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Lifestyle changes could prevent over a third of dementia cases, report suggests

More than a third of dementia cases might be avoided by tackling aspects of lifestyle including education, exercise, blood pressure and hearing, a new report suggests.

Approximately 45 million people worldwide were thought to be living with dementia in 2015, at an estimated cost of $ 818bn.

And numbers are rising: in England and Wales it is estimated that 1.2 million people will be living with dementia by 2040 – a 57% increase from 2016 figures, largely driven by people living longer.

But the new report from the Lancet Commission on dementia prevention, intervention and care, stresses that dementia is not an inescapable part of ageing – and that action can be taken to reduce risk.

“There are a lot of things that individuals can do, and there are a lot of things that public health and policy can do, to reduce the numbers of people developing dementia,” said Gill Livingston, professor of psychiatry of older people at University College London and a co-author of the report.

For many of the factors, including exercise and social activities, the best approach to reducing dementia risk is not yet clear, but Livingston stresses that steps can still be taken. “We expect it to be a long-term change that will be needed for exercise; joining a gym for two weeks is probably not going to do it,” she said.

Clive Ballard, professor of age-related diseases at the University of Exeter medical school and also a co-author of the report, added that the evidence suggests individuals should also try to follow a Mediterranean diet, maintain a healthy weight and keep an eye on their blood pressure.

In total, the study looked at nine lifestyle factors linked to an increased risk of dementia.

The results reveal that as many as 35% of dementia cases could, at least in theory, be prevented, with 9% linked to midlife hearing loss, 8% to leaving education before secondary school, 5% to smoking in later life and 4% to later life depression. Social isolation, later life diabetes, midlife high blood pressure, midlife obesity and lack of exercise in later life also contributed to potentially avoidable cases of dementia, the report notes.

By contrast, 7% of cases would be prevented if a solution to the leading genetic risk factor for dementia were found.

The authors say the findings highlight the importance of health and behaviour throughout life on the risk of developing dementia later on.

But they admit that the estimate that more than a third of dementia cases could be prevented is a best case scenario, with the figures based on a number of assumptions, including that each factor could be completely tackled. “I think the realistic figure is probably nearer 5%,” said Ballard, although he added that even a 5% reduction would mean 5,000 fewer dementia cases in the UK per year.

The authors also acknowledge that for some of the factors flagged it is not yet clear whether interventions could reduce the risk of dementia or delay its onset. Debate also exists around whether factors such as depression and social isolation drive an increased risk of dementia, or whether changes in the brain that lead to dementia could be behind such issues.

“There is lots of evidence that depression is associated with an increased risk of developing dementia. What we don’t know is whether treating depression better prevents it,” added Ballard.

Even so, Fiona Matthews, professor of epidemiology at Newcastle University who was not involved in the report, said that interventions for depression and social isolation could still prove valuable. “If we could actually resolve some of that issue, even if it is not 100% causal, it is likely we might be able to slow [dementia] progression – even if [an individual] is on a pathway to developing dementia already,” she said.

But Matthews noted that the report also showed that the majority of cases of dementia were not linked to the potentially preventable factors flagged, although she added that the proposed areas for action could offer myriad health benefits beyond lowering dementia risk.

However, the authors pointed out that an intervention that delayed dementia onset and progression by even a year could decrease the number of people with dementia worldwide in 2050 by nine million.

Dr Doug Brown, director of research at Alzheimer’s Society, said that the estimate that more than a third of dementia cases could be preventable was a cause for celebration, but noted that difficulties remain.

“Not all of the nine risk factors identified are easily modifiable – factors like poor education and social isolation are incredibly challenging to address. But there are easier wins, particularly cardiovascular factors like lowering blood pressure and smoking cessation,” he said.

“Though it’s not inevitable, dementia is currently set to be the 21st century’s biggest killer. We all need to be aware of the risks and start making positive lifestyle changes.”

Hearing loss could pose greater risk of potential dementia in later life – study

People who experience hearing loss could be at greater risk of memory and thinking problems later in life than those without auditory issues, research suggests.

The study focused on people who were at risk of Alzheimer’s disease, revealing that those who were diagnosed with hearing loss had a higher risk of “mild cognitive impairment” four years later.

“It’s really not mild,” said Clive Ballard, professor of age-related disease at the University of Exeter. “They are in the lowest 5% of cognitive performance and about 50% of those individuals will go on to develop dementia.”

Presented at the Alzheimer’s Association International Conference in London, researchers from the US looked at the memory and thinking skills of 783 cognitively healthy participants in late middle age, more than two-thirds of whom had at least one parent who had been diagnosed with Alzheimer’s disease.

The team carried out a range of cognitive tests on the participants over a four-year period, aimed at probing memory and mental processing, revealing that those who had hearing loss at the start of the study were more than twice as likely to be found to have mild cognitive impairment four years later than those with no auditory problems, once a variety of other risk factors were taken into account.

Taylor Fields, a PhD student at the University of Wisconsin who led the research, said that the findings suggest hearing loss could be an early warning sign that an individual might be at greater risk of future cognitive impairment – but added more research was necessary to unpick the link.

“There is something here and it should be looked into,” she said.

It is not the first study to suggest a link between hearing loss and cognitive troubles – previous research has found that the more severe hearing loss is, the greater the risk of dementia.

But it is not yet clear whether hearing loss is the result of changes linked to dementia, or whether hearing loss itself could contribute to cognitive decline. As a result, it is unclear whether treating hearing loss could mitigate against increased risk.

“Potentially it is something you can do something about, which I think makes it really important to understand better,” said Ballard.

In a separate study, researchers from Wisconsin found a link between thinking and memory difficulties, and changes to the fluency of speech. In 219 late-middle aged participants were assessed at the beginning and end of a two year period. The team found that those with early signs of mild cognitive impairment at the start of the study showed a steeper decline in fluency over the two years than those without.

A further series of studies presented at the conference focused on the link between diet and prowess at memory and thinking tasks. While all differed in the range of participants and the type of diet applied, overall the results suggest that eating healthily was linked to a lower risk of cognitive difficulties, and even a lower risk of dementia.

In one study, carried out by researchers in the US with almost 6,000 participants, scientists found that after taking into account a host of factors including smoking, physical activity, health and socioeconomic status, those who stuck best to a Mediterranean or similar diet over the course of a year were about 35% less likely to have low scores on cognitive tests than those who did not stick to the regime.

While the study does not show that eating badly triggers cognitive problems, and further work is needed to monitor the impact of the diet over time, Claire McEvoy – co-author of the research from the University of California San Francisco – noted that benefits of healthy eating seem to exist on a sliding scale.

“Even moderate adherence to these high quality dietary patterns showed a protective association with cognitive function,” she said.

Hearing loss could pose greater risk of potential dementia in later life – study

People who experience hearing loss could be at greater risk of memory and thinking problems later in life than those without auditory issues, research suggests.

The study focused on people who were at risk of Alzheimer’s disease, revealing that those who were diagnosed with hearing loss had a higher risk of “mild cognitive impairment” four years later.

“It’s really not mild,” said Clive Ballard, professor of age-related disease at the University of Exeter. “They are in the lowest 5% of cognitive performance and about 50% of those individuals will go on to develop dementia.”

Presented at the Alzheimer’s Association International Conference in London, researchers from the US looked at the memory and thinking skills of 783 cognitively healthy participants in late middle age, more than two-thirds of whom had at least one parent who had been diagnosed with Alzheimer’s disease.

The team carried out a range of cognitive tests on the participants over a four-year period, aimed at probing memory and mental processing, revealing that those who had hearing loss at the start of the study were more than twice as likely to be found to have mild cognitive impairment four years later than those with no auditory problems, once a variety of other risk factors were taken into account.

Taylor Fields, a PhD student at the University of Wisconsin who led the research, said that the findings suggest hearing loss could be an early warning sign that an individual might be at greater risk of future cognitive impairment – but added more research was necessary to unpick the link.

“There is something here and it should be looked into,” she said.

It is not the first study to suggest a link between hearing loss and cognitive troubles – previous research has found that the more severe hearing loss is, the greater the risk of dementia.

But it is not yet clear whether hearing loss is the result of changes linked to dementia, or whether hearing loss itself could contribute to cognitive decline. As a result, it is unclear whether treating hearing loss could mitigate against increased risk.

“Potentially it is something you can do something about, which I think makes it really important to understand better,” said Ballard.

In a separate study, researchers from Wisconsin found a link between thinking and memory difficulties, and changes to the fluency of speech. In 219 late-middle aged participants were assessed at the beginning and end of a two year period. The team found that those with early signs of mild cognitive impairment at the start of the study showed a steeper decline in fluency over the two years than those without.

A further series of studies presented at the conference focused on the link between diet and prowess at memory and thinking tasks. While all differed in the range of participants and the type of diet applied, overall the results suggest that eating healthily was linked to a lower risk of cognitive difficulties, and even a lower risk of dementia.

In one study, carried out by researchers in the US with almost 6,000 participants, scientists found that after taking into account a host of factors including smoking, physical activity, health and socioeconomic status, those who stuck best to a Mediterranean or similar diet over the course of a year were about 35% less likely to have low scores on cognitive tests than those who did not stick to the regime.

While the study does not show that eating badly triggers cognitive problems, and further work is needed to monitor the impact of the diet over time, Claire McEvoy – co-author of the research from the University of California San Francisco – noted that benefits of healthy eating seem to exist on a sliding scale.

“Even moderate adherence to these high quality dietary patterns showed a protective association with cognitive function,” she said.

Hearing loss could pose greater risk of potential dementia in later life – study

People who experience hearing loss could be at greater risk of memory and thinking problems later in life than those without auditory issues, research suggests.

The study focused on people who were at risk of Alzheimer’s disease, revealing that those who were diagnosed with hearing loss had a higher risk of “mild cognitive impairment” four years later.

“It’s really not mild,” said Clive Ballard, professor of age-related disease at the University of Exeter. “They are in the lowest 5% of cognitive performance and about 50% of those individuals will go on to develop dementia.”

Presented at the Alzheimer’s Association International Conference in London, researchers from the US looked at the memory and thinking skills of 783 cognitively healthy participants in late middle age, more than two-thirds of whom had at least one parent who had been diagnosed with Alzheimer’s disease.

The team carried out a range of cognitive tests on the participants over a four-year period, aimed at probing memory and mental processing, revealing that those who had hearing loss at the start of the study were more than twice as likely to be found to have mild cognitive impairment four years later than those with no auditory problems, once a variety of other risk factors were taken into account.

Taylor Fields, a PhD student at the University of Wisconsin who led the research, said that the findings suggest hearing loss could be an early warning sign that an individual might be at greater risk of future cognitive impairment – but added more research was necessary to unpick the link.

“There is something here and it should be looked into,” she said.

It is not the first study to suggest a link between hearing loss and cognitive troubles – previous research has found that the more severe hearing loss is, the greater the risk of dementia.

But it is not yet clear whether hearing loss is the result of changes linked to dementia, or whether hearing loss itself could contribute to cognitive decline. As a result, it is unclear whether treating hearing loss could mitigate against increased risk.

“Potentially it is something you can do something about, which I think makes it really important to understand better,” said Ballard.

In a separate study, researchers from Wisconsin found a link between thinking and memory difficulties, and changes to the fluency of speech. In 219 late-middle aged participants were assessed at the beginning and end of a two year period. The team found that those with early signs of mild cognitive impairment at the start of the study showed a steeper decline in fluency over the two years than those without.

A further series of studies presented at the conference focused on the link between diet and prowess at memory and thinking tasks. While all differed in the range of participants and the type of diet applied, overall the results suggest that eating healthily was linked to a lower risk of cognitive difficulties, and even a lower risk of dementia.

In one study, carried out by researchers in the US with almost 6,000 participants, scientists found that after taking into account a host of factors including smoking, physical activity, health and socioeconomic status, those who stuck best to a Mediterranean or similar diet over the course of a year were about 35% less likely to have low scores on cognitive tests than those who did not stick to the regime.

While the study does not show that eating badly triggers cognitive problems, and further work is needed to monitor the impact of the diet over time, Claire McEvoy – co-author of the research from the University of California San Francisco – noted that benefits of healthy eating seem to exist on a sliding scale.

“Even moderate adherence to these high quality dietary patterns showed a protective association with cognitive function,” she said.

Revealed: NHS cuts could target heart attack patients in Surrey and Sussex

Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in Surrey and Sussex, the Guardian can reveal.

NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty – the insertion of stents to tackle blocked arteries – despite the evidence that both procedures reduce the risk of patients dying.

The disclosure came as senior Tory MP Sarah Wollaston, the chair of the Commons health select committee, urged ministers to scrap the “capped expenditure process” – the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in a bid to save £500m – because it involves “draconian” cuts to services that will hit patient care.

“I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS,” she told the Guardian.

“The kind of issues that are being discussed [in the 14 areas subject to the CEP] would involve draconian measures that would have an impact on public health and services. [And] I do have concerns about ultimately patient safety.”

Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass.

Cutting the number of people who have either is one of a range of options which NHS bosses in Surrey and Sussex are considering in order to save £55m more under the CEP by March 2018 than the £106m of “efficiency savings” already agreed.

NHS bodies in Surrey and Sussex privately admit that fewer people will have those procedures as part of their plan to save the £55m by reducing “huge variation” in patients’ chances of having one, depending on which hospital they are treated at and which cardiologist they see. “We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor.

In future an unknown number of patients at risk of a heart attack will be monitored by “watchful waiting” rather than given an angiogram or angioplasty, the doctor explained.

Senior NHS sources in the area have disclosed that they are also being forced to consider proposals to:

  • Ration knee arthroscopy operations, cataract removals and tonsillectomies
  • Introduce “lifestyle rationing” so that patients who are obese and smoke will have to lose weight and stop smoking before they can have, for example, a knee replacement to treat their arthritis
  • Shut beds or even whole wards in community hospitals
  • Restrict patients’ access to hearing aids and IVF treatment

“We have been told to leave no stone unturned and think the unthinkable [in the quest to save the £55m],” one local senior NHS figure said, speaking anonymously.

“It’s quite delusional to think we can take out the £106m already planned and now this extra £55m so quickly. But NHS England have told us to do this. The trouble is that, after making lots of efficiency savings in recent years, there is very little fat to take out,” the official added.

NHS organisations in Surrey and Sussex tasked with pursuing the savings drive confirmed that access could be reduced to many different types of care. “We have been looking at all treatments and procedures provided across our area,” they said in a joint statement.

“There is considerable variation in the thresholds and criteria applied before patients are referred for treatment. We want to ensure that referral decisions are based on the latest clinical evidence of what works and are applied consistently, delivering the best value for money for the public and fairness for patients.”

The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18 … collectively, the plans would overspend by £55m against the financial ‘control total’ that has been set by NHS England and NHS Improvement,” they added.

Heart specialists warned that patients’ health could suffer if decisions about who had either procedure was made on anything other than purely medical grounds. “Any restriction on angiography or angioplasties should be based on clinical criteria and guidelines to ensure no adverse effect on patient care and health,” said Prof Sir Nilesh Samani, the medical director of the British Heart Foundation.

The British Cardiology Society, which represents heart specialists, underlined the importance of both procedures as measures to help save lives. A spokeswoman said: “Cardiovascular disease remains a significant burden to the UK and requires appropriate investigation and management to reduce mortality and morbidity. Despite significant reductions in mortality through medical and invasive treatments both primary and secondary preventive strategies remain important.”

The Royal College of Surgeons said introducing “lifestyle rationing” was “wrong”. A spokesman said: “There is no clinical guidance from NICE, the Royal College of Surgeons and other surgical associations to support restrictions for routine surgery on the basis of whether patients smoke or are overweight.

Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health thinktank.

“Many of these cutbacks in procedures will only save money in the short term. If they go ahead, this will mean putting off treating patients whose hip and eye conditions will worsen and must be treated eventually. Getting savings out will also require cutting staff,” he said.

This story was amended to correct the statement that a number of cabinet ministers’ seats are in the affected area.

Revealed: NHS cuts could target heart attack patients in Surrey and Sussex

Patients at risk of a heart attack could be denied vital tests and potentially life-saving operations under NHS plans to make £55m of budget cuts in an area in which four cabinet ministers are local MPs, the Guardian can reveal.

NHS organisations in Surrey and Sussex are considering restricting the number of patients who have an angiogram or an angioplasty – the insertion of stents to tackle blocked arteries – despite the evidence that both procedures reduce the risk of patients dying.

The disclosure came as senior Tory MP Sarah Wollaston, the chair of the Commons health select committee, urged ministers to scrap the “capped expenditure process” – the secretive cost-cutting regime which the NHS is imposing on 14 areas of England in a bid to save £500m – because it involves “draconian” cuts to services that will hit patient care.

“I don’t think that these extra cuts are reasonable. You can’t justify £500m to the DUP while taking another £500m out of the English NHS,” she told the Guardian.

“The kind of issues that are being discussed [in the 14 areas subject to the CEP] would involve draconian measures that would have an impact on public health and services. [And] I do have concerns about ultimately patient safety.”

Hospitals routinely use an angiogram to assess the health of a patient’s heart. The number of people in the UK undergoing angioplasty has risen eightfold since the early 1990s to almost 100,000 a year, reflecting its growing popularity as a non-invasive alternative to a heart bypass.

Cutting the number of people who have either is one of a range of options which NHS bosses in Surrey and Sussex are considering in order to save £55m more under the CEP by March 2018 than the £106m of “efficiency savings” already agreed.

NHS bodies in Surrey and Sussex privately admit that fewer people will have those procedures as part of their plan to save the £55m by reducing “huge variation” in patients’ chances of having one, depending on which hospital they are treated at and which cardiologist they see. “We have to rationalise cardiac investigations and treatments. There’s variation of 60% to 70% between hospitals. We’re looking into why that is. Who in future won’t get an angiogram? That’ll be up to cardiologists,” said one senior doctor.

In future an unknown number of patients at risk of a heart attack will be monitored by “watchful waiting” rather than given an angiogram or angioplasty, the doctor explained.

Senior NHS sources in the area have disclosed that they are also being forced to consider proposals to:

  • Ration knee arthroscopy operations, cataract removals and tonsillectomies
  • Introduce “lifestyle rationing” so that patients who are obese and smoke will have to lose weight and stop smoking before they can have, for example, a knee replacement to treat their arthritis
  • Shut beds or even whole wards in community hospitals
  • Restrict patients’ access to hearing aids and IVF treatment

“We have been told to leave no stone unturned and think the unthinkable [in the quest to save the £55m],” one local senior NHS figure said, speaking anonymously.

“It’s quite delusional to think we can take out the £106m already planned and now this extra £55m so quickly. But NHS England have told us to do this. The trouble is that, after making lots of efficiency savings in recent years, there is very little fat to take out,” the official added.

The chancellor, Philip Hammond (Runnymede and Weybridge), and the health secretary, Jeremy Hunt (South West Surrey), both represent Surrey in parliament, as do Michael Gove (Surrey Heath), the environment secretary, and Chris Grayling (Epsom and Ewell), the transport secretary. When the Guardian asked all four to comment, all declined to offer a view on the £55m cuts plan, the existence of which had been kept secret

NHS organisations in Surrey and Sussex tasked with pursuing the savings drive confirmed that access could be reduced to many different types of care. “We have been looking at all treatments and procedures provided across our area,” they said in a joint statement.

“There is considerable variation in the thresholds and criteria applied before patients are referred for treatment. We want to ensure that referral decisions are based on the latest clinical evidence of what works and are applied consistently, delivering the best value for money for the public and fairness for patients.”

The bodies made clear that they have to contemplate such controversial measures because NHSE and NHSI have told them to save the £55m. Despite already having “ambitious financial plans for 2017-18 … collectively, the plans would overspend by £55m against the financial ‘control total’ that has been set by NHS England and NHS Improvement,” they added.

Heart specialists warned that patients’ health could suffer if decisions about who had either procedure was made on anything other than purely medical grounds. “Any restriction on angiography or angioplasties should be based on clinical criteria and guidelines to ensure no adverse effect on patient care and health,” said Prof Sir Nilesh Samani, the medical director of the British Heart Foundation.

The British Cardiology Society, which represents heart specialists, underlined the importance of both procedures as measures to help save lives. A spokeswoman said: “Cardiovascular disease remains a significant burden to the UK and requires appropriate investigation and management to reduce mortality and morbidity. Despite significant reductions in mortality through medical and invasive treatments both primary and secondary preventive strategies remain important.”

The Royal College of Surgeons said introducing “lifestyle rationing” was “wrong”. A spokesman said: “There is no clinical guidance from NICE, the Royal College of Surgeons and other surgical associations to support restrictions for routine surgery on the basis of whether patients smoke or are overweight.

Saving the £55m this year will prove to be a false economy that costs the NHS more money in the long term, warned Nigel Edwards, chief executive of the Nuffield Trust health thinktank.

“Many of these cutbacks in procedures will only save money in the short term. If they go ahead, this will mean putting off treating patients whose hip and eye conditions will worsen and must be treated eventually. Getting savings out will also require cutting staff,” he said.

Fall in HIV among gay men could spell end for Britain’s epidemic, say experts

A big drop in the numbers of gay men becoming infected with HIV in London may signal that the Aids epidemic in Britain can be brought to a close, public health experts believe.

New data from Public Health England talks about the potential elimination of HIV, revealing the first downturn in the epidemic among gay and bisexual men since it began, thanks to a combination of frequent testing of people at high risk of infection and rapid treatment.

In the year beginning October 2015, HIV diagnoses fell by 32% compared with October 2014 to September 2015 among men who have sex with men (MSM) attending five of the biggest London sexual health clinics.

The reasons for the fall are thought to be the big step up in testing, so that gay men at high risk because their partner has HIV would be offered testing every three months, andoffering immediate antiretroviral drug treatment to those who test positive, which suppresses the virus.

At the same time, significant numbers of gay men in London have been taking pre-exposure prophylaxis (PrEP) – one of the same drugs that can prevent them becoming infected with the virus. Some have been involved in trials to establish how effective PrEP is, while others have bought the drug online following successful trials in the US.

Valerie Delpech, head of HIV surveillance for Public Health England, said the five big clinics had seen a substantial fall in the number of men becoming infected with HIV and that the success could be replicated across the country and beyond.

“Basically we are witnessing a phenomenal experiment. We are observing it. What we are seeing is the first downturn of the HIV epidemic in gay men,” said Delpech.

Pre-Exposure Prophylaxis (PrEP) drugs are thought to have contributed to the fall in infections.


Pre-Exposure Prophylaxis (PrEP) drugs are thought to have contributed to the fall in infections. Photograph: Alamy Stock Photo

“There is absolutely no reason why we cannot scale that up to further reduce new infections in gay men – and also in all people who may be at risk of HIV in the UK, regardless of gender, ethnicity or sexuality.”

Gay, bisexual and other men who have sex with men account for half of all people living with HIV in England and are the group most at risk of acquiring HIV, says the “rapid communication” paper by Public Health England in the journal Eurosurveillance, which tracks major diseases.

There was a drop in infections among gay and bisexual men of 17% in England as a whole and a drop of 25% in London. The five clinics that had a 32% drop in new diagnoses, from 880 to 595, had stepped up testing to the point that they were responsible for 41% of all the tests carried out in MSM in England over the year, and were quicker than others to get those who tested positive on treatment.

Sheena McCormack of the UK Medical Research Council and University College London – who coordinated the Proud study in 2014, which showed an 86% fall in new infections among MSM taking the drugs – believes the drop in new diagnoses in the second half of 2015 through 2016 fits the PrEP timeline well, suggesting it may play a substantial role.

“The high effect sizes reported by the Proud and Ipergay studies accelerated rollout in the US, with knock-on effects in the UK and Australia, where people were already familiar with the use of online pharmacies to purchase drugs that were not available in their health system. This took off in the UK from the last quarter of 2015, when community websites and clinics came together to promote, validate, and endorse online pharmacies,” said McCormack.

Dr Michael Brady, medical director of the Terrence Higgins Trust, which campaigns on HIV and Aids issues, said: “This points towards what can be achieved when we utilise all the weapons in our arsenal against HIV transmission. This includes access to condoms, testing, PrEP and diagnosing and treating people as early as possible so they can become uninfectious.

“This is extremely positive news for gay and bisexual men, who continue to be one of the groups most affected by HIV. However, it is no time for complacency and we must keep this momentum going, so we can see the same thing happening in other at-risk communities across the country and bring the epidemic to an end.”

Deborah Gold, chief executive of the National Aids Trust, said: “This data offers hope but also a new and urgent challenge. This model needs to be sustained, built on, and replicated elsewhere across the country. Further, we need to understand how to have a similar impact in other affected populations. However, our evidence shows that, just at the time we need to be intensifying our work, investment in HIV prevention has diminished and is under further threat. Without proper investment in prevention, HIV will remain a significant health inequality.”

NHS England resisted offering PrEP because of the potential cost, was challenged in the courts by HIV organisations and lost. In December it announced it would provide PrEP through an extended large-scale trial involving 10,000 people.

PHE suggests that all these measures combined could point the way to ending the epidemic. “Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable,” says the paper.

Fall in HIV among gay men could spell end for Britain’s epidemic, say experts

A big drop in the numbers of gay men becoming infected with HIV in London may signal that the Aids epidemic in Britain can be brought to a close, public health experts believe.

New data from Public Health England talks about the potential elimination of HIV, revealing the first downturn in the epidemic among gay and bisexual men since it began, thanks to a combination of frequent testing of people at high risk of infection and rapid treatment.

In the year beginning October 2015, HIV diagnoses fell by 32% compared with October 2014 to September 2015 among men who have sex with men (MSM) attending five of the biggest London sexual health clinics.

The reasons for the fall are thought to be the big step up in testing, so that gay men at high risk because their partner has HIV would be offered testing every three months, andoffering immediate antiretroviral drug treatment to those who test positive, which suppresses the virus.

At the same time, significant numbers of gay men in London have been taking pre-exposure prophylaxis (PrEP) – one of the same drugs that can prevent them becoming infected with the virus. Some have been involved in trials to establish how effective PrEP is, while others have bought the drug online following successful trials in the US.

Valerie Delpech, head of HIV surveillance for Public Health England, said the five big clinics had seen a substantial fall in the number of men becoming infected with HIV and that the success could be replicated across the country and beyond.

“Basically we are witnessing a phenomenal experiment. We are observing it. What we are seeing is the first downturn of the HIV epidemic in gay men,” said Delpech.

Pre-Exposure Prophylaxis (PrEP) drugs are thought to have contributed to the fall in infections.


Pre-Exposure Prophylaxis (PrEP) drugs are thought to have contributed to the fall in infections. Photograph: Alamy Stock Photo

“There is absolutely no reason why we cannot scale that up to further reduce new infections in gay men – and also in all people who may be at risk of HIV in the UK, regardless of gender, ethnicity or sexuality.”

Gay, bisexual and other men who have sex with men account for half of all people living with HIV in England and are the group most at risk of acquiring HIV, says the “rapid communication” paper by Public Health England in the journal Eurosurveillance, which tracks major diseases.

There was a drop in infections among gay and bisexual men of 17% in England as a whole and a drop of 25% in London. The five clinics that had a 32% drop in new diagnoses, from 880 to 595, had stepped up testing to the point that they were responsible for 41% of all the tests carried out in MSM in England over the year, and were quicker than others to get those who tested positive on treatment.

Sheena McCormack of the UK Medical Research Council and University College London – who coordinated the Proud study in 2014, which showed an 86% fall in new infections among MSM taking the drugs – believes the drop in new diagnoses in the second half of 2015 through 2016 fits the PrEP timeline well, suggesting it may play a substantial role.

“The high effect sizes reported by the Proud and Ipergay studies accelerated rollout in the US, with knock-on effects in the UK and Australia, where people were already familiar with the use of online pharmacies to purchase drugs that were not available in their health system. This took off in the UK from the last quarter of 2015, when community websites and clinics came together to promote, validate, and endorse online pharmacies,” said McCormack.

Dr Michael Brady, medical director of the Terrence Higgins Trust, which campaigns on HIV and Aids issues, said: “This points towards what can be achieved when we utilise all the weapons in our arsenal against HIV transmission. This includes access to condoms, testing, PrEP and diagnosing and treating people as early as possible so they can become uninfectious.

“This is extremely positive news for gay and bisexual men, who continue to be one of the groups most affected by HIV. However, it is no time for complacency and we must keep this momentum going, so we can see the same thing happening in other at-risk communities across the country and bring the epidemic to an end.”

Deborah Gold, chief executive of the National Aids Trust, said: “This data offers hope but also a new and urgent challenge. This model needs to be sustained, built on, and replicated elsewhere across the country. Further, we need to understand how to have a similar impact in other affected populations. However, our evidence shows that, just at the time we need to be intensifying our work, investment in HIV prevention has diminished and is under further threat. Without proper investment in prevention, HIV will remain a significant health inequality.”

NHS England resisted offering PrEP because of the potential cost, was challenged in the courts by HIV organisations and lost. In December it announced it would provide PrEP through an extended large-scale trial involving 10,000 people.

PHE suggests that all these measures combined could point the way to ending the epidemic. “Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable,” says the paper.

Cholestrol-lowering vaccine jab to stop heart attacks could be close

A vaccine jab that prevents heart attacks could be imminent after promising early research shows how the immune system can be directed to lower cholesterol.

Patients have already been enrolled into a phase one trial to see if the approach, so far tested on mice, will work in humans.

A cholesterol-lowering vaccine could theoretically provide a more effective and reliable alternative to statins.

The vaccine, known as AT04A, triggers the production of antibodies that target an enzyme involved in regulating levels of blood cholesterol. The enzyme, PCSK9, has been shown to impede the clearance of low-density lipoprotein (LDL) – the “bad” form of cholesterol that is largely to blame for blocked arteries – from the blood.

In tests, mice fed an unhealthy western-style fatty diet had their total blood cholesterol lowered by 53% by the vaccine.

Atherosclerotic damage, the build-up of hard fibrous deposits on the walls of arteries, was reduced by 64%, and biological markers of blood vessel inflammation by up to 28% compared with unvaccinated mice.

The new results, published in the European Heart Journal, open up the prospect of a yearly vaccine jab to keep cholesterol under control in at-risk patients.

Dr Gunther Staffler, researcher and chief technology officer at the Austrian biotech company AFFiRis, which developed the vaccine, said: “AT04A was able to induce antibodies that specifically targeted the enzyme PCSK9 throughout the study period in the circulation of the treated mice. As a consequence, levels of cholesterol were reduced in a consistent and long-lasting way, resulting in a reduction of fatty deposits in the arteries and atherosclerotic damage, as well as reduced arterial wall inflammation.

“If these findings translate successfully into humans, this could mean that, as the induced antibodies persist for months after a vaccination, we could develop a long-lasting therapy that, after the first vaccination, just needs an annual booster. This would result in an effective and more convenient treatment for patients, as well as higher patient compliance.”

PCSK9 is made in the liver and blocks LDL receptor molecules on cells that allow the body to get rid of harmful cholesterol. The vaccine causes the body to produce antibodies that lock on to and immobilise the enzyme, so that the LDL receptors can remain active.

Essentially it is an immunotherapy treatment. Unlike a conventional vaccine that targets foreign invaders such as bacteria and viruses, AT04A marshals the immune system to attack one of the body’s own proteins.

A phase one trial testing the safety and activity of the vaccine in 72 healthy patients was launched at the Medical University of Vienna in 2015. The trial is due to finish at the end of this year.

However, before the vaccine can be licensed and rolled out to patients, larger scale trials focusing on effectiveness as well as safety will have to be carried out.
Tim Chico, a reader in cardiovascular medicine at the University of Sheffield, said: “If similar effects were achieved in humans it would be likely to lead to a reduction in heart attacks.

“This was a well-conducted but very early study, using animals not humans, and many questions remain about whether this approach could work in man. The theory is sound and I think this might have the potential to replace the need to take regular cholesterol-lowering drugs.”

He added that it may take many years to be certain about the long-term safety of the vaccine which, unlike a drug, could produce permanent side effects.

Chico said: “This is yet more proof that cholesterol causes heart disease, and lowering cholesterol reduces risk of heart disease, so it confirms the importance of a healthy lifestyle for everyone and medications such as statins for some people to reduce risk of heart disease.”

One potential safety concern associated with targeting PCSK9 to reduce cholesterol is increasing the risk of diabetes, experts believe.

New blood test could see personalised prostate cancer treatment

A new three-in-one blood test could pave the way to precision-personalised treatment for advanced prostate cancer, say scientists.

The test has the potential to transform the way the disease is tackled by targeting specific gene mutations, it is claimed.

By looking for cancer DNA in blood samples, researchers were able to identify men with defective BRCA genes who were likely to benefit from a class of drugs called Parp inhibitors.

They also used the test to monitor DNA in the blood after treatment started, so patients who were not responding could quickly be switched to an alternative therapy.

Finally, the same test was used to pick up signs of evolving cancer showing the first signs of drug resistance.

Prof Johann de Bono, who led the team at the Institute of Cancer Research in London, said: “We were able to develop a powerful, three-in-one test that could in future be used to help doctors select treatment, check whether it is working and monitor the cancer in the longer term.

“We think it could be used to make clinical decisions about whether a Parp inhibitor is working within as little as four to eight weeks of starting therapy.

“Not only could the test have a major impact on treatment of prostate cancer, but it could also be adapted to open up the possibility of precision medicine to patients with other types of cancer as well.”

In future, the test could allow the Parp inhibitor olaparib to become a standard treatment for advanced prostate cancer, by targeting those most likely to benefit, picking up early signs that the drug might not be working, and monitoring for emerging resistance.

Parp inhibitors such as olaparib block an enzyme used by cancer cells with defective BRCA 1 and 2 genes to repair their DNA.

When Parp is disabled, the cells die. The drugs do not generally work on cancer cells with functioning BRCA genes, because these are primary DNA repair tools that make Parp unnecessary. While some patients respond to the drugs for years, others either fail to respond at an early stage or develop resistant cancer.

The new test, described in the journal Cancer Discovery, was developed with the help of 49 patients enrolled in TOPARP-A, a Phase II clinical trial investigating the effectiveness of olaparib.

Men responding to the drug were found to experience an average drop in circulating cancer DNA of 49.6% after eight weeks of treatment. In contrast, cancer DNA levels rose by 2.1% in patients who did not respond.

Patients whose cancer DNA blood levels were lowered by olaparib survived an average of 17 months compared with 10.1 months for those whose levels remained high.

The scientists also conducted a detailed investigation of the genetic changes in cancer DNA among men who stopped responding to olaparib. They found that the cells acquired genetic changes that cancelled out the DNA repair defects making them susceptible to the drug.

Prof Paul Workman, chief executive of the Institute of Cancer Research, said: “Blood tests for cancer promise to be truly revolutionary. They are cheap and simple to use, but most importantly, because they aren’t invasive, they can be employed or applied to routinely monitor patients to spot early if treatment is failing – offering patients the best chance of surviving their disease.

“This test is particularly exciting because it is multi-purpose, designed for use both before and after treatment, and using both the absolute amounts of cancer DNA in the bloodstream and also a readout of the specific mutations within that genetic material.

“We believe it can usher in a new era of precision medicine for prostate cancer.”

Each year, around 47,000 men in the UK are diagnosed with prostate cancer and more than 11,000 die from the disease.

Dr Matthew Hobbs, deputy director of research at the charity Prostate Cancer UK, which funded the research, said: “It’s clear that we need to move away from the current one-size-fits-all approach to much more targeted treatment methods.

“The results from this study and others like it are crucial as they give an important understanding of the factors that drive certain prostate cancers, or make them vulnerable to specific treatments.”