Health Newsfeed – Johns Hopkins Medicine Podcasts

The United States Preventive Services Task Force has just updated their guidelines on managing blood pressure. Greg Prokopowicz, a blood pressure expert at Johns Hopkins, says managing your blood pressure starts with getting it measured.

Prokopowicz: Starting at age 18, you should have your blood pressure checked. Another question is how often should you have it checked? So if you’re under 40 and your blood pressure is quote unquote normal, which by current guidelines would actually be under 120 over 80, so that would mean your blood pressure would have to been in the one-teens over 70s or lower. If your blood pressure is normal then they say check it every several years maybe every three years but if it’s in the high normal range, in the 120s over 70s, then you’d probably want to monitor it approximately yearly.   :33

Prokopowicz says some people may need to measure their blood pressure much more often, in particular when they’ve had a number of readings that indicate it is high. He says your provider can tell you if this is a necessary step for you. At Johns Hopkins, I’m Elizabeth Tracey.

Consumption of sugar sweetened beverages may explain part of the increase in colorectal cancer before the age of 50 we’re seeing nationally, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains the data.

Nelson: Out of this group of 95,000 women they could find 109 women who got colorectal cancer at this young age group, less than 50. The women who reported drinking two sugar sweetened beverages a day had twice the increased risk of this early onset colorectal cancer as women who didn’t and there was basically a 16% increased risk for each sugar sweetened beverage beyond that, that appeared especially significant when they were aged 13 to 18.  :30

Nelson notes that the United States Preventive Services Task Force has now recommended screening for colorectal cancer beginning at age 45 because of this increased incidence, and says people should be mindful of their own family history also. At Johns Hopkins, I’m Elizabeth Tracey.

Structural discrimination impacts very negatively on health, with resilience as a factor that can help modify it. Sarah Szanton, a researcher in the School of Nursing at Johns Hopkins, has developed measures of both.

Szanton: In the resilience world it’s usually measured individually, so are you a good coper? Are your religious? And then sometimes includes the family, did you have two parents growing up? There’s very little about community resilience, family resilience, biological resilience are all kind of put together, even though we know that those are all related, so for example Hurricane Katrina happened. More people died because of the way the community was set up and how segregated it was and resources, those individuals died partly because of aspects of the community.  :32

Szanton intends for both measures to be used to help individuals assess their own risk and also to assist governmental bodies in their reform efforts. At Johns Hopkins, I’m Elizabeth Tracey.

George Floyd’s death and the pandemic have brought structural discrimination into awareness for many, especially with regard to its impact on health. Now Sarah Szanton, a researcher in the School of Nursing at Johns Hopkins, has created a measurement tool to assess its impact.

Szanton: We are developing a measure across nine different domains of people’s life experience, for example, the employment domain, the environment in terms of the toxic things, and income credit and wealth, media and marketing, then looking across people’s life course with all those domains, for example, the education funding where they grew up, employment factors. People have conceptualized this about structural discrimination and health and people have done some measurement but this will be the first time of trying to get all those contexts across the life course for individual people.  :32

Szanton says the tool will be validated and hopefully used to inform improvement measures as well as policy. At Johns Hopkins, I’m Elizabeth Tracey.

There are a wide range of choices when it comes to medicines to manage diabetes. Rita Kalyani, a diabetes expert and author of a recent review paper in the New England Journal of Medicine, says if you have additional health conditions such as heart or kidney disease, there are medicines that may help both.

Kalyani: Over the past three to four years, cardiovascular outcome trials have actually shown superiority of some agents in their cardiovascular benefits. Also renal benefits of these glucose lowering drugs. In the SGL2 inhibitor class and the GLP1 receptor agonist class we now have multiple agents that are not only approved for their glucose lowering mechanism but also for their benefit in reducing recurrent heart attacks, stroke, or reducing mortality, or also for reducing the progression of chronic kidney disease.  :33

Kalyani says talk with your provider, and make sure to revisit this issue periodically to see if there’s a better drug for you. At Johns Hopkins, I’m Elizabeth Tracey.

The longer someone has had diabetes the greater the chance they’ll develop dementia, a recent study of thousands over 30 years of follow up has shown. Rita Kalyani, a diabetes expert at Johns Hopkins, says while associations between diabetes and many conditions is known, it’s unclear why.

Kalyani: We’ve tried to look at this for various geriatric conditions whether its frailty, muscle loss, falls, it’s really hard to tease out these associations between say it’s insulin and these outcomes, which we know is more related to hypoglycemia. That should also be noted, there is good literature that reports hypoglycemia as related to cognitive decline and dementia too, and so it’s both sides. High blood glucose and low blood glucose that likely contribute to the risk. :29

Kalyani says another big question is whether good blood sugar control attenuates the risk of both high and low blood sugar, and only additional long term studies with many people will help answer that question. At Johns Hopkins, I’m Elizabeth Tracey.

People who’ve had diabetes longer are at greater risk to develop dementia than those who’ve had diabetes for shorter periods of time, a large UK study following people for an average of 30 years has found. Rita Kalyani, a diabetes expert at Johns Hopkins, interprets the findings.

Kalyani: What they found in this very interesting study is that among more than 10,000 participants that they followed those who went on the develop dementia had a relatively earlier age of onset of diabetes and so this study in particular was very informative. It suggested that those at greatest risk of developing cognitive decline or dementia were those that were diagnosed with diabetes at an earlier age.   :26

Kalyani notes that studies like this clearly point to the need to control risk factors for diabetes, such as obesity and sedentary lifestyle, and says some researchers already refer to Alzheimer’s disease as type 3 diabetes since the link has been observed for some time. At Johns Hopkins, I’m Elizabeth Tracey.

Even people with some advanced cancers can benefit from genetic analysis of their tumors, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the contribution of genetics to overall risk for developing cancer.

Nelson: There have been studies that look at inherited tendencies, environmental exposures, and just the error prone aspects of the way cells divide. There’s a significant inherited contribution to cancer that’s on the order of 30-40%. If you look at the environmental exposure logic, it’s 80% or more of all cancers are caused by environmental influences, and the propensity for one cell to divide into two and make some mistakes that ultimately would lead to cancers, that’s also at an estimate that comes in at roughly 40%.   :32

Nelson says the reason this adds up to more than 100% is because of the overlap between factors, and notes that risk can clearly be impacted by individual choices. At Johns Hopkins, I’m Elizabeth Tracey.

Lung cancers are declining in the US as fewer people smoke cigarettes, but a recent look at cancer incidence worldwide finds that others are rising. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, looks at the domestic data.

Nelson: The ones that we have our eye on here in the US are cancers of the liver, cancers of the pancreas, they are definitely rising. Liver cancer rise in the US seems to be related to the obesity epidemic.  :13

Does this data indicate where we should be directing research? Not necessarily, Nelson says.

Nelson: Some of the ones for which the global disease burden is greater I’m not sure randomized clinical trials are the answer. So cervical cancer I’m not sure we need randomized clinical trials for advanced disease, we need to stop cervical cancer by vaccinating people against HPV. Liver cancer the global burden is caused by a virus that we need to vaccinate away.  :17

At Johns Hopkins, I’m Elizabeth Tracey.

Tanning bed use is associated with the development of skin cancers. Now a new study looks at how many skin cancers and associated healthcare costs would be impacted if teenagers were prohibited from using tanning beds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, looks at the data.

Nelson: These folks did a modeling simulation of 14 and 17 year olds. The idea was you ban tanning and they tried to estimate how much better people would do if they come up with 15,000 in the US melanoma cases 3300 or so would be life threatening melanoma among 17 million minors, you save $61 per every minor in normal and allied healthcare costs, increased quality adjusted life years, I think this model tells you what is easy to believe, that if you could ban this it’s a good idea.  :32

Nelson notes that adults too should choose not to use tanning beds, as their relationship with skin cancer is not limited to teens. At Johns Hopkins, I’m Elizabeth Tracey.