2 heart medications tied to greater heart-attack risk during very hot weather

 For people with coronary heart disease, beta-blockers can improve survival and quality of life, while aspirin and other antiplatelet medications can reduce the risk of a heart attack.

But those protections could backfire during hot-weather events, a time when heart attacks are more likely. A new study found that, among people suffering non-fatal heart attacks associated with hot weather, an outsize portion are taking these heart drugs.

“Patients taking these two medications have higher risk,” said Kai Chen, an assistant professor in the Department of Epidemiology (Environmental Health) at the Yale School of Public Health and first author of the study. “During heat waves, they should really take precautions.” 

Those precautions include cooling strategies like using air conditioning or visiting a public cooling center.

External environmental factors like air pollution and cold weather can trigger heart attacks. Growing evidence suggests hot weather can do so, too. But epidemiologists are still working to identify which groups of people are most vulnerable to these environmental extremes.

Methods

Using a registry, the authors looked at 2,494 cases in which individuals experienced a non-fatal heart attack in Augsburg, Germany during the hot-weather months (May through September) between 2001 and 2014.

In previous research, they had shown that exposure to either heat or cold made heart attacks more likely, and they calculated that heat-related heart-attack rates would rise once the planet has warmed by 2 to 3 degrees Celsius.

The current study built on that research by examining patients’ medication use prior to their heart attack.

They analyzed the data in a way that let patients serve as their own controls, by comparing heat exposure on the day of the heart attack versus the same days of the week within the same month. That is, if a person had a heart attack on the third Thursday in June, the authors compared their temperature exposure that day to their temperature exposure on other, “control” Thursdays in June.

Two medications tied to risk

It turned out that users of beta-blockers or antiplatelet medications were likelier to have heart attacks during the hottest days compared to control days. Antiplatelet medication use was associated with a 63% increase in risk and beta-blockers with a 65% increase. People taking both drugs had a 75% higher risk. Non-users of those medications were not more likely to have a heart attack on hot days.

The study doesn’t prove that these medications caused the heart attacks, nor that they make people more vulnerable to heart attack. Although it’s possible that they did increase the risk of heart attacks triggered by hot weather, it’s also possible that patients’ underlying heart disease explains both the prescriptions and the higher susceptibility to heart attack during hot weather.

Still, one clue does suggest the medications could be to blame.

When researchers compared younger patients (25 to 59 years) to older ones (60 to 74 years), they found, as expected, that the younger ones were a healthier group, with lower rates of coronary heart disease. Yet younger patients taking beta-blockers and antiplatelet medications were more susceptible to heat-related heart attack than older patients, despite the older ones having more heart disease.

Another clue that these two medication types may render people more vulnerable: For the most part, other heart medications didn’t show a connection to heat-related heart attacks. (An exception was statins. When taken by younger people, statins were associated with an over threefold risk of a heart attack on hot days.)

“We hypothesize that some of the medications may make it hard to regulate body temperature,” Chen said. He plans to try to untangle these relationships in future studies.

The results suggest that as climate change progresses, heart attacks might become a greater hazard to some people with cardiovascular disease.

The study appears online in Nature Cardiovascular Research. It was funded by the German Foundation of Heart Research, the University of Augsburg, and the University Hospital of Augsburg, Germany.

Professor Robert Dubrow was a co-author and Alexandra Schneider of Germany’s Helmholtz Zentrum Munchen was last author. The other co-authors were Susanne Breitner, Kathrin Wolf, Margit Heier, and Annette Peters, all of the Helmholtz Zentrum München–German Research Center; Jakob Linseisen of Ludwig-Maximilians-Universität München and University Hospital Augsburg; Timo Schmitz, Wolfgang von Scheidt, and Christa Meisinger of University Hospital Augsburg; and Bernhard Kuch of Hospital of Nördlingen (Germany). Brietner and Peters are also affiliated with Ludwig-Maximilians-Universität München, Peters with German Research Center for Cardiovascular Research, and Heier with University Hospital Augsburg.

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JOURNAL

Nature Cardiovascular Research

DOI

10.1038/s44161-022-00102-z 

ARTICLE TITLE

Triggering of myocardial infarction by heat exposure is modified by medication intake

ARTICLE PUBLICATION DATE

1-Aug-2022

https://www.eurekalert.org/news-releases/960506

Space travel: Bone aging in fast forward

 Long periods in space damage bone structure irreparably in some cases and can make parts of the human skeleton age prematurely by up to 10 years. This is what a sport scientist at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) has now discovered in conjunction with other researchers from Germany, Canada and the USA. Adapted training programs in conjunction with medication could provide better protection for astronauts on future space missions. The researchers have published their findings, which will now be also be used for treating rheumatic conditions in clinical practice, in the scientific journal Nature Scientific Reports.

Will humans one day fly to Mars? Such a mission has been the subject of debate for several decades and does not depend simply on technical requirements. "If human beings are in space for three years at a time, we need to keep an eye on the health risks involved as well," says Dr. Anna-Maria Liphardt. "This already applies today for missions where astronauts are subject to zero-gravity conditions for usually no longer than six months."

After space travel: Bones age by up to ten years

Liphardt is a sports scientist and gained her doctoral degree at the German Aerospace Center (DLR) and the German Sport University Cologne and now researches the effects of rheumatic-inflammatory diseases on the human skeleton at Universitätsklinikum Erlangen. In conjunction with fellow researchers from Germany, Canada and the USA, she investigated how bone structure changes in space and recovers back on Earth in a long-term study. 14 men and three women were checked before their flights into space as well as six and twelve months after their return. The bone density and strength of the tibia and radius (shin bone and lower arm bone) were measured as well as the trabecular microstructure inside the bones. The bone turnover was also measured using biomarkers in their blood and urine.

The results are worrying: Even twelve months after the end of their missions in space, nine out of the 17 astronauts had not completely recovered and had a reduction in bone strength and bone mineral density of up to 2 percent. "This may not sound like much, but it corresponds to age-related bone loss of at least a decade," explains Anna-Maria Liphardt. "For those affected, this means they will have to expect a much earlier onset of osteoporosis and susceptibility for fractures." In contrast to aging on Earth, the inner structure of astronauts' bones are affected more than the periosteum on the exterior surface. Some of the astronauts examined even have irreparable damage to the rod-shaped units or trabeculae. "We were able to demonstrate that regeneration is more difficult the longer the astronauts were in space," says Liphardt.

Training and medication must be adapted

Astronauts with higher bone turnover before spaceflight also had more significant problems with bone regeneration. "Bone turnover is the process by which cells are broken down and new ones form," explains Liphardt. "People with higher activity levels have a higher bone turnover and the challenge is to keep up these activity levels during missions in space." Even though the ISS has various types of equipment such as a running machine, exercise bike and a weight training program for the astronauts to maintain their levels of activity, adapting the training programs during spaceflight to better meet the individual needs of the astronauts is crucial. Liphardt: "Developing new sports equipment that works in zero-gravity conditions and that does not take up much space is particularly challenging."

Astronauts could also benefit from medication if it is taken during spaceflight in addition to exercise programs. This medication includes, for example, bisphosphonates, which are already successfully used for treating and preventing osteoporosis because they prevent bone degradation. "Bisphosphonates are already used by NASA, but we do not yet know enough about exactly how they work in microgravity," explains Liphardt. "We recommend conducting further systematic research into the combination of medical therapy and physical exercise."

Findings for clinical practice

The researchers' study not only supplied findings for future missions to space. Muscle and bone loss due to a lack of activity are also key problems in chronic diseases here on Earth. "In the field of rheumatology, it is not always clear which damage is caused by the inflammation and which by inactivity," says Liphardt. "Our study could thus also lay the foundations for new or adapted therapies."

A new generation of high-resolution peripheral quantitative computer tomography (HR-pQCT) machines used during the study with the astronauts could be beneficial for these therapies. These machines are capable of producing high resolution images of the interior structure of bones. "An algorithm was used in older machines in order to generate the individual parameters of the microstructure from the images it produced," explains Liphardt. "This led to imprecise results, especially in trabecular changes to the bone." The Department of Medicine 3 at Universitätsklinikum Erlangen now has a latest generation HR-pQCT machine -- which is set to benefit not astronauts but patients suffering from diseases of the muscular and skeletal systems.

Story Source:

Materials provided by Friedrich-Alexander-Universität Erlangen-Nürnberg. Note: Content may be edited for style and length.

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Journal Reference:

1. Leigh Gabel, Anna-Maria Liphardt, Paul A. Hulme, Martina Heer, Sara R. Zwart, Jean D. Sibonga, Scott M. Smith, Steven K. Boyd. Incomplete recovery of bone strength and trabecular microarchitecture at the distal tibia 1 year after return from long duration spaceflight. Scientific Reports, 2022; 12 (1) DOI: 10.1038/s41598-022-13461-1

https://www.sciencedaily.com/releases/2022/07/220729173222.htm

Llining of children's noses may provide protection from SARS-CoV-2 infection

 SARS-CoV-2 causes a broad range of clinical symptoms, including potentially fatal acute respiratory distress syndrome (ARDS). A study published August 1 in the open access journal PLOS Biology by Kirsty Short at University of Queensland, Queensland, Australia, and colleagues suggests the nasal epithelium (the lining of the nose) of children inhibits infection and replication of the ancestral strain of the SARS-CoV-2 virus and the Delta variant, but not the Omicron variant.

Children have a lower COVID-19 infection rate and milder symptoms than adults. However, the factors driving this apparent pediatric resistance to COVID-19 infections are unknown. In order to better understand lower infection and replication of ancestral SARS-CoV-2 virus in children, researchers obtained samples of primary nasal epithelium cells (NEC) from twenty-three healthy children aged 2-11 and fifteen healthy adults aged 19-66 in Australia. They exposed the cells of adults and children to SARS-CoV-2 and then observed the infection kinetics and antiviral responses in children compared to adults.

The researchers found that ancestral SARS-CoV-2 replicated less efficiently and was associated with a heightened antiviral response in the nasal epithelial cells of children. This lower viral replication rate was also observed with the Delta variant, but not the more recent Omicron variant. The study had several limitations however, including a small sample size, so future clinical studies will be needed to validate these preliminary findings in a larger population and to determine the role of other factors, such as antibodies in protecting children from SARS-CoV-2 infection. Additionally, pediatric protection from emerging variants has yet to be quantified.

According to the authors, "We have provided the first experimental evidence that the pediatric nasal epithelium may play an important role in reducing the susceptibility of children to SARS-CoV-2. The data strongly suggest that the nasal epithelium of children is distinct and that it may afford children some level of protection from ancestral SARS-CoV-2."

Short adds, "We use nasal epithelial cells from children and adults to show that the ancestral SARS-CoV-2 and Delta, but not Omicron, replicate less efficiently in pediatric nasal epithelial cells."

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Story Source:

Materials provided by PLOS. Note: Content may be edited for style and length.

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Journal Reference:

1. Yanshan Zhu, Keng Yih Chew, Melanie Wu, Anjana C. Karawita, Georgina McCallum, Lauren E. Steele, Ayaho Yamamoto, Larisa I. Labzin, Tejasri Yarlagadda, Alexander A. Khromykh, Xiaohui Wang, Julian D. J. Sng, Claudia J. Stocks, Yao Xia, Tobias R. Kollmann, David Martino, Merja Joensuu, Frédéric A. Meunier, Giuseppe Balistreri, Helle Bielefeldt-Ohmann, Asha C. Bowen, Anthony Kicic, Peter D. Sly, Kirsten M. Spann, Kirsty R. Short. Ancestral SARS-CoV-2, but not Omicron, replicates less efficiently in primary pediatric nasal epithelial cells. PLOS Biology, 2022; 20 (8): e3001728 DOI: 10.1371/journal.pbio.3001728

https://www.sciencedaily.com/releases/2022/08/220801150452.htm

Lilly, AZ, AbbVie, J&J face potential hit from Medicare pricing bill

 After years of government standstill on drug prices in the U.S., could the Senate this week pass a "watershed" bill enabling drug price negotiations? It remains to be seen, but analysts are busy poring over the available details to see how the legislation may affect the industry's top players.

Among big drugmakers, Eli Lilly, AstraZeneca, AbbVie and Johnson & Johnson are particularly exposed to the current Medicare negotiation proposal, analysts with SVB Securities wrote in a Friday note to clients. The companies sell a mix of lucrative oncology and diabetes medicines in Medicare.

As the legislation stands, if passed, Medicare would be able to control drug prices for 10 medicines in 2026, with the number growing to 60 by 2029, the analysts said. In 2026 and 2027, Medicare would only control Part D drug prices, but in 2028, it could also negotiate prices in Part B, where doctors administer therapies, according to the SVB team.

Medicines would be eligible for Medicare negotiations after nine or 13 years on the market, depending on whether they are a small molecule or a biologic. But because pharmaceutical companies often secure much longer periods of exclusivity than either nine or 13 years, the bill risks cutting off the "tail" of profitable drug sales, the SVB analysts pointed out. Drugs at risk of losing their "tail" include Johnson & Johnson's multiple myeloma med Darzalex plus AstraZeneca's cancer therapies Tagrisso and Calquence.

For drugs facing a generic or biosimilar rival, Medicare would no longer seek to negotiate prices, the SVB team pointed out.

"We are concerned about the negative impact of proposed legislation on future innovation and the financials associated with some of the most helpful drugs for Medicare recipients," the SVB analysts wrote. "Not only would the economics for many drugs be curtailed before loss of exclusivity, but innovators’ willingness to develop new drugs, in particular small molecule therapies for seniors, would likely diminish."

Notably, Merck doesn't have much exposure to the proposal because its superstar oncology drug Keytruda is expected to face expected biosimilars in 2028, or the first year that Part B drugs would be included, the analysts noted.

But there's still uncertainty around the discussions. The analysts are waiting to see the final legislation, plus they're waiting on whether the Senate parliamentarian supports the "teeth" of the bill that would give Medicare its negotiating power. And it's an open question as to whether the Senate can pass the bill before it goes on recess at the end of the week.

As congressional discussions have played out in recent weeks, biopharma has mounted a defense. Last month, Michelle McMurry-Heath, president and CEO of the trade group the Biotechnology Innovation Organization, called the Medicare negotiation proposal "misguided" and said it would "ultimately harm the very patients and seniors that lawmakers claim to be helping."

In all, the SVB analysts pointed out two "positives" and five "negatives" for the drug industry in their review of the available details. On the plus side, the analysts said many of today's top drugs don't face much exposure thanks to their projected loss of exclusivity later in the decade. And because Part B drugs aren't expected to be included until 2028, many existing big-selling medicines won't see much of an effect.

But the negatives outweigh the positives for the industry, the analysts figure. For one, the new discounts would apply to "gross" prices, but companies already pay sizable rebates in Medicare. That means the companies could have to make "massive payments to the government relative to reported net sales," the SVB team wrote.

Further, products such as CAR-T therapies and vaccines, which were expected to be safe from biosimilar competition, would face "significant" risk. 

While SVB's list of concerns goes on, the team also warned that the government could get more aggressive on drug pricing in the future if the bill passes.

Lawmakers and U.S. officials have been publicly hitting at high drug prices for years, but the government has been unable to pass major reform despite the subject being popular among voters. In June, a West Health/Gallup survey found 8 in 10 Americans favored government drug pricing actions over concerns of the reform hurting pharmaceutical innovation.

https://www.fiercepharma.com/pharma/lilly-az-abbvie-and-jj-face-big-potential-hit-medicare-pricing-bill-analysts

Cellectis OKd to Start 1st Product Candidate for B-cell Malignancies

 Cellectis (the “Company”) (Euronext Growth: ALCLS - NASDAQ: CLLS), a clinical-stage biotechnology company using its pioneering gene-editing platform to develop life-saving cell and gene therapies, today announced that the U.S. Food and Drug Administration (FDA) has cleared Cellectis’ Investigational New Drug (IND) application to initiate a Phase 1/2a clinical trial of UCART20x22 for patients with relapsed or refractory Non-Hodgkin Lymphoma (r/r NHL). The Company plans to begin enrolling patients in the NatHaLi-01 study in the second half of the year.

“We are delighted that the FDA has cleared our IND application for UCART20x22,” said André Choulika, PhD, Chief Executive Officer of Cellectis. “This is a very exciting product candidate, for two reasons: UCART20x22 will be our first dual allogeneic CAR T product candidate to enter clinical development, and dual targeting of CD20 and CD22, both validated targets in B-cell malignancies, has the potential to enhance tumor cell killing and increases the breadth of antigen targeting. These advantages may increase the addressable patient population and represent a potential therapeutic alternative to CD19-directed therapies.

UCART20x22 is also our first product candidate with fully integrated in-house development, showcasing our transformation into an end-to-end cell and gene therapy company, from discovery, process development, and GMP manufacturing to clinical development. We are very excited to start the clinical trial for patients with relapsed or refractory Non-Hodgkin Lymphoma.”

UCART20x22 features TALEN®-mediated disruptions of the TRAC gene (that has been shown to reduce the risk of graft-versus-host disease) and of the CD52 gene (to allow using a CD52-directed monoclonal antibody in patients’ preconditioning regimen and enhancing CAR T engraftment, expansion and persistence).

https://finance.yahoo.com/news/cellectis-receives-ind-clearance-ucart20x22-203000428.html

'Staggering' CVD Rise Projected in US, Especially in Minorities

 A new analysis projects steep increases by 2060 in the prevalence of cardiovascular (CV) risk factors and disease that will disproportionately affect non-White populations who have limited access to healthcare.

The study by Reza Mohebi, MD, Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues was published in the August 9 issue of the Journal of the American College of Cardiology .

"Even though several assumptions underlie these projections, the importance of this work cannot be overestimated," Andreas P. Kalogeropoulos, MD, MPH, PhD, and Javed Butler, MD, MPH, MBA, write in an accompanying editorial. "The absolute numbers are staggering."

From 2025 to 2060, the number of people with any one of four CV risk factors — type 2 diabetes, hypertension, dyslipidemia, and obesity — is projected to increase by 15.4 million, to 34.7 million.

And the number of people with of any one of four CV disease types — ischemic heart disease, heart failure, myocardial infarction, and stroke — is projected to increase by 3.2 million, to 6.8 million.

Although the model predicts that the prevalence of CV risk factors will gradually decrease among White Americans, the highest prevalence of CV risk factors will be among the White population because of its overall size.

Conversely, the projected prevalence of CV risk factors is expected to increase in Black, Hispanic, Asian, and other race/ethnicity populations.

In parallel, the prevalence of CV disease is projected to decrease in the White population and increase among all other race/ethnicities, particularly in the Black and Hispanic populations.

"Our results project a worrisome increase with a particularly ominous increase in risk factors and disease in our most vulnerable patients, including Blacks and Hispanics," senior author James L. Januzzi, Jr, MD, summarized in a video issued by the society.

"The steep rise in CV risk factors and disease reflects the generally higher prevalence in populations projected to increase in the United States, owing to immigration and growth, including Black or Hispanic individuals," Januzzi, also from Massachusetts General and Harvard, explained to theheart.org | Medscape Cardiology in an email.

"The disproportionate size of the risk is expected in a sense, as minority populations are disproportionately disadvantaged with respect to their healthcare," he said. "But whether it is expected or not, the increase in projected prevalence is, nonetheless, concerning and a call to action."

This study identifies "areas of opportunity for change in the US healthcare system," he continued. "Business as usual will result in us encountering a huge number of individuals with CV risk factors and diseases."

The results from the current analysis assume there will be no modification in healthcare policies or changes in access to care for at-risk populations, Mohebi and colleagues note.

To "stem the rising tide of CV disease in at-risk individuals," would require strategies such as "emphasis on education regarding CV risk factors, improving access to quality healthcare, and facilitating lower-cost access to effective therapies for treatment of CV risk factors," according to the researchers.

"Such advances need to be applied in a more equitable way throughout the United States, however," they caution.

Census Plus NHANES Data

The researchers used 2020 US census data and projected growth and 2013 to 2018 US National Health and Nutrition Survey (NHANES) data to estimate the number of people with CV risk factors and CV disease from 2025 to 2060.

The estimates are based on a growing population and a fixed frequency.

Projected Change in CV Risk Factors in the American Population From 2025 to 2060
Risk Factor	Increase (%)	Absolute Increase (Millions)
Type 2 diabetes	39.3	15.4
Hypertension	27.1	34.7
Dyslipidemia	27.6	27.1
Obesity	18.3	19.4

 

Projected Change in CVD in the American Population From 2025 to 2060
Disease	Increase (%)	Absolute Increase (Millions)
Ischemic heart disease	30.7	6.8
Heart failure	33.4	3.2
Myocardial infarction	16.9	3.7
Stroke	33.8	3.7

The projected changes in CV risk factors and disease over time were similar in men and women.

The researchers acknowledge that study limitations include the assumption that the prevalence patterns for CV risk factors and disease will be stable.

"To the extent the frequency of risk factors and disease are not likely to remain static, that assumption may reduce the accuracy of the projections," Januzzi said. "However, we would point out that the goals of our analysis were to set general trends, and not to seek to project exact figures."

Also, they did not take into account the effect of COVID-19. CV diseases were also based on self-report and CV risk factors could have been underestimated in minority populations that do not access healthcare.

Changing Demographic Landscape

It is "striking" that the numbers of non-White individuals with CV risk factors is projected to surpass the number of White individuals over time, and the number of non-White individuals with CV disease will be almost as many as White individuals by the year 2060, the editorialists note.

"From a policy perspective, this means that unless appropriate, targeted action is taken, disparities in the burden of cardiovascular disease are only going to be exacerbated over time," write Kalogeropoulos, from Stony Brook University, New York, and Butler, from Baylor University, Dallas.

"On the positive side," they continue, "the absolute increase in the percent prevalence of cardiovascular risk factors and conditions is projected to lie within a manageable range," assuming that specific prevention policies are implemented.

"This is an opportunity for professional societies, including the cardiovascular care community, to re-evaluate priorities and strategies, for both training and practice, to best match the growing demands of a changing demographic landscape in the United States," Kalogeropoulos and Butler conclude.

Mohebi is supported by the Barry Fellowship. Januzzi is supported by the Hutter Family Professorship; is a Trustee of the American College of Cardiology; is a board member of Imbria Pharmaceuticals; has received grant support from Abbott Diagnostics, Applied Therapeutics, Innolife, and Novartis; has received consulting income from Abbott Diagnostics, Boehringer Ingelheim, Janssen, Novartis, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for AbbVie, Siemens, Takeda, and Vifor. The disclosures of the other authors are listed with the article. Kalogeropoulos has received research funding from the National Heart, Lung, and Blood Institute, the American Heart Association, and the Centers for Disease Control and Prevention. Butler has been a consultant for Abbott, Amgen, American Regent, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Medtronic, Merck, Novartis, Novo Nordisk, Pfizer, Roche, and Vifor.

J Am Coll Cardiol. 2022;80: 565-578, 579-583. Abstract, Editorial

https://www.medscape.com/viewarticle/978366

More Evidence Ultraprocessed Foods Detrimental for the Brain

 More research suggests that eating a diet high in ultraprocessed foods (UPFs) is harmful for the aging brain.

Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), which included participants aged 35 and older, showed that higher intake of UPF was significantly associated with a faster rate of decline in both executive and global cognitive function.

"Based on these findings, doctors might counsel patients to prefer cooking at home [and] choosing fresher ingredients instead of buying ready-made meals and snacks," co-investigator Natalia Goncalves, PhD, University of São Paulo Medical School, Brazil, told Medscape Medical News.

Presented at the Alzheimer's Association International Conference (AAIC) 2022, the findings align with those from a study published last week in Neurology. As reported at the time by Medscape Medical News, that study linked a diet high in UPFs to an increased risk for dementia.

Increasing Worldwide Consumption

UPFs are highly manipulated, are packed with added ingredients, including sugar, fat, and salt, and are low in protein and fiber. Examples of UPFs include soft drinks, chips, chocolate, candy, ice cream, sweetened breakfast cereals, packaged soups, chicken nuggets, hotdogs, fries, and many more.

Over the past 30 years, there has been a steady increase in consumption of UPFs worldwide. They are thought to induce systemic inflammation and oxidative stress and have been linked to a variety of ailments, such as overweight/obesity, cardiovascular disease, and cancer.

UPFs may also be a risk factor for cognitive decline, although data are scarce as to their effects on the brain.

To investigate, Goncalves and colleagues evaluated longitudinal data on 10,775 adults (mean age, 50.6 years; 56% women; 55% White) who participated in the ELSA-Brasil study. They were evaluated in three waves (2008–2010, 2012–2014, and 2017–2019).

Information on diet was obtained via food frequency questionnaires and included information regarding consumption of unprocessed foods, minimally processed foods, and UPFs.

Participants were grouped according to UPF consumption quartiles (lowest to highest). Cognitive performance was evaluated using a standardized battery of tests.

Significant Decline

Using linear mixed effects models that were adjusted for sociodemographic, lifestyle, and clinical variables, the investigators assessed the association of dietary UPFs as a percentage of total daily calories with cognitive performance over time.

During a median follow-up of 8 years, UPF intake in quartiles 2 to 4 (vs quartile 1) was associated with a significant decline in global cognition (P = .003) and executive function (P = .015).

"Participants who reported consumption of more than 20% of daily calories from ultraprocessed foods had a 28% faster rate of global cognitive decline and a 25% faster decrease of the executive function compared to those who reported eating less than 20% of daily calories from ultraprocessed foods," Goncalves reported.

"Considering a person who eats a total of 2000 kcal a day, 20% of daily calories from ultraprocessed foods are about two 1.5 oz bars of KitKat, or five slices of bread, or about a third of an 8.5-oz package of chips," she explained.

Goncalves noted that the reasons UPFs may harm the brain remain a "very relevant but not yet well-studied topic."

Hypotheses include secondary effects from cerebrovascular lesions or chronic inflammation processes. More studies are needed to investigate the possible mechanisms that might explain the harm of UPFs to the brain, she said.

"Troubling but Not Surprising"

Commenting on the study for Medscape Medical News, Percy Griffin, PhD, director of scientific engagement for the Alzheimer's Association, said there is "growing evidence that what we eat can impact our brains as we age."

He added that many previous studies have suggested it is best for the brain for one to eat a heart-healthy, balanced diet that is low in processed foods and high in whole, nutritional foods, such as vegetables and fruits.

"These new data from the Alzheimer's Association International Conference suggest eating a large amount of ultraprocessed food can significantly accelerate cognitive decline," said Griffin, who was not involved with the research.

He noted that an increase in the availability and consumption of fast foods, processed foods, and UPFs is due to a number of socioeconomic factors, including low access to healthy foods, less time to prepare foods from scratch, and an inability to afford whole foods.

"Ultraprocessed foods make up more than half of American diets. It's troubling but not surprising to see new data suggesting these foods can significantly accelerate cognitive decline," Griffin said.

"The good news is there are steps we can take to reduce risk of cognitive decline as we age. These include eating a balanced diet, exercising regularly, getting good sleep, staying cognitively engaged, protecting from head injury, not smoking, and managing heart health," he added.

Past research has suggested that the greatest benefit is from engaging in combinations of these lifestyle changes and that they are beneficial at any age, he noted.

"Even if you begin with one or two healthful actions, you're moving in the right direction. It's never too early or too late to incorporate these habits into your life," Griffin said.

The study had no specific funding. Goncalves and Griffin have reported no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2022: Abstract 63301. Presented August 1, 2022.

https://www.medscape.com/viewarticle/978365