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By Dr. Sanchari Sinha Dutta, Ph.D. Nov 23 2023 Reviewed by Benedette Cuffari, M.Sc.

In a recent study published in The American Journal of Cardiology, researchers compare the trends in cardiovascular disease-related mortality among patients with Alzheimer’s disease (AD) with the general United States population aged 65 years and older.  

Study:  Trends in Cardiovascular Mortality Among Individuals with Alzheimer’s Disease in the United States, 1999-2020. Image Credit: Nymphalyda / Shutterstock.com Cardiovascular disease and AD

As the global population continues to age, a gradual increase in the prevalence of AD has been observed over the past several decades. Several genetic and non-genetic risk factors are associated with the development of AD, which is the main cause of dementia.

Various cardiovascular disease (CVD)-related risk factors are also known to increase the risk of AD. For example, apolipoprotein E (APOE) is a common genetic risk factor for AD and CVD due to its involvement in cholesterol transportation as well as brain development. Among non-genetic risk factors, hypertension, and cholesterol serve as potential risk factors for both AD and CVD.

The accumulation of amyloid-beta plaques in the brain is a major hallmark of AD. Impaired clearance of amyloid-beta plaques because of poor vascular integrity due to CVD is believed to be a potential mechanism linking CVD with AD. The poor vascular integrity in CVD has also been associated with poor integrity of the blood-brain barrier (BBB) in AD. About the study

In the current study, scientists compare CVD-related mortality rates between AD patients and the general U.S. population aged 65 years and above. Moreover, they investigate whether certain demographic characteristics including sex, ethnicity/race, geographic region, and urbanization can influence the risk of CVD-related mortality among AD patients.     

The U.S. Centers for Disease Control and Prevention (CDC) dataset was used to determine national trends in age-adjusted CVD-mortality rates and average annual percent change values in the study populations between 1999 and 2020. Important observations

A total of 332,870 deaths due to CVD as a primary cause and AD as a contributory cause were identified between 1999 and 2020. This accounted for an age-adjusted mortality rate of 35.8 for every 100,000 individuals.

Among AD patients, a reduction in age-adjusted CVD-related mortality rate was observed between 1999 and 2020 from 51.7 to 25.9, respectively, for every 100,000 individuals. Regarding the annual percent change in CVD-related mortality, a 3.5% reduction among AD patients and 2.6% reduction in the general U.S. population was observed. The reduction in CVD-related mortality in AD was significantly higher than that in the general population. Related StoriesIs climate change turning up the heat on China's aging population?Switching from animal-based to plant-based foods reduces risk of heart disease, diabetes, and mortalityHospitalization and mortality risks from COVID-19 by age during SARS-CoV-2 Delta and Omicron variants predominance

Among various causes of CVD-related deaths, including ischemic heart disease, hypertensive disease, cerebrovascular disease, and heart failure, no significant difference in hypertensive disease-related mortality rate was observed between AD patients and the general U.S. population. For other causes, the reduction in mortality rates between 1999 and 2020 was significantly higher among AD patients. The reduction was most prominent for ischemic heart disease-related mortality.       

A similar reduction in CVD-related mortality rates between 1999 and 2020 was observed among male and female AD patients. No significant difference in mortality rate reduction was observed between individuals living in urban or rural regions.

Considering racial groups, the highest reduction in CVD mortality rates was observed among American Indians and Alaskan Natives. Comparatively, the lowest reduction was observed among Asian or Pacific Islander patients with AD. 

When age was considered, a greater reduction in CVD mortality rates was observed among patients aged 65-74 and 75-84 years as compared those 85 years of age and older. In terms of ethnicity, a lower reduction in CVD mortality rates over time was observed among Hispanic AD patients as compared to non-Hispanic AD patients. Study significance

The current study reports a gradual reduction in CVD-related mortality rates among AD patients in the U.S. over the past two decades. This reduction is higher among AD patients as compared to the general U.S. population 65 years of age and older.

The study findings are valuable for public health efforts aimed at improving cardiovascular health among AD patients. Clinicians should motivate AD patients who are at higher risk for CVD mortality to adopt healthy lifestyle habits, such as a balanced diet, regular physical activity, adequate sleep, and smoking and alcohol cessation.     Journal reference: Ranganathan, S., Abramov, D., Chew, N. W. S., et al. (2023). Trends in Cardiovascular Mortality Among Individuals with Alzheimer’s Disease in the United States, 1999-2020. The American Journal of Cardiology. doi:10.1016/j.amjcard.2023.11.044.

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Is there £15bn of wiggle room in Rachel Reeves’s fiscal rules?

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Is there £15bn of wiggle room in Rachel Reeves's fiscal rules?

Are Rachel Reeves’s fiscal rules quite as iron clad as she insists?

How tough is her armour really? And is there actually scope for some change, some loosening to avoid big tax hikes in the autumn?

We’ve had a bit of clarity early this morning – and that’s a question we discuss on the Politics at Sam and Anne’s podcast today.

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And tens of billions of pounds of borrowing depends on the answer – which still feels intriguingly opaque.

You might think you know what the fiscal rules are. And you might think you know they’re not negotiable.

For instance, the main fiscal rule says that from 2029-30, the government’s day-to-day spending needs to be in surplus – i.e. rely on taxation alone, not borrowing.

And Rachel Reeves has been clear – that’s not going to change, and there’s no disputing this.

But when the government announced its fiscal rules in October, it actually published a 19-page document – a “charter” – alongside this.

And this contains all sorts of notes and caveats. And it’s slightly unclear which are subject to the “iron clad” promise – and which aren’t.

There’s one part of that document coming into focus – with sources telling me that it could get changed.

And it’s this – a little-known buffer built into the rules.

It’s outlined in paragraph 3.6 on page four of the Charter for Budget Responsibility.

This says that from spring 2027, if the OBR forecasts that she still actually has a deficit of up to 0.5% of GDP in three years, she will still be judged to be within the rules.

In other words, if in spring 2027 she’s judged to have missed her fiscal rules by perhaps as much as £15bn, that’s fine.

Rachel Reeves during a visit to Cosy Ltd.
Pic: PA
Image:
A change could save the chancellor some headaches. Pic: PA

Now there’s a caveat – this exemption only applies, providing at the following budget the chancellor reduces that deficit back to zero.

But still, it’s potentially helpful wiggle room.

This help – this buffer – for Reeves doesn’t apply today, or for the next couple of years – it only kicks in from the spring of 2027.

But I’m being told by a source that some of this might change and the ability to use this wiggle room could be brought forward to this year. Could she give herself a get out of jail card?

The chancellor could gamble that few people would notice this technical change, and it might avoid politically catastrophic tax hikes – but only if the markets accept it will mean higher borrowing than planned.

But the question is – has Rachel Reeves ruled this out by saying her fiscal rules are iron clad or not?

Or to put it another way… is the whole of the 19-page Charter for Budget Responsibility “iron clad” and untouchable, or just the rules themselves?

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Is Labour plotting a ‘wealth tax’?

And what counts as “rules” and are therefore untouchable, and what could fall outside and could still be changed?

I’ve been pressing the Treasury for a statement.

And this morning, they issued one.

A spokesman said: “The fiscal rules as set out in the Charter for Budget Responsibility are iron clad, and non-negotiable, as are the definition of the rules set out in the document itself.”

So that sounds clear – but what is a definition of the rule? Does it include this 0.5% of GDP buffer zone?

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The Treasury does concede that not everything in the charter is untouchable – including the role and remit of the OBR, and the requirements for it to publish a specific list of fiscal metrics.

But does that include that key bit? Which bits can Reeves still tinker with?

I’m still unsure that change has been ruled out.

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