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Dave Rengachary
SVP, Chief Medical Director

Welcome to another edition of ReSearch Vitals, RGA’s resource dedicated to providing you a collection of key article abstracts and links covering recent medical advances.

Our aim is to keep you up-to-date with the latest medical research, curating articles of interest to underwriters, medical officers and claims assessors. This edition includes articles relating to liquid biopsies, the fast-growing field of epigenetics, wearable devices, suicide risk, and many others.  

Please forward this email to your colleagues, and don’t forget to subscribe if you received this from a colleague. I hope you enjoy this issue and find it useful. 

As always, your feedback is welcomed; let me know what you think.

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In this edition

Cancer

Cancer icon Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer.  N Engl J Med via PubMed.

3 June 2018

Adjuvant endocrine therapy and chemoendocrine therapy had similar results for women with hormone-receptor-positive, HER2-negative, axillary node-negative breast cancer who had a midrange 21-gene recurrence score. Chemotherapy showed some benefit in some women aged 50 or younger.

Association of circulating tumor cell status with benefit of radiotherapy and survival in early-stage breast cancer.  JAMA Oncol via PubMed.

9 August 2018

In patients with early-stage breast cancer and detectable circulating tumor cells, radiotherapy treatment was associated with longer local recurrence-free survival, disease-free survival, and overall survival. 

 Liquid biopsy is receiving significant attention in the medical literature. The RGA global medical team recently described the current status of liquid biopsies in the context of cancer to include commentary about circulating tumor cells. See Liquid Biopsy: The RGA Perspective.

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016 a systematic analysis for the global burden of disease study. JAMA Oncol via PubMed.

2 June 2018

During the period of study, incident cancer cases grew by 28%. For men, the most common incident cancer was prostate cancer, and the leading causes of cancer deaths and disability-adjusted life-years (DALYs) were tracheal, bronchus, and lung cancers. Breast cancer was both the most common incident cancer and the leading cause of cancer deaths and DALYs for women.  

Lifestyle & Wellness

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Associations of combined genetic and lifestyle risks with incident cardiovascular disease and diabetes in the UK Biobank Study. JAMA Cardiol via PubMed.

27 June 2018

Poor lifestyles are associated with higher risks of cardiovascular disease and diabetes across all genetic risk groups, highlighting the potential benefits of positive lifestyle changes.

 

  Dr. Daniel Zimmerman, Senior Vice President and Chief Medical Director, provides An Insurance Perspective on the Fast-Growing Field of Epigenetics.He explains the new evidence on how our lifestyle choices are potentially measurably influencing mortality risk at an epigenetic level.    

Temporal associations of alcohol and tobacco consumption with cancer mortality. JAMA Network Open.

13 July 2018

Over a 20-year period, this Australian study found alcohol consumption per capita was positively associated with overall cancer mortality among men aged 50 to 69 years and women aged 50 years and older; tobacco consumption per capita was positively associated with overall cancer mortality among men aged 50 years and older.

Loss‐framed financial incentives and personalized goal‐setting to increase physical activity among ischemic heart disease patients using wearable devices: The ACTIVE REWARD randomized trial.  J Am Heart Assoc via PubMed.

9 June 2018

A 16-week trial of ischemic heart disease patients using wearables offered them money up front, with credits taken away if physical activity goals were not met. Physical activity increased during the 16 weeks, and these positive effects were still observed at an 8-week follow-up.

 Is the promise of wearable technology too good to be true? Inclusion of wearables in life insurance products to date has not matched the interest. But advances hold great promise. Julianne Callaway, Vice President and Strategic Research Actuary, explores the power and perils of these promising devices in

Psychiatry

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Association between traumatic brain injury and risk of suicide.  JAMA via PubMed.

14 August 2018

Compared with the general population, individuals with traumatic brain injury had an increased risk of suicide, with an incident rate ratio of 1.90.

Vital Signs: Trends in state suicide rates — United States, 1999–2016 and circumstances contributing to suicide — 27 states, 2015.  CDC Morbidity and Mortality Weekly Report.

8 June 2018

In the United States, suicide rates increased significantly across most states during from 1999 to 2016. Approximately half of suicide decedents did not have a known mental health condition. Various circumstances contributed to suicides among individuals with and without known mental health conditions.

Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: A cross-sectional study. Lancet Psychiatry via PubMed.

8 August 2018

In this large U.S. sample, all types of exercise were associated with a lower mental health burden, with the strongest associations seen for team sports, cycling and aerobic activities.

Cardiovascular

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Adverse change in employment status after acute myocardial infarction. Circ Cardiovasc Qual Outcomes via PubMed.

12 June 2018

The study found that patients who experienced an adverse change in employment post-MI reported lower quality of life and increased depression. Unplanned rehospitalizations and post-MI bleeding were the strongest predictors of adverse change in employment.

 

Erectile dysfunction as an independent predictor of future cardiovascular events: The multi-ethnic study of atherosclerosis. Circulation via PubMed.

11 June 2018

After adjusting for traditional CVD risk factors, depression, and β-blocker use, erectile dysfunction was found to be a significant predictor of CVD events.

Increasing population height and risk of incident atrial fibrillation: The Copenhagen City Heart Study. Eur Heart J via PubMed.

28 June 2018

Analysis found that height is a risk factor for incident atrial fibrillation, with HRs between 1.35 (95% CI 1.10–1.66; P = 0.004) and 1.65 (95% CI 1.40–1.93; P <0.001).

Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nature Genetics via PubMed.

13 August 2018

Researchers developed and validated genome-wide polygenic scores for common diseases, including coronary artery disease, atrial fibrillation, and type 2 diabetes. This important paper argues that it’s time to include polygenic risk prediction in clinical care.

  As genomic screening enters mainstream medicine, RGA’s Global Research and Data Analytics team has produced a series of webcasts to explore advances in genomic medicine and affordable direct-to-consumer genetic testing. See Use of Genetics in Insurance and Growing Opportunities for Anti-Selection.    

Longevity

Longevity Recent trends in life expectancy across high income countries: Retrospective observational study.  BMJ via PubMed.

15 August 2018

In many high-income countries, life expectancy declined during 2014-15 but experienced gains the following year. The UK and the U.S., however, seem to be experiencing continued declines in life expectancy

Aging as a biological target for prevention and therapy.  JAMA Viewpoint.

2 October 2018

Since average life expectancy is around 80 years and the theoretical maximum is 115 years, 35 years have yet to be realized. Research has shown that fundamental aging processes can be targeted by nutritional, genetic, and pharmacologic interventions to enhance and extend both health and longevity in experimental animal models. These findings clearly demonstrate that the biological rate of aging can be slowed.