School of Public Health.

The study will be published May 30 in the peer-reviewed Annals of Internal Medicine.

Both types of physicians are licensed to practice medicine in every state. Currently about 90% of practicing physicians hold MD degrees and 10% have DO degrees. But the latter group is rapidly growing due to an increasing number of osteopathic medical schools, with their numbers having swelled by 72% between 2010 and 2020 compared with a 16% increase in MDs during the same period, and their ranks are expected to continue expanding.

In addition, osteopathic physicians are more likely than their MD counterparts to serve patients in rural and underserved areas.

The researchers relied on four data sources: a 20% sample of Medicare fee-for-service beneficiaries, amounting to about 329,500 people aged 65 years and older who were hospitalized between Jan. 1, 2016 and Dec. 31 2019; Medicare Data on Provider Practice and Specialty; a comprehensive physician database assembled by Doximity, and the American Hospital Association’s annual survey on hospital characteristics. Of the patients, 77% were treated by MDs and 23% were treated by DOs.

The researchers found that patient mortality rates were 9.4% among MDs vs. 9.5% among DOs, patient readmission rates were 15.7% vs. 15.6% respectively, healthcare spending was $1004 vs. $1003, and lengths of stay were 4.5 days for both.

The results are similar because both types of medical schools deliver rigorous, standardized medical education and comply with comparable accreditation standards, including four-year curriculums mixing science and clinical rotations, Tsugawa said.

The study does have some limitations, the researchers write, primarily the fact that they focused on elderly Medicare beneficiaries who were hospitalized with medical conditions, so the results may not apply to other population groups. In addition, they limited outcomes to specific measures of care quality and resource use, so these findings may not generalize to other outcomes.

But the findings “should be reassuring for policymakers, medical educators, and patients because they suggest that any differences between allopathic and osteopathic medical schools, either in terms of educational approach or students who enroll, are not associated with differences in quality or costs of care, at least in the inpatient setting,” the researchers write.

Additional study authors are Dr. Atsushi Miyawaki of UCLA and the University of Tokyo; Dr. Anupam Jena of Harvard University, Massachusetts General Hospital and the National Bureau of Economic Research; and Dr. Nate Gross of Doximity.

The study was funded by the National Institutes of Health’s National Institute on Aging (R01AG068633) and the Social Science Research Council.

Wildfires and Long-Term Health Risks

As wildfires spread across southern Canada, smoke from those fires is rapidly drifting into the U.S. and the American Heart Association, warns that wildfire smoke exposure poses an increased risk for heart disease in both the short and long term.

“Most people think of breathing problems and respiratory health dangers from wildfire smoke, but it’s important to recognize the impact on cardiovascular health, as well.,” said Comilla Sasson, M.D., Ph.D., FAHA, vice president for science and innovation at the American Heart Association and a practicing emergency medicine physician. “Wildfire smoke contains a lot of pollutants including fine, microscopic particles linked to cardiovascular risk. As many of these fires burn out of control and contaminated smoke is traveling many miles beyond the immediately affected area.”

Several studies following wildfires in California in recent years linked smoke exposure to an increased risk of sudden cardiac arrest and a higher volume of visits to local emergency rooms for cardiovascular disease-related causes.

A study published in the Journal of the American Heart Association in 2020 found that exposure to heavy smoke during wildfires raised the risk of out-of-hospital cardiac arrests up to 70%. The risk was elevated among men and women, among adults 35-64 years old and in communities with lower socioeconomic status.

Previous findings from the same research group noted that wildfire smoke exposure was associated with increased rates of emergency room visits, not just for breathing trouble, but also ischemic heart disease, irregular heart rhythm, heart failure, pulmonary embolism and stroke. ER visits increased 42% for heart attacks and 22% for ischemic heart disease within a day of exposure to dense wildfire smoke. The increase was most notable for adults age 65 and older, according the study published in the Journal of the American Heart Association in 2018.

People with underlying cardiovascular disease risk factors may be at risk for an acute cardiovascular event when exposed to wildfire smoke. According to the American Heart Association, recognizing the signs of a heart attack or stroke are important, and if you or someone you’re with is experiencing serious symptoms, call 9-1-1 immediately. Knowing and performing CPR in the event of a cardiac arrest is also helpful.

The U.S. Environmental Protection Agency offers a zip code-level tracking map of current air quality at www.airnow.gov. Sasson recommends checking that site regularly if you’re seeing signs of wildfire smoke and haze developing where you live. It’s also important to stay informed about any special alerts sent out by your local health department.

Sasson offers the following tips for reducing exposure to wildfire smoke:

Stay indoors with doors and windows closed.

Use high-efficiency air filters in air conditioning systems or portable air cleaners.

Avoid exertion.

Keep well hydrated.

Consider seeking other shelter if your home does not have an air conditioner and it’s too warm to stay inside.

Be mindful that your pets may also be affected by the smoke and bring them indoors, as well.

“While these types of wildfires and the extent of their smoke reach can’t always be predicted, protecting yourself and your family from poor air quality throughout the year is something to consider,” Sasson said. “In the American Heart Association’s 2020 scientific statement on air pollution exposure, we note that one of the most effective measures is the use of portable air cleaners, which have been shown to reduce indoor particulate matter by as much as 50-60%. Given their modest upfront cost ($50-200) and potential benefits in reducing cardiopulmonary outcomes, this measure has a high benefit for the cost.”

Sasson said while most people in the U.S. are not directly impacted by the physical wildfires burning in Canada, the exposure to this lingering smoke can be extremely harmful and shouldn’t be taken for granted. “Protect yourself, be alert and prepared,” she said.

The American Heart Association has resources to help at www.heart.org.

5 Ways to Make the Most of Your Doctor Visit

Being able to talk with your doctor is important, especially if you have health problems or concerns.
Use these TIPS to make the most of your doctor visit.
Prepare for your visit.
Be ready to ask three or four questions. Share your symptoms, medicines or vitamins, health habits, and any major life changes.
Take notes or ask for
written materials.
Don’t be afraid to ask the doctor to repeat or clarify important information.

Make decisions with your doctor that meet your needs.
Discuss risks, benefits, and costs of tests and treatments. Ask about other options and preventive things you can do.
Be sure you are getting the message.
If you have trouble hearing, ask your doctor to face you when talking and to speak louder and more clearly.
Tell the doctor if you feel rushed, worried, or uncomfortable.
You can offer to return for a second visit or follow up by phone or email.
Learn more about communicating with your doctor:
https:/www.nia.nih.gov/health/ doctor-patient-communication.
National Institute on Aging

Measuring Cognitive Decline

People whose brains have less myelin — the fatty tissue that insulates nerve cells — experience steeper declines in cognition over time, according to a National Institute on Aging (NIA) study published in Alzheimer’s & Dementia. The findings show the impact of myelin content as healthy people age and underscore myelin as a potential therapeutic target for neurodegenerative diseases, such as Alzheimer’s and mild cognitive impairment.

Myelin is an insulating layer that forms around nerves, including those in the brain. It helps neurons communicate more efficiently, maintain a healthy water balance, and respond to signals involved in memory formation and other cognitive functions, the NIA said in a news release. Previous studies have shown that myelin production slows as people age, but whether changes in myelin are linked to age-related changes in cognition remains unknown. However, some animal study evidence suggests changes in myelin may be responsible for cognitive deficits in neurodegenerative diseases.

For this study, the team of NIA scientists gathered data from 123 cognitively unimpaired adults enrolled in the Baltimore Longitudinal Study of Aging and from the Genetic and Epigenetic Signatures of Translational Aging Laboratory Testing study. The researchers tested several different types of cognition and used magnetic resonance imaging (MRI) brain scans to measure myelin content in the brain. They looked at two different MRI-based measurements to estimate the amount of myelin: myelin water fraction (MWF) and longitudinal relaxation rate (R1).

For both measurements, lower myelin was linked to greater cognitive decline over time. Lower myelin, as measured with MWF, was associated with a steeper decline in executive function, which includes skills such as planning, problem-solving, organization, and multitasking. Lower myelin as measured with R1 was associated with a faster decline in verbal fluency, which measures the ability to retrieve information from memory. These findings contribute to a foundation for further studies that explore how age-related changes in myelin are different in people who develop neurodegenerative diseases.

While overall this study establishes a meaningful relationship between myelin content and cognition, the authors noted some limitations, mainly that the cohort size was relatively small and included a higher proportion of men and White participants. Future research should reexamine the link in a larger, more diverse study cohort; explore the link between myelin and cognition in people with neurodegenerative diseases; and test whether promoting myelin production could be an effective strategy to prevent disease.

Cholesterol Tests From A to Z

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States—more than even all types of cancer combined. One of the simplest indicators of a person’s heart health is their cholesterol levels. But what exactly is cholesterol, and what kind of tests are available? Dr. Robert Segal, a board-certified cardiologist and founder of Manhattan Cardiology, has answers to those questions and more.

First and most importantly, what exactly is cholesterol?

“Cholesterol is a natural, waxy substance made by the liver that’s found in most tissues of the body. It has a lot of important uses from digestion to hormone production,” says Segal.

The liver produces enough cholesterol for all of the body’s functional needs, but cholesterol can also be found in many foods. In effect, this dietary cholesterol can lead to having too much cholesterol overall in the body—and in particular in the bloodstream—where it starts to stick together and build up.

“Because of cholesterol’s waxiness, it can stick to the inner walls of arteries. Once that starts, more and more cholesterol tends to build up, narrowing and hardening the arteries. This increases blood pressure, decreases the supply of oxygen to the heart, and can directly cause a heart attack,” says Segal.

There are a few different types of cholesterol that are important to know about.

Low-density lipoprotein (LDL). This is often referred to as “bad” cholesterol or “L” for “lousy”, although the body does need a small amount of LDL cholesterol for normal functioning. Lower LDL levels are associated with lower risk of heart disease and stroke.

High-density lipoprotein (HDL). This is often referred to as “good” cholesterol. HDL cholesterol can collect extra LDL cholesterol and return it to the liver to be broken down and removed from the body. Higher HDL levels are associated with lower risk of heart disease and stroke.

Triglycerides. This is a type of fatty compound the body uses to store extra energy. Triglycerides can be broken down later to release energy, but if the need never arises, the fat continues to build up. Lower levels of triglycerides are generally healthier.

“Often times when someone’s cholesterol levels are too high, there aren’t any noticeable symptoms until they have a heart attack or a stroke. But if someone knows they have high cholesterol, there’s a lot that can be done to lower their risk of those dramatic outcomes. That’s why it’s so important for people to regularly have their cholesterol levels tested. This is generally a simple procedure that can be performed during an annual physical,” says Segal.

There are several types of cholesterol tests available. Some are more generalized, while others have more specific uses.

• Lipid Panel. This very common test can be performed in a doctor’s office and yields results in a couple of days. Blood is drawn and sent to a laboratory for analysis. This type of test typically directly measures total cholesterol, HDL, and triglycerides, and then uses this information to calculate LDL levels.

• HDL-C test. This test is usually ordered as needed as a follow up test to a standard lipid panel. It can show whether HDL levels have gone either up or down since a previous screening.

• LDL-C test. Where a standard lipid panel uses a formula to calculate LDL levels, this test directly measures LDL cholesterol. For people with very high triglyceride levels, this may provide a more accurate assessment of LDL levels.

• Lipoprotein (a) = LpA  The amount of lipoprotein in your blood is determined by a lipoprotein test. You may be at an increased risk for heart disease and stroke if you have a high level of lipoprotein (a). 

• CAC test. A coronary artery calcium score uses a CT scan instead of a blood draw. The scan measures the amount of calcium in the arteries around the heart to determine how much plaque is built up. This type of test can help doctors decide if someone would benefit from taking statins (a type of medication) to lower their cholesterol. The higher the calcium score, the higher risk of heart disease.

“Cholesterol tests are an efficient and effective way to find out if someone’s cholesterol levels are too high. But that information is only useful if some sort of action is taken,” says Segal.

While statins and other medications are one available option, most of the time the most significant long-term benefits can be gained from making lifestyle changes.

A diet low in trans fat and saturated fats, refined sugars, and red meats can help lower cholesterol. These foods can be replaced with fish, fresh vegetables, nuts, legumes, seeds, and whole grains. Regular moderate exercise, healthy sleep habits, managing stress, maintaining a healthy weight, and quitting tobacco products are also all associated with improved heart health.

“The best part is that these options don’t require special equipment or a prescription. They’re simple concepts that most people understand intuitively. Sometimes it’s just about getting back to basics,” said Segal.

Manhattan Cardiology is the premier facility for preventive cardiology treatment in New York. Our cardiologists practice under the guiding principle that early detection is the best form of prevention.  www.manhattancardiology.com