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From the Literature
Tracy Hampton, PhD

Great Recession Worsened

Blood Pressure and
Glucose Levels in American
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When researchers examined the

health effects of the 2008 Great Re-
cession using longitudinal data from
2000 to 2012 on ≈4600 people from
MESA (Multi-Ethnic Study of Ath-
erosclerosis), they found significant
increases in both blood pressure and
glucose postrecession compared
with individuals’ predicted values
from prerecession trends with age.
The Great Recession was the most
significant economic crisis since the Many commonly prescribed nonantibacterial medications may affect the
Great Depression of the 1930s. growth of the bacteria that normally reside in the gastrointestinal tract.
In the Proceedings of the Nation-
al Academy of Sciences study, the
increases were especially large for
“This work is important because Common Medications
it points to significant increases in Inhibit Gut Bacteria
individuals who were taking hyper-
two major cardiovascular risk fac-
tension or diabetes medications at Approximately one quarter of com-
tors—blood pressure and glucose—
the onset of the recession. This may monly prescribed nonantibacte-
as a function of a major economic
in part be the result of declines ob- rial pharmaceuticals may affect the
downturn,” said lead author Teresa
served in medication use and treat- growth of the bacteria that live in
Seeman, PhD, of the David Geffen
ment intensity for hypertension and the gastrointestinal tract, according
School of Medicine at UCLA. “This
diabetes mellitus after the recession. to a large-scale screen of the human
finding highlights the fact that cli-
Larger increases in blood pres- gut microbiota.
nicians and their patients (as well
sure and glucose levels were also For the Nature study, a team led
as society at large) should be alert
seen in subgroups of people who by investigators at the European
to the likely negative cardiovascu-
were more severely hit by the reces- Molecular Biology Laboratory in
sion: younger adults (who are most lar impacts of economic stressors Germany screened >1000 marketed
likely still in the labor force) and including economic downturns in drug compounds against 40 repre-
older homeowners (whose declining order to take more effective action sentative gut bacterial strains. Twen-
home wealth likely reduced a key to prevent or counteract such shifts ty-four percent of the drugs with a
element of their financial security). toward increased cardiovascular mechanism of action that affects
On the other hand, older individuals risk.” human cells, including members of
without a college degree (who were Seeman T et al. The Great Recession all therapeutic classes, inhibited the
worsened blood pressure and blood glucose
likely to be reliant on Medicare and growth of at least 1 strain in vitro.
levels in American adults. Proc Natl Acad Sci
Social Security payments) were the U S A. 2018;115:3296–3301. doi: 10.1073/pnas. Three classes—antimetabolites, an-
least affected by the recession. 1710502115. tipsychotics, and calcium channel

2534 June 5, 2018 Circulation. 2018;137:2534–2535. DOI: 10.1161/CIRCULATIONAHA.118.035635

Hampton Cardiology News

blockers—were significantly over- Maier L et al. Extensive impact of non-an- pan, along with follow-up data from
tibiotic drugs on human gut bacteria. Nature.
represented. 2018;555:623–628. doi: 10.1038/nature25979.
2009. Individuals with high calorie
An examination of data from pre- and high salt intake had a signifi-

vious cohort studies revealed that cantly higher cumulative incidence
many of these drugs have antibiot- High-Salt Diet Linked to of diabetes mellitus than individu-
ic-like adverse effects. It is unclear Obesity and Diabetes als with high calorie and low salt
whether the effects of the drugs on Mellitus intake. In addition, the cumulative
gut microbes are linked to the ben- incidence of nonalcoholic fatty liver
eficial mechanism of action of the New research may provide an ex- disease was higher in the adults who
drug or whether differences in the planation for why high salt intake consumed the most salt.
makeup of individuals’ gut micro- has been linked to the develop- “Salt along with sugar are the two
biome may affect the effectiveness ment of obesity and insulin re- ingredients more commonly added
of the medications. Previous stud- sistance independently of calorie to foods as they stimulate taste
ies have shown that bacteria can consumption. and flavor. While a vast literature
modulate drug efficacy and toxicity, In a Proceedings of the National already exists about the potential
however. Academy of Sciences study, mice fed deleterious effects of sugar in induc-
The investigators also noted an an elevated salt solution consumed ing features of metabolic syndrome,
overlap between resistance mecha- more food and were more likely to little is known about the effects of
nisms against antibiotics and against develop obesity and metabolic syn- salt which is commonly considered
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human-targeted drugs, implying a drome than mice fed a control so- as ‘safe’ as it does not provide any
potential risk of acquiring antibiotic lution, but only if fructose metabo- calories,” said lead author Miguel
resistance by consuming nonanti- lism was normal. Mice deficient in Lanaspa, DVM, PhD, of the Univer-
biotic drugs. fructokinase, the primary enzyme sity of Colorado Anschutz Medical
The study “opens up new ave- that metabolizes fructose, were pro- Campus. “To date, salt restriction is
nues for translational applications in tected from the obesity-inducing ef- only recommended by physicians for
mitigating drug side effects, improv- fects of the high-salt diet. (Fructose hypertension. Our study indicates
ing drug efficacy, repurposing of is a component of table sugar but that salt restriction should be rec-
human-targeted drugs as antibacte- is also produced endogenously from ommended not only for high blood
rials or microbiome modulators, and glucose.) pressure but also for other features
controlling antibiotic resistance,” Additional experiments revealed of metabolic syndrome like fatty liver,
the authors wrote. They stressed that fructose production in response diabetes, or obesity.”
that before any translational ap- to salt intake led to resistance to the
Lanaspa MA et al. High salt intake causes
plication can be pursued, however, hunger-inhibiting hormone leptin, leptin resistance and obesity in mice by stimu-
the mechanisms underlying their which preceded weight gain. lating endogenous fructose production and
metabolism. Proc Natl Acad Sci U S A. 2018;115:
findings must be investigated, and In applying the research to hu-
3138–3143. doi: 10.1073/pnas.1713837115. n
their in vitro results must be tested mans, investigators evaluated 2004
in animal models, pharmacokinetic medical records and questionnaires

studies, and clinical trials. from 13 000 healthy adults in Ja- © 2018 American Heart Association, Inc.

Circulation. 2018;137:2534–2535. DOI: 10.1161/CIRCULATIONAHA.118.035635 June 5, 2018 2535

From the Literature
Tracy Hampton

Circulation. 2018;137:2534-2535
doi: 10.1161/CIRCULATIONAHA.118.035635
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