Elder Pharmacology

Studying and treating the chronic diseases
associated with aging needs serious revamping.
BY NIR BARZILAI

What is the greatest menace associated with age-related
diseases? Hypertension? Obesity? High cholesterol?
No. It’s simply the number of years an individual lives.
For example, elevated plasma cholesterol is considered a major
risk factor for cardiovascular-disease death. Yet, when compared
with aging itself, the risk of high cholesterol alone pales. For a typical
adult, high cholesterol poses a threefold increase in the risk of
dying from cardiovascular disease. Simply aging from 35 to 85,
however, increases that risk about a thousand fold.
Similar patterns are observed for cancer, type 2 diabetes,
and Alzheimer’s disease. National Institutes of Health data
indicate that the risk of dying from these diseases accelerates
logarithmically by approximately 100 to 1,000-fold between
ages 35 and 85. No wonder so many elderly people deal with
several age-related diseases simultaneously, and can face
additional complications from taking multiple drugs, prescribed
separately to treat each disease.
This reality is further aggravated by the fact that many carefully
conducted clinical trials exclude patients over the age of 65
as well as patients taking multiple drugs. This means that while
the majority of drugs are consumed by the elderly, there is little
to no “evidence-based medicine” to inform us about the safety
of polypharmacological therapy for this population.
And an even more fundamental problem looms.
Gerontologists have made significant progress in understanding
the biology of aging. They’ve identified pathways
involved in normal aging, flagged genes associated with
increased longevity, and even extended healthy life span by
genetic means, nutritional manipulation, or through drugs in
a variety of animal models, including mammals.
One conclusion from these studies is that the biology of a
young body is substantially different from that of an old body.
Not every treatment that works in the young will work or be
safe in the elderly.
Estrogen therapy for postmenopausal women exemplifies
this. The Women’s Health Initiative terminated its landmark
study on estrogen replacement because study participants were
showing higher-than-expected levels of breast cancer, cardiovascular
disease, and cognitive decline. In retrospect, many mechanistic
studies on rodents have used young, ovariectomized female
mice as models to induce cardiovascular disease, stroke, or other
diseases relevant to human females. In that research, estrogen
seemed protective. However, when those studies were repeated
in older, postmenopausal female mouse models, estrogen therapy
was detrimental. The fact that a single drug like estrogen did not
show anti-aging properties or protections opens the possibility
that this holds true for many other approved drugs used to treat
chronic conditions associated with aging.
The increased use of statins to treat cardiovascular disease—
one of the biggest contributions to mortality in the
Western world (~40 percent)—is another example. There is
no doubt that statins have decreased the occurrence of cardiovascular
events and mortality. And recent recommendations
have emerged that may lead to even more people being
treated with this drug class.
However, statins consistently did not change overall mortality!
How does this math work? If statins reduce a major
cause of mortality, but do not change overall mortality, it suggests
people on statins die from other causes. Indeed, we and
other researchers have shown that statin use significantly
increases diabetes risk, supporting the notion that these
drugs may actually contribute to other diseases of aging (Diabetes
Care, 32:1924-29, 2009).
In the statin case, it is important to note who is pushing the
agenda. Because of great progress in preventing and treating
cardiovascular disease, cardiologists have deepened the belief
that heart health is central. Cardiologists also inform us that
decreased blood pressure is good for the heart. But studies have
shown that blood pressure status and cognitive function in the
elderly are related. Low blood pressure in elderly people is associated
with reduced cognitive performance, while mild hypertension
may help prevent cognitive decline (Am J Hypertens,
16:818-26, 2003). Other studies have suggested that treating
high blood pressure with some drugs may accelerate cognitive
decline (Amer J Ther, 17:358-64, 2010).
So, if there are real risks associated not just with multiple
drugs but with any single drug, what solutions must we consider?
First, in order to ensure safety and effectiveness, a significant
percentage of elderly subjects (at least 50 percent of the study sample)
needs to be included in clinical drug trials for any age-related
disease. Another approach is to design a sub-trial on the elderly.
Second, when a drug is promoted by a medical professional
group, its effect on overall mortality needs to be assessed. It
has to be clear that this drug is not merely exchanging one disease
for another.
Third, studies of exceptionally long-lived people, such as the
LonGenity and Longevity Genes Project at Albert Einstein College
of Medicine, which includes healthy centenarians and their
families, have identified functional genetic changes associated with
such longevity. The goal of such research is to translate these findings
into drugs that can extend healthy life span for people who do
not share this genetic pattern, and some drugs based such projects
are currently in clinical trials.
Lastly, and most important, developing drugs that are based
on an understanding of the biology of aging has the potential to
provide therapies for the prevention of many age-related diseases.
Such a strategy may promote healthy life spans and significantly
reduce the financial burden of late-life illness and
end-of-life care.
Nir Barzilai is a professor of medicine and genetics at Albert
Einstein College of Medicine of Yeshiva University in New York
City and director of Einstein’s Institute for Aging Research and
its two Centers of Excellence (NIH-Nathan Shock Center and
Paul F. Glenn Center for the Biology of Human Aging Research).
He is also the co-scientific director of the American Federation
for Aging Research. His research focuses on mechanisms of
aging, including the genetic determinants of life span and the
role of nutrients in extending life.

Best Roach Killer 2020 Best Wood Glue Best Power Inverter
Best Electric Knife Sharpener Best Outdoor Solar Lights Best Lawn Fertilizer
Best Wood Stove Best Insect Repellent Best Deer Repellent
Best Drain Cleaner Best Lawn Edger Best Gaming Monitor
Best Memory Foam Mattress Best Gaming Keyboarda Best Air Mattress
Best Air Fryer Best Gaming Mouse Best Coffee Grinder
Best Gaming Headset Best Gaming Chair Best Tool Belt
Best Soldering Iron Best Pruning Saw Best Backpacking Tent
Best Torque Wrench Best Car Battery Charger Best Adjustable Wrench
Best Digital Caliper Best Concrete Cleaner Best Cordless Screwdriver
facts about Italy facts about Germany facts about Poland
facts about France facts about Hollland facts about Mexico
facts about Peru facts about Spain facts about Pakistan
facts about Costa Rica facts about Ireland facts about Egypt
facts about Jordan facts about Armenia facts about Israel
facts about Philippines facts about Panama facts about Russia
facts about Madagascar facts about Haiti facts about Hong Kong
facts about Bahamas facts about Kenya facts about Benin
facts about Guyana facts about Tunisia facts about Malawi
facts about Norway facts about Scotland facts about Sweden
facts about North Korea facts about Bolivia facts about Argentina
facts about England facts about Portugal facts about Finland
facts about Malaysia facts about Greece facts about Canada
facts about Croatia facts about Cambodia facts about Bangladesh
facts about South Africa facts about Hungary facts about New Zealand
facts about China facts about Thailand facts about Vietnam
facts about Saudi arabia facts about Iceland facts about Venezuela
facts about Ireland facts about India facts about Chile
facts about Indonesia facts about Singapore facts about Jamaica
facts about Japan facts about Brazil facts about South Korea
facts about canada facts about Italy facts about Columbia
facts about Mexico facts about USA weird facts North Korea
facts about Slovenia facts about Australia facts about Country
simple facts Venezuela simple facts South Korea simple facts New Zealand
simple facts Jamaica simple facts Greece simple facts Canada
simple facts China simple facts England simple facts Argentina
simple facts Bolivia simple facts South Africa simple facts India
simple facts Thailand simple facts Australia simple facts Bangladesh
simple facts Japan simple facts USA simple facts Czech
simple facts St.Vincent simple facts Ivory Coast simple facts Switzeland
structured settlement company structured settlements annuities structured settlement buyer
small business administration structured settlement purchasers houston tx auto insurance
selling structured settlement selling annuity structered settlement
caraccidentlawyer auto accident attorney Torrance attorney orange county
attorneys orange county personal injury accident lawyer car accident lawyers los angeles
cheap travel insurance los angeles motorcycle accident state of california car insurance
selling a structured settlement hughes net business structured settlement need cash
fast cash for house maritime lawyer houston personal injury attorney ocala fl
home equity loan reverse mortgage us bank home mortgage
personal loans for bad credit peer to peer lending home equity loan rates
refinance mortgage personal loan rates first time home buyer programs
cash out refinance home mortgage rates mortgage lenders
homeowners insurance home insurance state farm car insurance
comprehensive insurance commercial insurance cheap auto insurance
cheap health insurance indemnity car insurance companies
progressive quote usaa car insurance insurance near me
term life insurance auto insurance near me state farm car insurance
comprehensive insurance progressive home insurance house insurance
progressive renters insurance state farm insurance quote metlife auto insurance
best insurance companies progressive auto insurance quote cheap car insurance quotes
allstate car insurance rental car insurance car insurance online
liberty mutual car insurance cheap car insurance near me best auto insurance
home insurance companies usaa home insurance list of car insurance companies
full coverage insurance allstate insurance near me cheap insurance quotes
national insurance progressive home insurance house insurance
health insurance quotes ameritas dental state farm renters insurance
medicare supplement plans progressive renters insurance aetna providers
title insurance sr22 insurance medicare advantage plans
aetna health insurance ambetter insurance umr insurance
massmutual 401k private health insurance assurant renters insurance
assurant insurance dental insurance plans state farm insurance quote
health insurance plans workers compensation insurance geha dental
metlife auto insurance boat insurance aarp insurance
costco insurance flood insurance best insurance companies
cheap car insurance quotes best travel insurance insurance agents near me
car insurance car insurance quotes auto insurance
auto insurance quotes long term care insurance auto insurance companies
home insurance quotes cheap car insurance quotes affordable car insurance
professional liability insurance cheap car insurance near me small business insurance
vehicle insurance best auto insurance full coverage insurance
motorcycle insurance quote homeowners insurance quote errors and omissions insurance
general liability insurance best renters insurance cheap home insurance
cheap insurance near me cheap full coverage insurance cheap life insurance
horrible serial killer beautiful phenomena deadly UFO attacks
most mysterious sounds creepiest website most toxic ghost towns
coronavirus explained deepest hole in the world weirdest discoveries
what is darkest material facts about mars facts about sun
most dangerous plant most science facts most venomous snakes
most dangerous animals dangerous africa animals most venomous spider
dangerous gangs all time weird and gross candy weird history story
most bizarre hobbies most bizarre trends most banned foods
most dangerous jobs make money online way facts about Jamaica
most dangerous countries most visited cities most evil people
best airports in the world best capitals in the world best places in the world

will refinancing hurt my credit va loan multi family va loan after chapter 7 va home loan specialist us bank home mortgage top insurance companies tax debt relief program tax credit for college students structured settlement loan small business loans personal loan rates permanent life insurance payday loans online no credit check loans national guard va home loan mortgage life insurance maximum fha loan amount low cost health insurance Irs Tax Debt Relief Program how to get preapproved for a va home loan how long does a credit card balance transfer take homeowners insurance companies home loan interest rate home equity line of credit health insurance free car insurance quotes fixed annuity fha loan foreclosure waiting period does opening a checking account affect credit define insurance brokers current mortgage rates cost to refinance home loan Compare Vehicle Insurance cheap travel insurance bad credit car loans average home insurance cost

No comments:

Post a Comment