{"title":"Polypharmacy research: in need of a new conceptual framework","authors":"Constantinos Christopoulos","doi":"10.1016/S2666-7568(24)00072-2","DOIUrl":"10.1016/S2666-7568(24)00072-2","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 6","pages":"Page e388"},"PeriodicalIF":13.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000722/pdfft?md5=5ea13d3fc28ceaf01ae04528180f6b9e&pid=1-s2.0-S2666756824000722-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The need for a more holistic approach to dementia prevention","authors":"Jason R Smith , Jennifer A Deal","doi":"10.1016/S2666-7568(24)00071-0","DOIUrl":"10.1016/S2666-7568(24)00071-0","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 6","pages":"Pages e382-e383"},"PeriodicalIF":13.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000710/pdfft?md5=d34ed927a82584c80c8c85556652372b&pid=1-s2.0-S2666756824000710-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The role of dementia in the association between APOE4 and all-cause mortality: pooled analyses of two population-based cohort studies","authors":"Mélina Régy PhD , Aline Dugravot PhD , Séverine Sabia PhD , Catherine Helmer PhD , Prof Christophe Tzourio PhD , Prof Bernard Hanseeuw PhD , Prof Archana Singh-Manoux PhD , Prof Julien Dumurgier PhD","doi":"10.1016/S2666-7568(24)00066-7","DOIUrl":"10.1016/S2666-7568(24)00066-7","url":null,"abstract":"<div><h3>Background</h3><p>The ε4 allele of the apolipoprotein E gene (<em>APOE4</em>) plays a role in neurodegeneration and in cardiovascular disease, but findings on its association with mortality are inconsistent. We aimed to examine the association between <em>APOE4</em> and mortality, and the role of dementia in this association.</p></div><div><h3>Methods</h3><p>In this pooled analysis, data on White participants aged 45–90 years who underwent <em>APOE</em> genotyping were drawn from two population-based cohorts: the Whitehall II study (UK), which began in 1985 and is ongoing, and the Three-City study (France), initiated in 1999 and ended in 2012. In the Three-City study, vital status was ascertained through linkage to the national registry of death Institut National de la Statistique des Études économiques, and dementia was ascertained via a neuropsychological evaluation and validation of diagnoses by an independent committee of neurologists and geriatricians. In the Whitehall II study, vital status was ascertained through linkage to the UK national mortality register, and dementia cases were ascertained by linkage to three national registers. Participants with prevalent dementia at baseline and participants missing an <em>APOE</em> genotype were excluded from <em>analyses</em>. Cox regression proportional hazard models were used to examine the association of <em>APOE4</em> with all-cause, cardiovascular, and cancer mortality. The role of dementia in the association between <em>APOE4</em> status and mortality was examined by excluding participants who developed dementia during follow-up from the analyses. An illness-death model was then used to examine the role of incident dementia in these associations.</p></div><div><h3>Findings</h3><p>14 091 participants (8492 from the Three-City study and 5599 from the Whitehall II study; 6668 [47%] of participants were women and 7423 [53%] were men), with a median follow-up of 15·4 years (IQR 10·6–21·2), were included in the analyses. Of these participants, <em>APOE4</em> carriers (3264 [23%] of the cohort carried at least one ε4 allele) had a higher risk of all-cause mortality compared with non-carriers, with hazard ratios (HR) of 1·16 (95% CI 1·07–1·26) for heterozygotes and 1·59 (1·24–2·06) for homozygotes. Compared with <em>APOE3</em> homozygotes, higher cardiovascular mortality was observed in <em>APOE4</em> carriers, with a HR of 1·23 (1·01–1·50) for heterozygotes, and no association was found between <em>APOE4</em> and cancer mortality. Excluding cases of incident dementia over the follow-up resulted in attenuated associations with mortality in homozygotes but not in heterozygotes. The illness-death model indicated that the higher mortality risk in <em>APOE4</em> carriers was not solely attributable to dementia.</p></div><div><h3>Interpretation</h3><p>We found a robust association between <em>APOE4</em> and all-cause and cardiovascular mortality but not cancer mortality. Dementia explained a sig","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 6","pages":"Pages e422-e430"},"PeriodicalIF":13.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000667/pdfft?md5=f558e5586e63a8f953114a471aedc44b&pid=1-s2.0-S2666756824000667-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Hartwell Garred MD , Morten Malmborg PhD , Mariam Elmegaard Malik MD , Deewa Zahir MD , Daniel Mølager Christensen PhD , Anojhaan Arulmurugananthavadivel MD , Prof Emil L Fosbøl PhD , Prof Gunnar Gislason PhD , Prof John J V McMurray MD , Prof Mark C Petrie MD , Charlotte Andersson PhD , Prof Lars Køber DMSc , Prof Morten Schou PhD
{"title":"Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study","authors":"Caroline Hartwell Garred MD , Morten Malmborg PhD , Mariam Elmegaard Malik MD , Deewa Zahir MD , Daniel Mølager Christensen PhD , Anojhaan Arulmurugananthavadivel MD , Prof Emil L Fosbøl PhD , Prof Gunnar Gislason PhD , Prof John J V McMurray MD , Prof Mark C Petrie MD , Charlotte Andersson PhD , Prof Lars Køber DMSc , Prof Morten Schou PhD","doi":"10.1016/S2666-7568(24)00029-1","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00029-1","url":null,"abstract":"<div><h3>Background</h3><p>Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups.</p></div><div><h3>Methods</h3><p>Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18–95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan–Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996–2000, 2001–05, 2006–10, 2011–15, and 2016–20) and three age groups (<65 years, 65–79 years, and ≥80 years).</p></div><div><h3>Findings</h3><p>194 997 patients with heart failure were included. Mortality significantly decreased from 1996–2000 (66% [95% CI 65·5–66·4]) to 2016–20 (43% [42·1–43·4]), with similar results shown in all age groups (<65 years: 35% [33·9–36·1] to 15% [14·6–16·3]; 65–79 years: 64% [63·1–64·5] to 39% [37·6–39·6]; and ≥80 years: 84% [83·1–84·3] to 73% [71·7–73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8–31·0] to 12·7% [12·0–13·4] and 65–79 years: 41·1% [40·3–41·9] to 25·1% [24·4–25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9–31·3] to 28% [27·2–28·8]).</p></div><div><h3>Interpretation</h3><p>Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure.</p></div><div><h3>Funding</h3><p>None.</p></div><div><h3>Translation</h3><p>For the Danish translation of the abstract see Supplementary Materials section.</p></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e326-e335"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000291/pdfft?md5=74e8b71555153d1e90274d8a16e7ca45&pid=1-s2.0-S2666756824000291-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shahram Oveisgharan MD , Tianhao Wang PhD , Lisa L Barnes PhD , Julie A Schneider MD , David A Bennett MD , Aron S Buchman MD
{"title":"The time course of motor and cognitive decline in older adults and their associations with brain pathologies: a multicohort study","authors":"Shahram Oveisgharan MD , Tianhao Wang PhD , Lisa L Barnes PhD , Julie A Schneider MD , David A Bennett MD , Aron S Buchman MD","doi":"10.1016/S2666-7568(24)00033-3","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00033-3","url":null,"abstract":"<div><h3>Background</h3><p>Many studies have reported that impaired gait precedes cognitive impairment in older people. We aimed to characterise the time course of cognitive and motor decline in older individuals and the association of these declines with the pathologies of Alzheimer's disease and related dementias.</p></div><div><h3>Methods</h3><p>This multicohort study used data from three community-based cohort studies (Religious Orders Study, Rush Memory and Aging Project, and Minority Aging Research Study, all in the USA). The inclusion criteria for all three cohorts were no clinical dementia at the time of enrolment and consent to annual clinical assessments. Eligible participants consented to post-mortem brain donation and had post-mortem pathological assessments and three or more repeated annual measures of cognition and motor functions. Clinical and post-mortem data were analysed using functional mixed-effects models. Global cognition was based on 19 neuropsychological tests, a hand strength score was based on grip and pinch strength, and a gait score was based on the number of steps and time to walk 8 feet and turn 360°. Brain pathologies of Alzheimer's disease and related dementias were assessed at autopsy.</p></div><div><h3>Findings</h3><p>From 1994 to 2022, there were 1570 eligible cohort participants aged 65 years or older, 1303 of whom had cognitive and motor measurements and were included in the analysis. Mean age at death was 90·3 years (SD 6·3), 905 (69%) participants were female, and 398 (31%) were male. Median follow-up time was 9 years (IQR 5–11). On average, cognition was stable from 25 to 15 years before death, when cognition began to decline. By contrast, gait function and hand strength declined during the entire study. The combinations of pathologies of Alzheimer's disease and related dementias associated with cognitive and motor decline and their onsets of associations varied; only tau tangles, Parkinson's disease pathology, and macroinfarcts were associated with decline of all three phenotypes. Tau tangles were significantly associated with cognitive decline, gait function decline, and hand function decline (p<0·0001 for each); however, the association with cognitive decline persisted for more than 11 years before death, but the association with hand strength only began 3·57 years before death and the association with gait began 3·49 years before death. By contrast, the association of macroinfarcts with declining gait function began 9·25 years before death (p<0·0001) compared with 6·65 years before death (p=0·0005) for cognitive decline and 2·66 years before death (p=0·024) for decline in hand strength.</p></div><div><h3>Interpretation</h3><p>Our findings suggest that average motor decline in older adults precedes cognitive decline. Macroinfarcts but not tau tangles are associated with declining gait function that precedes cognitive decline. This suggests the need for further studies to test if gait impairment is ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e336-e345"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000333/pdfft?md5=e34bd8bbc108b19f2ab62d243ea22f5d&pid=1-s2.0-S2666756824000333-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"10-h time-restricted eating: are there broad health benefits?","authors":"Wanyang Li , Wei Chen","doi":"10.1016/S2666-7568(24)00045-X","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00045-X","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e304-e305"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266675682400045X/pdfft?md5=b61f07f903018eb2edeeb00eb8632054&pid=1-s2.0-S266675682400045X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Social health and cognition: the mediating role of depression and inflammation","authors":"Shian Ming Tan, Iris Rawtaer","doi":"10.1016/S2666-7568(24)00065-5","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00065-5","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e312-e313"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000655/pdfft?md5=5777a608919fd6e5ddc427b2134b1190&pid=1-s2.0-S2666756824000655-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonas Salling Quist PhD , Hanne Enghoff Pedersen PhD , Marie Møller Jensen PhD , Kim Katrine Bjerring Clemmensen PhD , Natasja Bjerre PhD , Trine Spragge Ekblond MSc , Sarah Uldal MD , Joachim Størling PhD , Nicolai J Wewer Albrechtsen PhD , Prof Jens Juul Holst DMSc , Prof Signe Sørensen Torekov PhD , Martin Erik Nyeland PhD , Dorte Vistisen PhD , Prof Marit Eika Jørgensen PhD , Prof Satchidananda Panda PhD , Prof Christina Brock PhD , Prof Graham Finlayson PhD , Martin Bæk Blond PhD , Kristine Færch PhD
{"title":"Effects of 3 months of 10-h per-day time-restricted eating and 3 months of follow-up on bodyweight and cardiometabolic health in Danish individuals at high risk of type 2 diabetes: the RESET single-centre, parallel, superiority, open-label, randomised controlled trial","authors":"Jonas Salling Quist PhD , Hanne Enghoff Pedersen PhD , Marie Møller Jensen PhD , Kim Katrine Bjerring Clemmensen PhD , Natasja Bjerre PhD , Trine Spragge Ekblond MSc , Sarah Uldal MD , Joachim Størling PhD , Nicolai J Wewer Albrechtsen PhD , Prof Jens Juul Holst DMSc , Prof Signe Sørensen Torekov PhD , Martin Erik Nyeland PhD , Dorte Vistisen PhD , Prof Marit Eika Jørgensen PhD , Prof Satchidananda Panda PhD , Prof Christina Brock PhD , Prof Graham Finlayson PhD , Martin Bæk Blond PhD , Kristine Færch PhD","doi":"10.1016/S2666-7568(24)00028-X","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00028-X","url":null,"abstract":"<div><h3>Background</h3><p>Time-restricted eating (TRE) has been suggested to be a simple, feasible, and effective dietary strategy for individuals with overweight or obesity. We aimed to investigate the effects of 3 months of 10-h per-day TRE and 3 months of follow-up on bodyweight and cardiometabolic risk factors in individuals at high risk of type 2 diabetes.</p></div><div><h3>Methods</h3><p>This was a single-centre, parallel, superiority, open-label randomised controlled clinical trial conducted at Steno Diabetes Center Copenhagen (Denmark). The inclusion criteria were age 30–70 years with either overweight (ie, BMI ≥25 kg/m<sup>2</sup>) and concomitant prediabetes (ie, glycated haemoglobin [HbA<sub>1c</sub>] 39–47 mmol/mol) or obesity (ie, BMI ≥30 kg/m<sup>2</sup>) with or without prediabetes and a habitual self-reported eating window (eating and drinking [except for water]) of 12 h per day or more every day and of 14 h per day or more at least 1 day per week. Individuals were randomly assigned 1:1 to 3 months of habitual living (hereafter referred to as the control group) or TRE, which was a self-selected 10-h per-day eating window placed between 0600 h and 2000 h. Randomisation was done in blocks varying in size and was open for participants and research staff, but outcome assessors were masked during statistical analyses. The randomisation list was generated by an external statistician. The primary outcome was change in bodyweight, assessed after 3 months (12 weeks) of the intervention and after 3 months (13 weeks) of follow-up. Adverse events were reported and registered at study visits or if participants contacted study staff to report events between visits. This trial is registered on <span>ClinicalTrials.gov</span><svg><path></path></svg> (<span>NCT03854656</span><svg><path></path></svg>).</p></div><div><h3>Findings</h3><p>Between March 12, 2019, and March 2, 2022, 100 participants (66 [66%] were female and 34 [34%] were male; median age 59 years [IQR 52–65]) were enrolled and randomly assigned (50 to each group). Of those 100, 46 (92%) in the TRE group and 46 (92%) in the control group completed the intervention period. After 3 months of the intervention, there was no difference in bodyweight between the TRE group and the control group (–0·8 kg, 95% CI –1·7 to 0·2; p=0·099). Being in the TRE group was not associated with a lower bodyweight compared with the control group after subsequent 3-month follow-up (–0·2 kg, –1·6 to 1·2). In the per-protocol analysis, participants who completed the intervention in the TRE group lost 1·0 kg (–1·9 to –0·0; p=0·040) bodyweight compared with the control group after 3 months of intervention, which was not maintained after the 3-month follow-up period (–0·4 kg, –1·8 to 1·0). During the trial and follow-up period, one participant in the TRE group reported a severe adverse event: development of a subcutaneous nodule and pain when the arm was in use. This side-effect was evaluated to be related to the ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e314-e325"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266675682400028X/pdfft?md5=2a86b774d05269156d86de416e4f9463&pid=1-s2.0-S266675682400028X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Declining motor and cognitive functioning and the role of gait in dementia","authors":"Emma Nichols , Jennifer S Rabin","doi":"10.1016/S2666-7568(24)00049-7","DOIUrl":"https://doi.org/10.1016/S2666-7568(24)00049-7","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 5","pages":"Pages e308-e309"},"PeriodicalIF":13.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824000497/pdfft?md5=cfdadbd8c8161b994d5c5c4624b0b8f5&pid=1-s2.0-S2666756824000497-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140824639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}