Medical Bulletin 1/ March/ 2024

A new UCLA Health study, published in the journal Translational Psychiatry, has found that yoga offers multiple cognitive benefits for older women at risk of Alzheimer's disease. These include restoring neural pathways, preventing brain matter decline, and reversing aging and inflammation-associated biomarkers.

Led by UCLA Health psychiatrist Dr. Helen Lavretsky of the Jane and Terry Semel Institute for Neuroscience and Human Behavior, the study aimed to assess if certain types of yoga could mitigate cognitive decline and Alzheimer's disease trajectories in postmenopausal women, who face approximately twice the risk of developing the condition compared to men, attributed to factors such as longer life expectancy, menopausal estrogen level changes, and genetics.

For the study, over 60 women aged 50 and above with self-reported memory problems and cerebrovascular risk factors were recruited from a UCLA cardiology clinic. They were split into two groups: one engaged in weekly Kundalini yoga sessions for 12 weeks, while the other underwent weekly memory enhancement training. Researchers evaluated cognition, subjective memory, depression, and anxiety after the initial 12 weeks and again 12 weeks later to evaluate the sustainability of any improvements. Blood samples were collected to analyse gene expression related to ageing markers and inflammation, both linked to Alzheimer's disease. Additionally, a subset of patients underwent MRIs to examine brain matter changes.

The findings revealed that participants in the Kundalini yoga group experienced several enhancements not observed in the memory enhancement training group. These included notable improvements in subjective memory complaints, prevention of brain matter declines, heightened connectivity in the hippocampus responsible for stress-related memories, and positive changes in peripheral cytokines and gene expression of anti-inflammatory and anti-ageing molecules.

"That is what yoga is good for -- to reduce stress, to improve brain health, subjective memory performance and reduce inflammation and improve neuroplasticity," concluded Lavretsky.

References: Adrienne Grzenda, Prabha Siddarth, Michaela M. Milillo, Yesenia Aguilar-Faustino, Dharma S. Khalsa, Helen Lavretsky. Cognitive and immunological effects of yoga compared to memory training in older women at risk for Alzheimer’s disease. Translational Psychiatry, 2024; 14 (1) DOI: 10.1038/s41398-024-02807-0

Study identifies blood biomarkers to forecast cardiovascular disease risk in rheumatoid arthritis patients

A recent study in the Journal of the American Heart Association, led by physicians at Mass General Brigham, identified six blood biomarkers linked to cardiovascular risk in rheumatoid arthritis patients which helped in improving predictions of future arterial inflammation.

Rheumatoid arthritis impacts approximately 17.6 million people globally and is associated with an increased risk of cardiovascular disease. Assessing cardiovascular risk is difficult in patients with rheumatoid arthritis because standard clinical assessments based on factors like age, cholesterol, and smoking status tend to underestimate cardiovascular risk in individuals with rheumatoid arthritis.

“We think these biomarkers might improve our ability to predict risk and intervene early to help our patients,” said first author Daniel H. Solomon, MD, MPH, chief of the Section of Clinical Sciences in the Division of Rheumatology. “The idea is that if we measure biomarkers that are specific to rheumatoid arthritis, we might be able to better identify those at highest risk of cardiovascular events.”

To identify rheumatoid arthritis-specific biomarkers of cardiovascular risk, the researchers assembled a panel of 24 candidate biomarkers that had been previously shown to be associated with rheumatoid arthritis and systemic inflammation and measured the concentration of these biomarkers in 109 patients with rheumatoid arthritis who were taking part in a randomized clinical trial (the TARGET Trial) to compare the efficacy of two different treatments for rheumatoid arthritis at preventing cardiovascular disease. They measured the biomarkers at the beginning of the study and six months later, imaging the patients’ arteries at each time to assess their arterial inflammation—an indicator of cardiovascular risk.

The findings of the study revealed that six of the 24 biomarkers were associated with increased cardiovascular risk and could be used in predictive models to improve the researchers’ ability to predict increases in arterial inflammation compared to standard clinical indices which are based on factors such as age, sex, cholesterol, blood pressure, diabetes, and smoking.

“Arterial inflammation can predict future cardiovascular disease risk,” said cardiologist and co-author Ahmed Tawakol, MD, the director of Nuclear Cardiology and co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital. “If you take a snapshot of a person's blood vessels, the more inflammation that is measured there, the greater the likelihood the person will have progression of their disease, and the greater likelihood that they will have a stroke or a myocardial infarction.”

Reference: Hunter TM, Boytsov NN, Zhang X, Schroeder K, Michaud K, Araujo AB. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004–2014. Rheumatol Int. 2017; 37:1551–1557. DOI: 10.1161/JAHA.123.032095

Smoking cannabis linked to higher risk of heart attack and stroke

A recent study, published in the Journal of the American Heart Association, highlights the potential cardiovascular risks associated with frequent cannabis smoking and that individuals who smoke cannabis regularly may face a significantly heightened risk of experiencing heart attacks and strokes.

Cannabis consumption has increased significantly within the past 20 years as negative perceptions of its use has declined. Some studies have linked its regular use to impaired brain development and lung damage, as well as to certain cardiovascular diseases. While the exact mechanisms linking cannabis to heart disease are unclear, multiple factors could play a role. In addition to toxins, endocannabinoid receptors — the part of cells responsible for recognizing tetra-hydro-cannabinol (THC), the main psychoactive ingredient in cannabis — are widespread in the body’s cardiovascular tissues and might facilitate heart risks.

To explore the link between cannabis use and health, Abra Jeffers, Ph.D., a data analyst at Massachusetts General Hospital in Boston, along with her team analyzed 2016–2020 data from the CDC's Behavioral Risk Factor Surveillance Survey which included 4,34,104 adults aged 18-74. They assessed how often participants smoked cannabis in the past 30 days and its association with self-reported cardiovascular outcomes, such as coronary heart disease, heart attack, stroke, and a composite measure of all three. The analysis adjusted for various factors, including tobacco use, age, sex, race, BMI, obesity, diabetes, physical activity, and socioeconomic status.

The findings revealed that daily use of cannabis was associated with 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared to non-use of the drug. Less frequent use was also associated with an increased risk of cardiovascular events. Weekly users showed a 3% increased likelihood of heart attack and a 5% increased likelihood of stroke.

“We've known for a long time that smoking tobacco is linked to heart disease, and this study is evidence that smoking cannabis appears to also be a risk factor for cardiovascular disease, which is the leading cause of death in many countries,” Jeffers said. “Cannabis use could be an important, underappreciated source of heart disease.”