(Press-News.org) Future prevention and treatment strategies for vascular diseases may lie in the evaluation of early brain imaging tests long before heart attacks or strokes occur, according to a systematic review conducted by a team of cardiologists, neuroscientists, and psychiatrists from Icahn School of Medicine at Mount Sinai and published in the October issue of JACC Cardiovascular Imaging.
For the review, Mount Sinai researchers examined all relevant brain imaging studies conducted over the last 33 years. They looked at studies that used every available brain imaging modality in patients with vascular disease risk factors but no symptoms that would lead to a diagnosis of diseased blood vessels (vascular disease) in the heart or brain, or periphery (e.g. arms and legs).
The review demonstrates that patients with high blood pressure, diabetes, obesity, high cholesterol, smoking, or metabolic syndrome, but no symptoms, still had visible signs on their neuroimaging scans of structural and functional brain changes long before the development of any events related to vascular diseases of the heart (heart attack) or brain (stroke).
"This is the first time we have been able to disentangle the brain effects of vascular disease risk factors from the brain effects of cardiovascular and cerebrovascular disease and/or events after they develop," says the article's lead author, Joseph I. Friedman, MD, Associate Professor in the Departments of Psychiatry and Neuroscience at Icahn School of Medicine at Mount Sinai. "Moreover, subtle cognitive impairment is an important clinical manifestation of these vascular disease risk factor-related brain imaging changes in these otherwise healthy persons."
Dr. Friedman added that, because diminished cognitive capacity adversely impacts a person's ability to benefit from treatment for these medical conditions, early identification of these brain changes may "present a new window of opportunity" for doctors to intervene early and improve prevention of advancement from vascular disease risk factors to established cardiovascular and cerebrovascular diseases. His team is currently testing these hypotheses in ongoing studies at Mount Sinai.
"Patients need to start today to control their vascular risk factors, otherwise their brains may forever harbor physical changes leading to devastating heart and vascular conditions impacting their future overall health and even cognitive decline causing diseases like dementia or when it exists it can accelerate Alzheimer's," says study author, Valentin Fuster, MD, PhD, Director of Mount Sinai Heart, Physician-in-Chief of The Mount Sinai Hospital, and Chief of the Division of Cardiology at Icahn School of Medicine at Mount Sinai. "Our publication raises the possibility that these early brain changes are major warning signs of what the future may hold for these asymptomatic patients. These high risk patients, along with their doctors, hold the power to modify their daily vascular risk factors to help halt the future course of the manifestation of their potentially looming cardiovascular diseases."
"We hope our publication serves as a primer for cardiologists and other doctors interpreting the early neuroimaging data of their patients who may be high risk for vascular disease," says senior article author Jagat Narula, MD, PhD, Director of Cardiovascular Imaging, Professor of Medicine and Philip J. and Harriet L. Goodhart Chair in Cardiology at Icahn School of Medicine at Mount Sinai. "These subtle brain changes are clues to us physicians that our patients need to start to lower their vascular risk factors always and way before symptoms or a cardiac or brain event happens. This simple step to lower vascular risk factors can have huge impacts on global prevention efforts of cardiovascular diseases."
Researchers identified the following impact of key vascular risk factors on the structural and functional brain health of asymptomatic patients:
Hypertension is associated with globally appreciable brain volume reductions, connecting brain fiber abnormalities, reduced brain blood flow, and alterations in the normal pattern of synchronized brain activity between different regions.
Diabetes is associated with connecting brain fiber abnormalities, reduced brain blood flow, and alterations in the normal pattern of synchronized brain activity between different regions.
Obesity is associated with brain volume reductions, reduced brain blood flow and metabolism.
High total cholesterol and LDL cholesterol are associated with brain volume reductions, and connecting brain fiber abnormalities. In addition, high triglycerides is associated with reduced brain blood flow, and high total cholesterol is associated with reduced brain metabolism.
Smoking is associated with brain volume reductions, and alterations of the normal pattern of blood flow. In addition, it causes reduced MAO B (Monoamine Oxidase B) which metabolizes dopamine, the neurotransmitter chemical that controls the brain's reward and pleasure zones.
Metabolic Syndrome is associated with a greater burden of silent brain infarcts (SBIs), visible only on MRI, which represents subclinical cerebrovascular disease. In addition, it is associated with connecting brain fiber abnormalities, and alterations in the normal pattern of synchronized brain activity between different regions.
INFORMATION:
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven member hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community‐based facilities to tertiary and quaternary care.
The System includes approximately 6,600 primary and specialty care physicians, 12‐minority‐owned free‐standing ambulatory surgery centers, over 45 ambulatory practices throughout the five boroughs of New York City, Westchester, and Long Island, as well as 31 affiliated community health centers. Physicians are affiliated with the Icahn School of Medicine at Mount Sinai, which is ranked among the top 20 medical schools both in National Institutes of Health funding and by U.S. News & World Report.
For more information, visit http://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.
No-till farming, a key conservation agriculture strategy that avoids conventional plowing and otherwise disturbing the soil, may not bring a hoped-for boost in crop yields in much of the world, according to an extensive new meta-analysis by an international team led by the University of California, Davis.
As the core principle of conservation agriculture, no-till has been promoted worldwide in an effort to sustainably meet global food demand. But after examining results from 610 peer-reviewed studies, the researchers found that no-till often leads to yield declines compared ...
University of Southampton scientists have designed a new experiment to test the foundations of quantum mechanics at the large scale.
Standard quantum theory places no limit on particle size and current experiments use larger and larger particles, which exhibit wave-like behaviour. However, at these masses experiments begin to probe extensions to standard quantum mechanics, which describe the apparent quantum-to-classical transition.
Now, Southampton researchers, with colleagues from the University of Duisburg-Essen in Germany, have designed a new type of experiment ...
Vedolizumab (trade name Entyvio) has been approved since May 2014 for patients with moderately to severely active Crohn disease or ulcerative colitis. In an early benefit assessment pursuant to the Act on the Reform of the Market for Medicinal Products (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) examined whether the drug offers an added benefit over the appropriate comparator therapy in these patient groups. According to the findings, such an added benefit is not proven because the dossier contained no suitable data for any of the two ...
On behalf of the Federal Ministry of Health (BMG), the German Institute for Quality and Efficiency in Health Care (IQWiG) examined whether specific methodological aspects have to be considered in the conduct, analysis and assessment of the certainty of results of studies on rare diseases. Within the framework of the same commission, the Institute also analysed the underlying studies for the approval of so-called orphan drugs, i.e. drugs for rare diseases, in Europe.
The result: For a different approach than in more common diseases, there are neither scientific reasons ...
Multiple pathways exist to a low greenhouse gas future, all involving increased efficiency and a dramatic shift in energy supply away from fossil fuels. A new tool 'SWITCH' enables policymakers and planners to assess the economic and environmental implications of different energy scenarios. It is presented today at the congress Global Challenges: Achieving Sustainability, hosted by the University of Copenhagen.
"SWITCH is a tool we can use to examine the different choices of technologies within the electrical power sector and their locations. It enables us to estimate ...
For teenagers, learning to establish a healthy degree of autonomy and closeness in relationships (rather than easily giving in to peer pressure) is an important task. A new longitudinal study has found one reason adolescents struggle with balancing autonomy and closeness in relationships: parents' psychological control. Teens whose parents exerted more psychological control over them when they were 13 had more problems establishing friendships and romantic relationships that balanced closeness and independence, both in adolescence and into early adulthood.
The study, ...
The lives of adolescents at home and at school may seem quite separate, but recent research has highlighted important connections. Family conflict and problems at school tend to occur together on the same day and sometimes even spill over in both directions to the next day, with family conflict increasing the likelihood of problems at school and vice versa. Now a new study has found that conflicts at home spill over to school and school problems influence problems at home up to two days later, and that negative mood and psychological symptoms are important factors in the ...
While losses in family income predict increases in behavior problems for many children, attending high-quality early childhood education and care centers offers some protection against families' economic declines, according to a new study out of Norway. In Norway, publicly subsidized high-quality early childhood education and care is available to all children, from low-income to affluent, starting at age 1. The study found that children who don't take part in such programs have more early behavior problems when their families' income drops.
The study was conducted by ...
Many different microbes can cause pneumonia, and treatment may be delayed or off target if doctors cannot tell which bug is the culprit. A novel approach—analyzing a patient's breath for key chemical compounds made by the infecting microbe—may help detect invasive aspergillosis, a fungal infection that is a leading cause of mortality in patients with compromised immune systems, according to a proof-of-concept study now online in Clinical Infectious Diseases.
Currently difficult to diagnose, this type of fungal pneumonia often requires a lung biopsy for definitive ...
A rare form of a devastating disease which causes low blood sugar levels in babies and infants may now be recognised earlier thanks to a new test developed by researchers from The University of Manchester.
Congenital hyperinsulinism starves a baby's brain of blood sugar and can lead to lifelong brain damage or permanent disability according to previous research carried out by the Manchester team. The condition occurs when specialised cells in the pancreas release too much insulin which causes frequent low sugar episodes - the clinical opposite of diabetes. Treatment ...
