Pat Oceanridge: Welcome to our fun new game show, Wheel of Four Chambers. We have with us today three prominent cardiologists who will try to guess our mystery phrases pertaining to a concept in cardiology. First up is Dr Robert Bruce from Rochester New York. He developed the stress test protocol that is used the world over. Next is Dr Hein Wellens from Holland, a master of the heart’s electrical system. Lastly, we have Dr Andreas Gruentzig from Switzerland, the father of cardiac angioplasty.
Pat Oceanridge: Doctors, here is the first phrase:
S_ _ _ n T_ _ _ s_ nd S_ _ ps P_ r _ _y
Dr Bruce: It is Seven Thousand Steps Per Day.
Pat Oceanridge: Correct. Would you care to elaborate?
Dr Bruce: Certainly. We don’t necessarily need to take 10,000 step per day to lower cardiac risk. In fact, 10,000 steps was a catch phrase made up in 1964 by a Japanese manufacturer of pedometers to sell more units. Good quality research shows us that fewer steps are needed for good health. A review of studies showed that the benefits of walking leveled off at around 5000 to 7000 steps per day. Compared to 2000 steps per day, taking 7000 steps per day lowered the risk of dying by 47%, decreased heart disease by 25%, lowered the risk of cancer by 6%, decreased type 2 diabetes by 14%, decreased dementia by 38% and reduced the chance of falling by 28%. Even walking 4000 steps per day (compared to 2000 steps) improved health outcomes. Another large review found that even increasing the step count from 2000 steps to 2500 steps per day lowered mortality by 8% and cardiac disease by 11%. This study also noted that the benefit leveled off at 7000 to 8000 steps per day. The bottom line is that the more steps taken per day, the better the benefit and the optimal number of steps is between 4000 and 7000 steps per day.
Pat Oceanridge: Very good. Here is our next phrase: O_ _ L _ gg _d S _ _ _ d
Dr Wellens: I would guess One Legged Stand
Pat Oceanridge: Excellent. Can you explain?
Dr Wellens: It is well known that muscle mass, muscle strength and balance all decline as we get older. Men will lose 33% and women 26% of their muscle mass between 60 and 90 years of age. Muscle strength goes down linearly with each decade as well. It is also well known that with loss of muscle mass, muscle strength and worsening balance, the risk for falls increases and the risk of dying goes up. For example, people with low muscle mass are 86% more likely to die compared to people with higher muscle mass. The same is true for muscle strength. We know how to measure cardiac fitness (using the stress test). We don’t have a standardized way to measure non-cardiac fitness (muscle mass, strength and balance). One way is the one-legged stand. It is easy to do, it doesn’t require special equipment and it tests both muscle strength and balance. The test is simple: stand on one leg without holding onto anything. If you can do this for 10 seconds or more, then you pass the test. As expected, the ability to pass the 10 second one-legged stand decreases with aging. It reaches 50/50 at around age 70 (ie, 50% of 70-year-olds can stand on one leg for 10 seconds or more). It turns out that the risk of dying for those who cannot do a 10 second leg stand is 3.8 times higher than those who can.
Pat Oceanridge: A great discussion. Here is the next phrase: S _ tt _ _ g T_ R _ s _ _ g
Dr Greuntzig: I know! I know! Sitting To Rising. Another easy test that measures non-cardiac fitness is the sitting to rising test. This test assesses all the main components discussed earlier: muscle mass, muscle strength and balance. The test is easy: sit on the floor and try to rise using the minimum amount of support that you need, then sit back down again. A score of 5 is given for sitting or rising without any support. One point is subtracted if you need to use a hand, arm, knee or side of leg to help you. How does sitting and rising translate into a longer life? In people aged 46 to 75 years old, the lower the sitting to rising score, the higher the mortality. Those with low scores have a 5 to 6 times higher risk of dying compared to those with higher scores. It may also be a factor in longevity on the Blue Zone Japanese island of Okinawa. On the island people sit on the floor to eat and to socialize, sitting and rising multiple times through the day, thus maintaining strength and balance late in life.
Pat Oceanridge: The next phrase is: D _ m _ n _ _ a
Dr Bruce: The phrase looks familiar, but I’m having trouble coming up with the answer. Oh, wait. Dementia!
Pat Ocenridge: Yes! Would you care to enlighten us on what is new in the world of diagnosing and delaying Alzheimer’s disease?
Dr Bruce: It takes at least 20 years for Alzheimer’s disease to manifest. Over that 20 years, amyloid and other proteins (tau proteins) accumulate in the brain and initiate inflammation. A major milestone is the development of a very accurate blood test to predict Alzheimer’s disease. The blood test is called p-Tau217 and it tracks brain pathology. In people who don’t have dementia or even mild cognitive impairment, p-Tau217 can predict the development of Alzheimer’s disease years into the future. In addition, the blood test will go down with intervention (for example starting an exercise program) so it can be used to track the disease. As p-Tau217 levels go down, dementia progression is slowed. We are not yet sure who should get the blood test, but in the future p-Tau217 may be used to predict and track Alzheimer’s disease much like cholesterol levels are used in heart disease today.
Once high-risk cases are identified (abnormal p-Tau217, family history of Alzheimer’s, genetic variant in apolipoproteinE4) dementia can be delayed. Life style modifications can be made (exercise, weight loss, following a Mediterranean diet, smoking cessation, avoiding excess alcohol, reducing ultraprocessed foods) and treating chronic diseases (high blood pressure, diabetes, hearing and vision loss) can slow the progression. What about brain boosting supplements? Most research has shown that these supplements don’t have the benefit that they claim in advertisements. However, there are new approaches which seem promising. For example, taking a multivitamin pill may help with cognition in older adults. Music may be helpful as well. It has been reported that people who play a musical instrument (especially keyboard or woodwind) have better working memory and executive function than those who aren’t musical.
Pat Oceanridge: Here is our last phrase: Sh _ n _ l _ s
Dr Wellens: I just had a case. It is Shingles. Shingles is very painful and can have long -term consequences; it is not fun to get. It is caused by a virus, varicella-zoster, that also causes chicken pox. If you had chickenpox as a child, the virus can live in your nerve cells for years. Later in life, with stress or with a weakened immune system, the virus is activated. It causes a rash and severe pain in the skin attached to the nerve. Fortunately, there is a vaccine which can help prevent shingles called Shingrix. One side benefit from the vaccine is that it reduces the risk for dementia. People who received the vaccine are 20% less likely to develop dementia. The vaccine decreases inflammation along the brain blood vessels caused by the virus and boosts the immune system, causing it to remove harmful proteins such as amyloid. So it may be worth getting the vaccine for a couple of reasons.
Pat Oceanridge: That is it for our installment of Wheel of Four Chambers. I’d like to thank our esteemed guests for playing and enlightening us.
