Higher aerobic fitness linked to longevity and better quality of life

A new study from Cleveland clinic found that increased cardiorespiratory fitness (CRF) or aerobic fitness is associated with lower long-term all-cause mortality with no upper limit observed for the amount of exercise. Patients who demonstrated extreme CRF (≥2 SDs above the mean for age and sex) was at the lowest risk of adjusted all-cause mortality as compared to other performance groups.

People with poor aerobic fitness face the same likelihood of dying as that due to chronic diseases like diabetes, hypertension and cardiovascular disease note the researchers of this retrospective study published in the Journal of the American Medical Association Network Open.

This retrospective study recruited the largest reported cohort of 122 007 patients between Jan. 1, 1991, and Dec. 31, 2014, who underwent Exercise treadmill testing (ETT) at a tertiary care center. ETT eliminates the bias introduced due to self-reporting and is the most widely used method to measure the CRF.

Demographics and other co-morbidities were noted at the time of undergoing specified stress test under the supervision of exercise physiologist. Patients were classified into performance group by age- and sex-associated cutoffs as follows: elite (≥97.7th percentile), high (75th-97.6th percentile), above average (50th-74th percentile), below average (25th-49th percentile), and low (<25th percentile).

The mean age was 53.4years, and about 60% were male. As the performance level increased, the associated co-morbidities decreased except for hyperlipidemia (present in 30% of elite performers).

After multivariate analysis, it was seen that at any given point of time, patients in the elite group were 80% less likely to die as compared to patients with low CRF (elite vs. low: adjusted HR, 0.20; 95% CI, 0.16-0.24; P < .001). The survival benefit was more evident in older patients (70 and more) and those with hypertension. Long-term survival was adjusted for a patient’s age, sex, height, weight, BMI, medications, and comorbidities.

Hypertensive patients in the elite group were 30% less likely to suffer mortality as compared to those in the high-performance group (75th-97.6th percentile).

Patients with lowest aerobic fitness (<25th percentile) faced risks that were comparable or more than patients with chronic disease like CVD (24% more), diabetes (40% more) and smoking (40% more). 

These findings highlight the importance of aerobic fitness concerning prolonging life and improving the quality of life. This study reinforces the results of previous studies that have demonstrated the benefits of achieving CRF.

“Aerobic fitness is something that most patients can control. And we found in our study there is no limit to how much exercise is too much,” said Wael Jaber, M.D., Cleveland Clinic cardiologist and senior author of the study in a news release.  “Everyone should be encouraged to achieve and maintain high fitness levels.”

It also stresses the importance of continued high-level physical activity in older adults and the benefits of maintaining the highest aerobic fitness. Some recent studies have demonstrated an association between extreme high level of exercise and an increased incidence of atrial fibrillation, coronary artery calcification, myocardial fibrosis, and aortic dilation. However, it is not clear whether these findings are a simple physiological adaptation or because of cardiovascular pathology.

“We were particularly interested in the relationship between extremely high fitness and mortality,” said Kyle Mandsager, M.D., an electrophysiology fellow at Cleveland Clinic and the lead author of the study.  “This relationship has never been looked at using objectively measured fitness, and on such a large scale.”

The authors conclude, “Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.”

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Study: Dad's exercise before conception impacts child's lifelong health

Researchers at Joslin Diabetes Center have shown that paternal exercise has a significant impact on the metabolic health of their offspring well into adulthood.

Study: Dad's exercise before conception impacts child's lifelong health

First blood pressure monitor with cellular connectivity launched in the USA

Livongo Health, the leading consumer digital healthcare company today announced its launch of first blood pressure monitor with cellular connectivity in the U.S. at Health 2.0. It provides the simplest way to acquire, monitor and transfer the blood pressure reading to the cloud for Remote Patient Monitoring (RPM). This seamless “cuff to cloud” transfer enables the consumer to remain in the relaxed atmosphere of their home, thereby eliminating the “white coat syndrome.”

The patients also receive useful and timely insight into BP and Health Nudges TM from certified professional specially trained in the management of chronic diseases.

Just as we did with diabetes, Livongo wants to make it easier for people to stay healthy by checking their blood pressure, receiving real-time personalized feedback, sharing the information with their physician and other members of their connected care community from home, thereby avoiding a rise in blood pressure that can come with visiting a doctor," said Amar Kendale, Chief Product Officer, 

Livongo. 

"We are proud to introduce the first cellular-enabled blood pressure monitoring system to market in the U.S. and to add this capability to our comprehensive platform for people with all kinds of chronic conditions. This allows us to treat the whole person and the challenges they face seamlessly."

Livongo’s signature offerings include Livongo for Diabetes, Livongo for Hypertension, and Livongo Diabetes Prevention (DPP) powered by Retrofit.

Diabetes and Hypertension are the fastest growing chronic diseases in the United States and account for 458 billion dollars in healthcare costs. Improving the blood pressure control through lifestyle change and adherence to medication can bring down the chance of cardiovascular event by 50%.

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ACOG/AHA calls for including a ‘Heart-talk’ during the annual well-woman visit

A joint advisory issued by American College of Obstetrician and Gynecologists (ACOG) and American Heart Association(AHA) calls for all gynecologist to screen women for signs of cardiovascular disease and risk factors during their annual ‘well-woman’ visit.

The presidential advisory published 10 May in Journal Circulation calls for a collaboration between cardiologists and Ob/Gyn physicians to use these visits as an opportunity to screen, counsel and educate women about lifestyle factors that influence the risk of heart diseases.

This is important because, for more than 50% of women, their Ob/Gyn physician is the only primary care doctor they visit every year.

“OB/GYNs are primary care providers for many women, and the annual ‘well woman’ visit provides a powerful opportunity to counsel patients about achieving and maintaining a heart-healthy lifestyle, which is a cornerstone of maintaining heart health” said John Warner, M.D. president of the American Heart Association, executive vice president for Health System Affairs at University of Texas Southwestern Medical Center in Dallas, Texas.

Dr. Stacey Rosen, MD, a cardiologist, co-author of the advisory and vice president of The Katz Institute for Women's Health at Northwell Health said, "We know that 90 percent of women have at least one risk factor for heart disease and that 80 percent of heart disease is preventable through a heart-healthy lifestyle.”

A post-partum visit is an ideal opportunity to identify women with pregnancy complications like pre-eclampsia, eclampsia, chronic hypertension, gestational diabetes, gestational hypertension, pre-term delivery, and low-for-estimated-gestational-age birth weight which all indicate a subsequent increase in the mother’s cardiovascular risk.

Preeclampsia and gestational hypertension impart a three- to six-fold excess risk of subsequent hypertension and a two-fold risk for subsequent heart disease.

In 2001, the Institute of Medicine now the National Academy of Sciences, issued a monograph" Exploring the Biological Contributions to Human Health: Does Sex Matter?" This initiated research on gender-specific risk factors for chronic diseases and development of guidelines that are distinct for men and women based on their unique health risks.

This has considerably helped in bringing down the morbidity and mortality associated with cardiac disease in women in last two decades.

Despite this progress, gender-specific inequalities continue when it comes to managing risk factors for cardiac disease. For example, women who have diabetes are at increased risk of CVD as compared to men (19% vs 10%) but they are far less likely to receive preventive treatment as compared to men.

Similarly, only 29% of older women have a well-controlled blood pressure as compared to 41% of older men.

In women, the CVD risk factors are often related to hormonal or pregnancy influences, such as pregnancy complications and polycystic ovary syndrome, menopausal status and hormone use, but these are seldom considered when calculating the risk of CVD.

Some of the common recommendations in the advisory include:

• All women should be weighed at every visit and diet assessment should be performed through a predetermined questionnaire.
• Women are advised to perform 150 minutes per week of moderate-intensity physical activity, 75 minutes per week of vigorous-intensity aerobic physical activity or a combination of both levels. Women should also walk 10,000 steps per day.
• Presence of behavioral risk factors like smoking and alcohol should be assessed.
• Screening for Glucose intolerance should be done in women 40 to 70 years with obesity or overweight, a history of gestational diabetes, a family history of diabetes or established CVD.
• All women above 20 years of age with a family history of CVD, should undergo lipid screening. Lifestyle modification followed by statins is advised in those with elevated lipids.
• Women with family history of CVD should also be screened for blood pressure every 2 years and annually after 40 years of age.
• Medical therapy would be considered for women without CVD or elevated risk for the disease and with BP measurements greater than 140 mm Hg/90 mm Hg.
• Ob/Gyn and cardiologist should make sure that patients Electronic Health Record (EHR) is complete during each visit and is something does not look good, patients should be referred to a specialist.

The clinicians and patients can visit the following websites to get patient education material.

AHA Life's Simple 7 

AHA's Go Red for Women

ACOG's patient page

Full Text

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Here is one video from  AHA series ' Life's Simple 7'

On the go blood glucose monitoring by inbuilt Glucometer in Smartphone Case

With a wide array of features like GPS, depth perception and many health-related features like BP and ECG monitoring, Smartphones have become indispensable part of our daily lives. They are the health gadgets of future. But, so far nothing was much developed for diabetics, other than the use of  phone screen to display results of continuous glucose monitoring on the screen.

Engineers at the University of California San Diego have cleverly integrated a glucose monitor in the smartphone case and app, that will enable diabetic patients to record and track their blood glucose readings, whether they’re at home or on the go.

Currently, there is no way for people with diabetes to check the blood glucose when they are out of the house or travelling. They must pack the whole kit and carry it along with them.

Patrick Mercier, a professor of electrical and computer engineering at UC San Diego is the brain behind this new gadget. “Integrating blood glucose sensing into a smartphone would eliminate the need for patients to carry a separate device,” said Patrick Mercier, he said in a news release. “An added benefit is the ability to autonomously store, process and send blood glucose readings from the phone to a care provider or cloud service.”

The new device is named GPhone, and has two main parts. A slim, aesthetically designed, 3D printed case that fits over the smartphone with a permanent, reusable sensor at the top left corner.

The sensor has to be activated by one-time use enzyme packed pellets that magnetically attach to the sensor.

To run a test, a user has to activate the sensor by dispensing a pellet on it, followed by adding a drop of blood to the now activated sensor. The sensor measures the glucose concentration and wireless send it via a Bluetooth to a custom designed android app, that displays the results on the screen.

The user can communicate the results with his healthcare provider or store it in icloud, to track it over a long period of time.

The pellet is discarded after use and the sensor is deactivated. A 3D printed stylus with capacity of 30 pellets store them, and remains attached to the side of the case.

The pellet contains enzyme called glucose oxidase which reacts with glucose and generates an electrical signal in proportion to glucose levels that is picked by the sensor’s electrode.

The work is currently at proof of concept stage. Joseph Wang, nanoengineering professor and his other colleagues dream of integrating the monitor with the smartphone instead of case. They are also working currently to reduce the amount of blood needed for testing and bringing down the cost of the pellets, which are costlier than usual test strips.

The work was recently published in Biosensors and Bioelectronics.

UC San DiegoNewsletter

Journal Abstract 

All Media: Courtesy UC San Diego Newsletter

News from ASRM 2017: Subfertility May be Harbinger of Disease Later in Life

The American Society for Reproductive Medicine (ASRM) 2017 Scientific Congress kicked of today morning by an opening keynote address from President Richard J. Paulson, M.D. at San Antonio, TX. The agenda ranges from the latest molecular and genetic technologies to advocacy for the patients with a focus on access to care.

Researchers from the University of Pennsylvania today presented research showing that women seeking infertility treatment have a shorter life span as compared to their parous counterparts. They have a higher risk of dying from endocrine related disorders such as diabetes and breast cancer than other women.

This retrospective cohort study examined  records of nearly 80,000 women and followed them for nearly 13 years, with an aim to determine the association of a history of infertility with all-cause mortality.

These women were enrolled in the Prostate Lung, Colorectal, and Ovarian (PLCO) Cancer screening trial from 1992-2001. Nearly 76,000 women had data on infertility.

It was seen that 14.5% (n=11,006) of women did not have any children. The average age at death for each cohort was similar (74 years) but women in infertile cohort had 10% greater chances of dying as compared to fertile cohort.  (HR1.10, 95%CI 1.03, 1.17, p=0.005).

Infertile women also face 69% increased chances of dying due to diabetes, 49% more chances of death due to breast cancer.

Ovarian cancer and Endometrial cancer did not increase the risk of death, although infertile women had marginally high risk of ovarian cancer.

This large retrospective study does show an association between endocrine related diseases and infertility but does not prove causation.It stresses the need of prospective studies and more research  in this area.

But, infertility can present an early opportunity to screen these women for chronic diseases and interventions.

Richard J. Paulson, MD, President of ASRM said in a News Release, “This is an intriguing and potentially very important study. More work is clearly needed to help us understand if, in some patients, there might be an underlying medical problem that presents as infertility during the reproductive years and then contributes to endocrine-related disease later in life. We also need to investigate if infertility treatments can counter some of this increased risk.”

The study is also published in Fertility and Sterility September supplement.

Artificial sweeteners are now linked to increased cardio-metabolic risk and gain in weight -Not weight loss.

Artificial sweeteners are now linked to significantly higher risks of diabetes, heart disease and increased weight gain according to results of a systematic review and meta-analysis published today in Canadian Medical Association Journal.

Artificial sweeteners are synthetic food additives that we all are familiar with, they provide a sweet taste to the food without adding significant calories to it.

They are found in many common products we consume in our daily life Diet Soda, cough syrup, salad dressings, yoghurts and many more.

It is frequently added to tea, coffee and other sweet dishes to reduce the daily calorie consumption.

The present review was conducted by researchers from the University of Manitoba, Canada and reviewed data from 37 randomized control trials (RCTs) and prospective cohort studies which analyzed more than 406,000 people for an average period of 10 years.

Seven studies were RCTs, considered a gold trials in research arena.

The primary outcome that the researchers were interested was BMI, while secondary outcomes included weight, obesity and other cardiometabolic end points.

The data analysis of included RCTs shows that artificial sweeteners had no significant effect on BMI, whereas the analysis of cohort study showed a moderate increase in BMI over the course of years.

Further analysis of data from RCTs showed no further effect on other parameters of body composition or risk of cardiometabolic diseases. However, the data from cohort studies was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events.

Because the data from RCTs does not resulted in increased weight gain and higher risk of cardiometabolic events, the systematic review does not prove causation.  

Meghan Azad, lead study researcher and an assistant professor in the department of pediatrics and child health at the University of Manitoba in Canada said, “I think there’s an assumption that when there are zero calories, there is zero harm. This research has made me appreciate that there’s more to it than calories alone.”

Susan Swithers, a professor in the department of psychological studies at Purdue University said, “Unfortunately, the quality of evidence that would support using sweeteners is not really strong. I think we are at a place where we can say that they don’t help.”

The current USDA guidelines allows for 10 teaspoons of sugar a day for average person, that equals to just one 16-ounce bottle of regular soda.

There are just five sweeteners approved by the Food and Drug Administration for use in the United States: acesulfame potassium (sold as Sunett and Sweet One), aspartame (sold as Equal, Nutrasweet and Sugar Twin), neotame (sold as Newtame), saccharin (sold as Sweet'N Low, Sweet Twin and Necta Sweet) and sucralose (sold as Splenda).

“More research is definitely needed,” says Azad. “You need a long-term study.” But, lack of proven benefits does make people pause and think, before choosing an artificial sweetener.

In the meantime, researcher’s advice that reducing your taste for sweet altogether rather than choosing between a sugar-sweetened or artificially sweetened drink or food is the best choice at present.

The FDA strongly believes that  use of these sweetener in moderation will not do much harm, till results of more studies proving the harms and benefits are available.  

Stevia, a natural sweetener derived from plants, was not included in the study. 

How not to die---Foods scientifically proven to reverse and prevent disease.

Yesterday I had the opportunity to listen to a lecture by Dr. Michael Greger as a part of monthly lecture series by Vegetarian society of Hawaii.

Michael Greger, MD, FACLM is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, among countless other symposia and institutions; testified before Congress; has appeared on shows such as The Colbert Report and The Dr. Oz Show; and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.[1]

His website is NutritionFacts.org, which has got a collection of videos and articles about healthy plant based diet.

The topic of his presentation was How not to die: The role of diet in preventing, arresting and reversing our top 15 killers. The presentation was based upon his latest book How not to Die, which became an instant New York Times Best Seller.

The book is available on Amazon and other sites in kindle, audio CD, paperback and hardcover. 

Photo courtesy:  Amazon 

The presentation begins with a personal note about Dr.Greger’s grandmother, who was diagnosed with end stage heart disease at age 65 and was sent home to await death as Drs. Said that nothing could be done to improve her condition.  She was confined to wheelchair and was in a really bad shape. She was rescued by Nathan Pritikin, one of our early lifestyle medicine pioneers.

She was put on a completely different diet of lots of fruits and vegetables, and the outcome is a history.

Not only she defied death, but lived a healthy life for another 31 years --- till the age of 96, and enjoyed her 6 grandchildren and great grandchildren.

This incidence inspired Dr. Greger to choose medicine and later specialize and dedicate his life to life style changes and prevention and cure of diseases.

He maintains his non-profit website solely dedicated to nutrition, diet and cure of diseases through healthy plant based diet- NutritionFacts.org.

The 15 most common cause of diseases worldwide are Heart disease, Cancer, Hypertension, smoking and COPD, Stroke, Diabetes, kidney failures, respiratory infection, suicide, blood septicemia, parkinsonism.

Talking about heart disease Dr. Greger said “Heart disease is a choice like dental cavities.”Coronary heart disease; atherosclerosis; hardening of the arteries, begins in childhood. By age 10, the arteries of nearly all kids raised on the standard American diet already have fatty streaks—the first stage of the disease.[2]

When researchers took people with heart disease and put them on the kind of plant-based diet followed by those populations that didn’t suffer from heart disease, their hope was to slow the disease process down—maybe even stop it. But instead, something miraculous happened.

The disease started to reverse, to get better. As soon as patients stopped eating an artery-clogging diet, their arteries started opening up.  Their bodies were able to start dissolving some of the plaque away. Even in some cases of severe triple vessel heart disease, arteries opened up without drugs, without surgery—suggesting their bodies wanted to heal all along, but were just never given the chance. This improvement in blood flow to the heart is after just three weeks of eating healthy.

Similarly, he has put out reasons and evidence for each of the 15 diseases he described that can be prevented, or reversed with diet.

The complete lecture can be heard here. 

He has a famous list of daily dozen that should be consumed daily to add years to your life.  

This is the list by Dr.Michael  Greger as told to Daily Mail, UK.[3]

1Cruciferous vegetables, such as broccoli, brussels sprouts, cabbage, cauliflower, kale, spring greens, radishes, turnip tops, watercress

One serving a day: A serving is half a cup chopped or quarter of a cup of broccoli or brussels sprouts.

2 Greens including spring greens, kale, young salad greens, sorrel, spinach, swiss chard

Two servings a day: A serving is one cup raw or half a cup cooked.

3 Other vegetables: Asparagus, beetroot, peppers, carrots, corn, courgettes, garlic, mushrooms, okra, onions, pumpkin, sugar snap peas, squash, sweet potatoes, tomatoes

Two servings a day: A serving is one cup raw leafy vegetables; half a cup raw or cooked non-leafy vegetables; half a cup vegetable juice; a quarter of a cup dried mushrooms

4 Beans: Black beans, cannellini beans, black-eyed peas, butter beans, soyabeans, baked beans, chickpeas, edamame, peas, kidney beans, lentils, miso, pinto beans, split peas, tofu, hummus

Three servings a day: That's a quarter of a cup of hummus or bean dip; half a cup of cooked beans, split peas, lentils or tofu; or a full cup of fresh peas or sprouted lentils.

5 Berries: Any small edible fruit, including grapes, raisins, blackberries, cherries, raspberries and strawberries

One serving a day: A serving is half a cup of fresh or frozen, or quarter of a cup of dried.

6 Other fruit, such as apples, apricots, avocados, bananas, cantaloupe melon, clementines, dates, figs, grapefruit, honeydew melon, kiwi, lemons, limes, lychees, mangos, nectarines, oranges, papaya, passion fruit, peaches, pears, pineapple, plums, pomegranates, prunes, tangerines, watermelon

Three servings a day: One serving is a cup of cut-up fruit, or one medium fruit, or a quarter of a cup of dried fruit.

7 Flaxseeds

Snack on one tablespoon a day.

8 Nuts

A quarter of a cup a day, or two tablespoons of peanut, almond or other nut butter.

9 Spices

A quarter teaspoon of turmeric in addition to any other spices you enjoy.

10 Whole grains

Buckwheat, rice, quinoa, cereal, pasta, bread.

Three servings a day: Half a cup of cooked rice or pasta; one cup of cereal; a slice of bread; half a bagel.

11 Exercise

Ideally 90 minutes a day of moderate activity, such as walking.

12 Water

Five large (12oz/340ml) glasses a day.

Here are some important links to his articles:

http://nutritionfacts.org/topics/heart-disease/

http://nutritionfacts.org/topics/cancer

http://nutritionfacts.org/topics/blood-pressure

http://nutritionfacts.org/topics/diabetes

http://nutritionfacts.org/topics/chronic-diseases/

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[1] http://www.drgreger.org/about

[2] http://nutritionfacts.org/video/how-not-to-die

[3] http://www.dailymail.co.uk/health/article-3470450/Foods-eat-day-Dr-Michael-Greger-s-Daily-Dozen.html

Hormone replacement, Insulin sensitivity and Diabetes: Is there a critical window of opportunity?

This article is based on a commentary Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital and   a recent paper published in Journal of Clinical Endocrinology & Metabolism by Pereira R et al which concluded that there certainly is a time period in postmenopausal women when giving estrogen would alter the development of Insulin resistance and subsequent T2DM.

Pereira and colleague conducted a very small and short term RCT consisting of 46 postmenopausal women. Half of the subjects were less than 6 years into menopause and the other half were older and nearly 10 years past menopause.

All these women were given transdermal estradiol in high dose of 150 µg/day for a week.

After that they were given Glucose disposal rate ( GDR)  test which measures the rate of glucose uptake from the blood by the peripheral tissues, such as skeletal muscle with a hyperinsulinemic-euglycemic clamp.

There is no apparent time dependent decline in GDR with age or menopausal status per se. But, it was seen that after estrogen therapy  in younger women with less than 6 years into  menopause, a improvement in GDR and insulin sensitivity was observed , whereas those women who are older and further down the lane from menopause there was deterioration in GDR test and decrease in insulin sensitivity.

In the past there are several Randomized Control trials studying the effect of hormone therapy on diabetes in menopausal women. The data from the Heart and Estrogen/progestin Replacement Study (HERS), in which 2763 postmenopausal women with documented coronary heart disease (CHD) were randomly assigned to daily estrogen plus progestin therapy or to placebo showed that those assigned to hormone therapy had a 35% lower risk of diabetes.

Similarly two trials from the Women’s Health initiative also showed benefits, although the effect was smaller when using estrogen and progesterone as when using estrogen alone.

Now does that mean that HRT should be solely started to prevent the happening of diabetes? No, because HRT is associated with its own risks of venous embolism and stroke.

The study simply gives us one more reason to be optimistic and instrumental in starting HRT in those recently postmenopausal women who have other indications for hormone therapy, such as hot flashes and other symptoms where hormone therapy would be indicated. The study also points to important metabolic benefits of hormone therapy that should be studied in greater details with much larger trials. 

References:

Pereira RI, Casey BA, Swibas TA, et al. Timing of estradiol treatment after menopause may determine benefit or harm to insulin action. J Clin Endocrinol Metab. 2015;100:4456-4462. Abstract

Margolis KL, Bonds DE, Rodabough RJ, et al.; for the Women's Health Initiative investigators. Effect of oestrogen plus progestin on the incidence of diabetes in postmenopausal women: results from the Women's Health Initiative hormone trial. Diabetologia. 2004;47:1175-1187. Abstract

Kanaya AM, Herrington D, Vittinghoff E, et al.; for the Heart and Estrogen/progestin Replacement Study investigators. Glycemic effects of postmenopausal hormone replacement therapy: the Heart and Estrogen/progestin Replacement Study. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003;138:1-9.

http://www.ndei.org/Glossary/Glucose_disposal_rate/

http://care.diabetesjournals.org/content/30/5/1143.full

Wonderdrug ' Metformin', the next breakthrough in anti-aging.

Common Diabetes drug Metformin could be next breakthrough in Anti-aging.