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Common drug class may increase risk of heart disease

The risk of cardiovascular disease increased in line with how much anticholinergic medication the participants used each year. Those with the highest exposure had a 71 per cent higher risk of a cardiovascular event than people who did not use anticholinergic medication at all.

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People who use drugs with anticholinergic effects, including certain antidepressants, drugs for urinary incontinence and common antihistamines, are at higher risk of developing cardiovascular disease.

This is shown in a study from Karolinska Institutet published in BMC Medicine.

Anticholinergic drugs reduce the effect of the neurotransmitter acetylcholine and are commonly prescribed to middle-aged and older people. This large group of drugs includes antihistamines used for allergic conditions, anxiety or insomnia, drugs for urinary incontinence, and certain antidepressants, where tricyclic antidepressants have a strong anticholinergic effect, whereas SSRIs have a weaker effect. A high cumulative use of these drugs, referred to as anticholinergic burden (see fact box), has previously been linked to impaired cognitive ability. 

May affect heart regulation 

The new study suggests that the drugs may also affect the parasympathetic nervous system and thereby the regulation of the cardiovascular system. The results show that it may be important to monitor the total drug burden in everyday clinical practice.

The study included more than 500,000 people in Stockholm, Sweden, who were 45 years of age or older and had no prior cardiovascular disease, except for hypertension, at the start of the study. The researchers followed the participants for up to 14 years and analysed how the use of anticholinergic drugs was associated with the development of cardiovascular disease.

“Many of these drugs are used by older people and by people with multiple medical conditions. We wanted to investigate whether the total exposure had any significance for the risk of developing cardiovascular disease over time,” says Nanbo Zhu, postdoctoral researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

71 per cent higher cardiac risk

The study showed that the risk of cardiovascular disease increased in line with how much anticholinergic medication the participants used each year. Those with the highest exposure had a 71 per cent higher risk of a cardiovascular event than people who did not use anticholinergic medication at all. The association was seen for all types of cardiovascular disease but was particularly clear for heart failure and various forms of arrhythmia.

“Our results indicate that the cumulative drug burden can affect heart regulation, not only in the short term but also over the long term. This does not mean that the drugs should always be avoided, but that exposure should be monitored carefully,” says Hong Xu, assistant professor at the Department of Neurobiology, Care Sciences and Society.

The researchers point out that the study is observational, meaning it cannot establish a causal relationship. Other factors, such as underlying diseases, may also influence the associations.

The work was carried out within the Stockholm CREAtinine Measurements project in collaboration between several research groups at Karolinska Institutet and Region Stockholm. The study was funded by the Swedish Research Council, the Center for Innovative Medicine Foundation, and other foundations. Some researchers report assignments for the pharmaceutical industry, which are disclosed in the scientific publication.

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Loneliness strongly linked to poorer mental health and wellbeing, study finds

Loneliness was found to be linked with worse general health, including experiencing multiple health conditions. Social isolation is associated with lower wellbeing, too.

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People who feel lonely are much more likely to experience poorer mental health and lower wellbeing, a collaborative study led by the University of Bristol, Nesta and Amsterdam UMC has found. Loneliness was also found to be linked with worse general health, including experiencing multiple health conditions. Social isolation is associated with lower wellbeing, too.

Loneliness is increasingly recognised as a major public health issue, with growing evidence connecting it to poorer health. However, it is unclear whether loneliness itself contributes to poor health or whether these links are driven by other factors.

The study, in association with the universities of Oxford and Manchester, combined evidence from three different research methods, including observational analysis, sibling comparisons, and Mendelian randomisation, a genetics-based approach, to build a clearer understanding of these relationships.

Using data from the UK Biobank and large-scale genome-wide association studies, the researchers investigated how both loneliness – the quality of a person’s social relationships; and social isolation – the number of social connections, relate to health and wellbeing. The study is published in Nature Communications.

The research team found that loneliness and social isolation are linked to poorer mental health and reduced wellbeing, with loneliness also associated with worse general health. While the study found no clear evidence of effects on specific physical health conditions, these potential impacts cannot be ruled out.

The findings suggest that loneliness, and potentially social isolation, remain important public health issues, particularly because of their links with mental health, wellbeing and overall health.

As loneliness becomes an increasingly important public health challenge, tackling it could bring benefits for both individuals and society.

Dr Zoe Reed, Research Fellow in the School of Psychology and Neuroscience at the University of Bristol, and corresponding author, said: “Our findings suggest that loneliness, and possibly social isolation, are still important public health concerns, especially for mental health and general health. Supporting people who feel lonely or socially isolated could help improve mental health, wellbeing and overall health.”

Lauren Bowes Byatt, Director of Nesta’s healthy life mission, added: “This research underlines that loneliness is likely to have a detrimental impact on our mental health and wellbeing. While this link may seem obvious, the topic has long been understudied. Studies like this can help to bridge this research gap and by understanding how loneliness or social isolation may be contributing to ill-health, we can get closer to new and more effective solutions.”

The researchers suggest more research is needed to understand exactly how loneliness and social isolation affect health and to develop the most effective ways to reduce their impact.

As the study focused on middle-aged and older adults, future studies should explore whether these patterns are similar in younger people. It will also be important to investigate the effects of persistent or long-term loneliness, as the study measured loneliness at a single point in time.

The paper’s findings add to growing evidence that loneliness and social isolation are not just social issues, they are important public health concerns with wide-ranging implications for wellbeing and mental and physical health. The research reinforces the importance of addressing these issues as part of public health policy and practice.

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Weight loss drugs could help with binge eating disorder

Drugs commonly used for weight loss, known as GLP-1 receptor agonists, have been found to reduce the key symptoms of binge eating disorder

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Drugs commonly used for weight loss, known as GLP-1 receptor agonists, have been found to reduce the key symptoms of binge eating disorder, in a new review of evidence led by University College London (UCL) researchers.

The systematic review and meta-analysis, published in eClinicalMedicine, found that weight loss drugs can reduce binge eating episodes, loss-of-control eating and emotional eating, and highlights its potential role to treat binge eating disorder as well as obesity.

Lead author Dr Ilaria Costantini (UCL Psychiatry) said: “Binge eating disorder, where people regularly eat an excessive amount of food while feeling they have lost control, is common and highly impairing, affecting over 17 million people worldwide.

“But treatment options are limited and there are currently no approved medications, so there remains a need for better ways to help people living with this condition. We found evidence that weight loss drugs may help to manage some key symptoms of binge eating disorder.”

In the largest study to date on the subject, the researchers pulled together evidence from 25 randomised controlled trials that took place in 12 countries on four continents, including data from 8,069 participants.

The studies were testing the effects of drugs targeting the appetite-regulating hormone GLP-1 such as semaglutide (often marketed under brand names Ozempic or Wegovy), tirzepatide (also known as Mounjaro) or liraglutide.

These drugs can suppress appetite by targeting the central nervous system and insulin secretion, and they can delay stomach emptying, while also potentially influencing brain processes of reward and impulse control.

The researchers found that the drugs yielded benefits beyond weight loss, including reducing binge eating, loss of control eating and emotional eating.

Participants also reported increased cognitive or dietary restraint (which relates to how much people intentionally limit their eating), but the researchers say more research is needed to understand this link.

The study’s first author, PhD candidate Izzy Emptage (UCL Psychiatry), said: “From the evidence available, we cannot say whether the increase in dietary restraint reflects a positive and helpful form of self-regulation or if it is a more dysfunctional pattern of eating. We hope that future research can clarify whether or not taking weight loss drugs might contribute to more pathological forms of eating restriction such as meal skipping.”

The researchers say their findings demonstrate that weight loss drugs could be an important part of treatment plans for people with binge eating disorder, alongside psychological therapies and social support.

Izzy Emptage added: “Many people with binge eating disorder cannot access weight loss drugs through their public healthcare providers, so many have to seek treatment privately at considerable personal cost.

“We hope that by highlighting the potential of weight loss drugs to help with binge eating symptoms, our findings will lead to further funding of larger high-quality studies in this area, to better understand how this medication could be used in practice and improve treatment options.”

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Poor-quality sleep involves different parts of the brain, depending on age

College-age adults with poor sleep quality exhibited overconnected brain regions involved in movement, suggesting that their bodies aren’t physically ready to sleep.

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Have trouble sleeping? The reason may depend in part on your age.

A recent study including psychology researchers from Binghamton University, State University of New York investigates how poor sleep alters brain communication across the adult lifespan, specifically examining how these changes vary by age and biological sex.

The article, “Sleep quality is associated with default mode and salience network connectivity differently across age and sex,” appeared in a recent edition of the journal Neurobiology of Aging. Co-authors include psychology graduate student Sepehr Gourabi, and Associate Professor of Psychology Ian McDonough, both at Binghamton; and Selene Tan, Matthew Cribbet, and Jeanne Cundiff of The University of Alabama.

The researchers analyzed brain scans from two large groups totaling more than 1,300 participants to see how brain networks connect at rest in people who report having poor sleep quality. 

“We discovered that the poorly slept older brain looks like it is suffering from a general breakdown in its sleep-regulation systems,” McDonough said. 

College-age adults with poor sleep quality exhibited overconnected brain regions involved in movement, suggesting that their bodies aren’t physically ready to sleep. In older adults, typically age 65 and above, these same regions were under-connected; instead, they showed hyperconnectivity in brain regions involved in cognition.

In particular, older women with poor sleep showed abnormal hyperconnectivity between the Default Mode Network (DMN), which is involved in internal thoughts and memory, and the Frontal Parietal Network (FPN), which is involved in sustained attention and working memory. This over-communication pattern was directly linked to poorer memory performance and mirrors brain wiring patterns seen in the preclinical, silent stages of Alzheimer’s disease, McDonough said.

The reasons behind these differences are currently unclear. Older adults may become habituated to hyperarousal or develop coping mechanisms, including a willingness to take sleep-related medications. Another possible factor is rumination, a state of overthinking often associated with anxiety or depression, although anyone can experience it, depending on their personal situation. 

“One strong possibility is that people who have a lot of running thoughts right before bed are not in a calm state, but rather more of an agitated state,” McDonough said.

Depression has a complicated relationship with dementia, with some studies showing a link between the two conditions. Other research has suggested that depression can resemble cognitive decline, but cognition improves once the individuals are treated for depression, McDonough said.

A chicken-and-egg issue remains: Do abnormal connections in the brain cause sleep dysfunction, or does sleep dysfunction cause those abnormalities? Hyperconnectivity between the DMN and FPN was associated with poorer cognition over time, suggesting that cognitive consequences follow sleep disturbance or increased connectivity between these networks, McDonough said.

Growing evidence suggests that between-network connectivity, especially with the DMN, is an early sign of declining brain health. Because of this, getting enough shut-eye is essential.

For young adults, efforts to reduce arousal before bedtime could help, such as journaling to reduce running thoughts. For older adults, however, the mechanisms are less clear, given that hyperarousal may not be the source. If you’re having problems sleeping, consult your physician, McDonough recommended. 

 “If connectivity changes do precede sleep loss, then strengthening brain networks could be one solution,” he said.

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