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Heart failure and stroke rising in men under 40

Heart failure and stroke are unusual diagnoses among younger people. But they are now clearly on the rise in men below the age of 40.

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Heart failure and stroke are unusual diagnoses among younger people. But they are now clearly on the rise in men below the age of 40, according to a University of Gothenburg study. The scientists have found links to obesity and low fitness in the upper teens.

The present study, published in Journal of Internal Medicine, includes data on 1,258,432 men who, at an average age of 18.3 years, enlisted for military service in Sweden between 1971 and 1995.

Particulars of the men’s weight, height and physical fitness on enlistment were merged with data in the National Board of Health and Welfare’s National Patient Register and Cause of Death Register for the period 1991-2016. From when they enlisted, the men were thus monitored over a period exceeding 20 years.

The proportion of participants who were overweight at the time of enlistment, i.e. with a body mass index (BMI) of 25-30, increased from 6.6 to 11.2 percent between 1971 and 1995, while the proportion with obesity (BMI over 30) rose from 1.0 to 2.6 percent. During the same period, their fitness level at the time of enlistment also declined slightly.

“These factors — that is, overweight, obesity and low fitness — partly explain the large increase in heart failure we see in the study, and the rise in stroke as well,” states David Åberg. An Associate Professor at Sahlgrenska Academy, University of Gothenburg, and specialist doctor at Sahlgrenska University Hospital, Åberg is the study’s first author.

“It’s pleasing to see, despite rising obesity, a fairly sharp fall in heart attacks among these younger men, and also their reduced mortality from cardiovascular diseases,” he continues.

Heart-failure cases within 21 years of enlistment rose, according to the study, by 69 percent — from 0.49 per 1,000 of the men who had enlisted in the first five years (1971-75) to 0.83/1,000 of those who enlisted in the last five (1991-95).

The number of stroke cases — cerebral infarction and cerebral hemorrhage — showed a similar trend. The increase for cerebral infarction was 32 percent, from 0.68 for the first five-year cohort to 0.9 per 1,000 for the last. For cerebral hemorrhage the rise was 20 percent, from 0.45 to 0.54 per 1,000.

In contrast, heart attacks within 21 years of enlistment fell by 43 percent, from 1.4 to 0.8 per 1,000, of the cohorts enlisting first and last respectively. The proportion of deaths from all cardiovascular disease also decreased, by 50 percent — from 1.5 to 0.74 per 1,000.

The fact that the trends for cardiovascular diseases move in differing directions over time suggests that other, unknown factors are involved as well. According to the researchers, post-enlistment weight trends may be one such factor, but stress and drug use may be others. Especially for heart attacks, researchers believe that a sharp fall in smoking underlies the decline. The fact remains, however, that overweight and obesity are influential.

“We see that heart attacks would have decreased even more if it hadn’t been for the rise in overweight and obesity. Our results thus provide strong support for thinking that obesity and, to some extent, low fitness by the age of 18 affect early-onset cardiovascular disease. So at societal level, it’s important to try to get more physical activity, and to have already established good eating habits by adolescence, while being less sedentary,” David Åberg concludes.

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Eating late increases hunger, decreases calories burned, and changes fat tissue

Eating later had profound effects on hunger and appetite-regulating hormones leptin and ghrelin, which influence our drive to eat. Specifically, levels of the hormone leptin, which signals satiety, were decreased across the 24 hours in the late eating condition compared to the early eating conditions.

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Obesity afflicts approximately 42 percent of the adult population and contributes to the onset of chronic diseases, including diabetes, cancer, and other conditions. While popular healthy diet mantras advise against midnight snacking, few studies have comprehensively investigated the simultaneous effects of late eating on the three main players in body weight regulation and thus obesity risk: regulation of calorie intake, the number of calories you burn, and molecular changes in fat tissue. A new study by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, found that when we eat significantly impacts our energy expenditure, appetite, and molecular pathways in adipose tissue. Their results are published in Cell Metabolism.

“We wanted to test the mechanisms that may explain why late eating increases obesity risk,” explained senior author Frank A. J. L. Scheer, PhD, Director of the Medical Chronobiology Program in the Brigham’s Division of Sleep and Circadian Disorders. “Previous research by us and others had shown that late eating is associated with increased obesity risk, increased body fat, and impaired weight loss success. We wanted to understand why.”

“In this study, we asked, ‘Does the time that we eat matter when everything else is kept consistent?’” said first author Nina Vujović, PhD, a researcher in the Medical Chronobiology Program in the Brigham’s Division of Sleep and Circadian Disorders. “And we found that eating four hours later makes a significant difference for our hunger levels, the way we burn calories after we eat, and the way we store fat.”

Vujović, Scheer and their team studied 16 patients with a body mass index (BMI) in the overweight or obese range. Each participant completed two laboratory protocols: one with a strictly scheduled early meal schedule, and the other with the exact same meals, each scheduled about four hours later in the day. In the last two to three weeks before starting each of the in-laboratory protocols, participants maintained fixed sleep and wake schedules, and in the final three days before entering the laboratory, they strictly followed identical diets and meal schedules at home.

In the lab, participants regularly documented their hunger and appetite, provided frequent small blood samples throughout the day, and had their body temperature and energy expenditure measured. To measure how eating time affected molecular pathways involved in adipogenesis, or how the body stores fat, investigators collected biopsies of adipose tissue from a subset of participants during laboratory testing in both the early and late eating protocols, to enable comparison of gene expression patterns/levels between these two eating conditions.

Results revealed that eating later had profound effects on hunger and appetite-regulating hormones leptin and ghrelin, which influence our drive to eat. Specifically, levels of the hormone leptin, which signals satiety, were decreased across the 24 hours in the late eating condition compared to the early eating conditions. When participants ate later, they also burned calories at a slower rate and exhibited adipose tissue gene expression towards increased adipogenesis and decreased lipolysis, which promote fat growth. Notably, these findings convey converging physiological and molecular mechanisms underlying the correlation between late eating and increased obesity risk.

Vujović explains that these findings are not only consistent with a large body of research suggesting that eating later may increase one’s likelihood of developing obesity, but they shed new light on how this might occur. By using a randomized crossover study, and tightly controlling for behavioral and environmental factors such as physical activity, posture, sleep, and light exposure, investigators were able to detect changes the different control systems involved in energy balance, a marker of how our bodies use the food we consume.

In future studies, Scheer’s team aims to recruit more women to increase the generalizability of their findings to a broader population. While this study cohort included only five female participants, the study was set up to control for menstrual phase, reducing confounding but making recruiting women more difficult. Going forward, Scheer and Vujović are also interested in better understanding the effects of the relationship between meal time and bedtime on energy balance.

“This study shows the impact of late versus early eating. Here, we isolated these effects by controlling for confounding variables like caloric intake, physical activity, sleep, and light exposure, but in real life, many of these factors may themselves be influenced by meal timing,” said Scheer. “In larger scale studies, where tight control of all these factors is not feasible, we must at least consider how other behavioral and environmental variables alter these biological pathways underlying obesity risk. ”

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DKSH, LEO Pharma partner to deliver products, solutions to people with skin conditions, thrombosis

DKSH Business Unit Healthcare, a leading partner for healthcare companies seeking to grow their business in Asia and beyond, has partnered with LEO Pharma to bring high-quality therapeutic products for dermatology and thrombosis to patients across Asia.

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DKSH Business Unit Healthcare, a leading partner for healthcare companies seeking to grow their business in Asia and beyond, has partnered with LEO Pharma to bring high-quality therapeutic products for dermatology and thrombosis to patients across Asia.

Partnering in Hong Kong, Malaysia, Singapore, Taiwan, Thailand, Vietnam, and the Philippines, the two companies seek to solidify brand presence, grow market share, and ultimately improve patient health outcomes in the region. Skin diseases can cause serious physical and social discomfort for millions of patients around the world whereas thrombosis can affect anyone regardless of their age, race, gender, and ethnicity.

DKSH will support LEO Pharma by building dedicated sales and marketing teams on the ground in Asia and managing logistics and product distribution in these markets. The firm’s experienced teams and broad distribution network will ensure LEO Pharma products reach modern trade, traditional trade, hospitals, clinics, and other medical channels, as well as patients in need across the region.

LEO Pharma is a global company dedicated to advancing the standard of care for the benefit of people with skin conditions, their families and society. With decades of research and development to advance the science of dermatology, LEO Pharma now offers a wide range of innovative treatments and therapies for all skin disease severities as well as thrombosis.

Khalid Aouidat, Vice President, responsible for commercial activities in Southeast Asia at LEO Pharma commented: “At LEO Pharma, we are dedicated to changing the standards of care for people with skin diseases by bringing new innovative treatments forward and making them easily accessible. Supporting this ambition, we are delighted to be partnering with DKSH. Their experience and strong regional footprint in Asia, as well as their marketing and sales expertise will help to further strengthen LEO Pharma’s brand and its continued growth.”

Bijay Singh, Head of Business Unit Healthcare at DKSH, said: “We are committed to enriching people’s lives and improving healthcare for all. The partnership with LEO Pharma strengthens our ambition to become the preferred partner for clients to help patients in Asia to have better access to high-quality and innovative products and solutions. While we drive their growth across the region, LEO Pharma can focus on researching and developing products and solutions for people with skin conditions.”

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Epson partners with WWF, launches mangrove restoration project in Palawan

Epson, which has previously supported the development of WWF-Philippines’ virtual museum Museo Kalikasan, is now supporting the Mangrove Restoration Project in the municipalities of Balabac and Bataraza, Southern Palawan.

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Epson Philippines’ partnership with the World Wide Fund for Nature (WWF) Philippines for marine ecosystem restoration has officially kickstarted with a ceremonial launch in Balabac, Palawan. Supported by project stakeholders such as the European Union delegation to the Philippines and local government officials, the project launch highlights the importance of rehabilitating mangrove sites, recognizing their critical role in marine biodiversity and protecting coasts from erosion and storm surges.

Epson, which has previously supported the development of WWF-Philippines’ virtual museum Museo Kalikasan, is now supporting the Mangrove Restoration Project in the municipalities of Balabac and Bataraza, Southern Palawan. As part of the wider European Union-funded Ocean Governance Project—an initiative focused on strengthening habitat resilience through restoration in the Sulu Sulawesi Seascape that covers the Philippines, Indonesia, Malaysia—the joint mission in Palawan aims to boost local capacity in taking care of the mangroves, as well as address other critical issues such as plastic waste management. With Epson as a key partner, the Mangrove Restoration Project was able to expand beyond Balabac and into the neighboring municipality of Bataraza. In addition, the growing relationship between Epson Philippines and WWF-Philippines only further drives Epson Philippines’ commitment to support sustainable innovations and initiatives to solve the world’s greatest challenges.

“Corporations have a shared responsibility in sustainable development,” said Eduardo Bonoan, Epson Philippines’ General Manager for Marketing Division, who shared his remarks virtually during the project launch. “As Epson continues its commitment to sustainable innovation and environmental responsibility, we believe in forming critical partnerships with organizations that are aligned with our values—such as WWF-Philippines.”

To further the goals of the Mangrove Restoration Project, WWF-Philippines will continue to work with local government and key stakeholders such as Epson Philippines to establish a ‘Community Learning and Innovation Hub’ that aims to bridge knowledge gaps and strengthen coastal communities’ experience in resource management, thereby helping to build local capacity.

“It is important that we continue to protect and manage Balabac’s valued mangrove forests to boost our efforts in keeping a healthy environment and supporting local livelihoods,” said Balabac Mayor Shuiab J. Astami, who officially launched the project in Balabac Island.

“We are excited to be part of this multi-stakeholder effort that will restore critical mangroves in Balabac, Palawan and improve the way their coastal resources are managed for the long haul. We strongly hope that this project will succeed and serve as an example for many other communities,” said Executive Director of WWF-Philippines, Katherine Custodio.

Moving forward, Epson aims to continue setting a more sustainable example for corporations across the region.

“Working alongside governments, local champions and conservation organizations, we are proud to be part of this public-private partnership that is aligned with our renewed Epson 25 Corporate Vision—which aims to enrich communities and help realize a sustainable society,” concludes Bonoan. ”We hope that this opens up a path for more sustainable partnerships in the future.”

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