The Arising · The Heart

THE ARISING · LONGEVITY & HEALTHSPAN SUNDAY, OCTOBER 18, 2026 IN THIS EDITION · LONGEVITY & HEALTHSPAN 1 ACOG Now Recommends Hormone Therapy for Many Women With Hot Flashes 2 Cardiologists Urge Doctors to Prescribe Exercise as Routine Heart Care 3 Fasting and Autophagy in Humans: Summary Calls Link Unproven 4 Gut Supplements May Modestly Improve Cognition in Adults Over 60, Review Finds 5 Higher Ultra-Processed Food Intake Linked to Silent Brain Damage on MRI 6 Higher VO2 Max Linked to Lower Depression and Anxiety Risk in UK Biobank 7 Bonn Lab Study Shows Blood Cells From Older Donors Lose Epigenetic Age in a Dish 8 Longer Sleep Linked to Kidney Disease Risk in Type 2 Diabetes LONGEVITY & HEALTHSPAN · WEEKLY READ · 2 MIN AMERICAN COLLEGE OF CARDIOLOGY Cardiologists Urge Doctors to Prescribe Exercise as Routine Heart Care You may not need 10,000 steps a day to protect your heart. A new statement from the American College of Cardiology says the biggest gains come when inactive people start moving at all. This is an expert scientific statement that synthesizes existing evidence, not a new trial, and it is written mainly as guidance for clinicians. he statement, published online October 15, 2026, in JACC, asks doctors to treat exercise as a foundational part of routine cardiovascular care. It coversT both preventing heart disease and managing it. The writing committee was chaired by Jonathan N. Myers, PhD. Its central message is simple. "Some activity is better than none," Myers said. According to the statement, the greatest benefit comes when people move from inactivity to regular physical activity. More activity, and more intensity where clinically appropriate, is linked to further benefit. THE ARISING · OCTOBER 18, 2026 PAGE 6 What counts as enough? The statement points to growing evidence that meaningful benefits come well below 10,000 steps a day. About 5,000 to 7,000 daily steps is associated with lower cardiovascular and all-cause mortality for many adults. That is an association seen in studies of populations. It does not prove that walking that amount is the cause of the lower risk. This is the weakest part of the argument: the step-count evidence is observational. "Patients do not need to become athletes to improve their cardiovascular health," Myers said. "Small increases in physical activity can produce meaningful benefits, particularly for those who are currently inactive." Strength work gets a place in the plan too. The statement says resistance training should complement aerobic exercise for most adults. Aerobic exercise is walking, cycling or anything that raises your heart rate for a sustained period. Resistance training means lifting weights, using bands or doing bodyweight exercises. The statement recommends doing both. The statement also says exercise should be individualized. A plan should reflect a person's heart condition, functional capacity, symptoms, goals and preferences. A person recovering from a heart event needs a different plan than someone with no symptoms who is trying to stay healthy. On testing, the statement says routine exercise testing is not required before starting exercise for most people who have no symptoms or whose conditions are stable. Testing can still provide useful information for shaping a prescription when it is clinically appropriate. For many people with known heart disease, cardiac rehabilitation remains first-line treatment, the statement says. Access to it should be expanded. Insurance reimbursement is still a barrier for many. Patients with known heart disease who cannot take part in a formal program should still receive an individualized exercise prescription. The statement also says wearable devices and virtual or home-based programs may help people keep exercising over time, especially alongside structured programs. Myers said exercise is one of the most effective therapies for preventing and managing cardiovascular disease, yet it remains underutilized in routine care. The statement calls for more exercise counseling in routine visits, better clinician training and expanded access to rehabilitation. THE ARISING · OCTOBER 18, 2026 PAGE 7 Exercise is not a replacement for medical care. Do not start, stop or change any treatment, including medications or a prescribed rehabilitation plan, without your clinician. The statement is written for clinicians, so questions about how it applies to you belong with your own care team. The statement also calls for more research on long-term adherence, clinical outcomes, diverse populations and scalable ways to deliver exercise programs. Watch for whether those studies follow, and whether insurers move on cardiac rehabilitation coverage. Source: American College of Cardiology (JACC) THE ARISING · OCTOBER 18, 2026 PAGE 8

OCTOBER 15, 2026 People who carry active brown fat tend to have healthier blood sugar, cholesterol and hearts. A large new analysis suggests they may also have lower rates of psychiatric disease. But the finding shows a link, not a cause, and it does not mean anyone should start a blood pressure drug to get more of this tissue. Do not start, stop or change losartan, other blood pressure drugs of its class, SSRIs or any medication without talking to your clinician. A tissue known for heat production appears here in a much broader set of health associations. Large-scale clinical records can reveal those relationships, although they cannot explain them on their own. The work was published in Nature in 2026. It is an observational study in people, not a trial. Researchers drew on a cohort of 101,243 patients at a large cancer centre. They also ran a proof-of-concept test of the drug losartan, which the study reports increased brown fat cell activity and whole-body energy expenditure. Observational data can show that two things go together. They cannot show that one causes the other. Brown fat is different from the white fat that stores energy. According to the study's abstract, brown adipose tissue uses energy to produce heat. Earlier work had linked detectable brown fat in humans to a lower prevalence of cardiometabolic disease, meaning conditions that affect the heart and metabolism. What was missing, the authors write, was a full picture of which health conditions it relates to, and a fast way to measure how active the tissue is in many people. The team used big data and artificial intelligence to fill that gap. In an unbiased sweep across all diagnoses, cardiovascular and psychiatric diseases were less prevalent in people with brown fat. Then a machine learning approach semi-automatically measured brown fat activity in about 8,700 patients. Higher activity was tied to lower odds of cardiometabolic disease and to a healthier distribution of white fat. This was especially true for brown fat in the axillary depot, the area around the armpit. People with brown fat also had more favourable blood sugar measures, lipid profiles, inflammatory markers and echocardiographic indices, which are measures taken from heart ultrasound. The medication analysis produced the headline-friendly result. Use of angiotensin receptor blockers, a class of blood pressure drugs, was positively associated with having brown fat. As a proof of concept, the authors showed that one of them, losartan, increased brown fat cell activity and whole-body energy expenditure. Here the coverage goes further than the abstract. News-Medical, summarising a Rockefeller University release, reports that the energy findings came from experiments in cultured cells and in healthy mice, which kept a steady body weight. It also quotes first author Nicolás Gómez-Banoy saying losartan acts on brown fat through different molecular pathways than its blood pressure effect. That could, he says, allow future therapies to stimulate brown fat in people with normal blood pressure. The abstract does not give those details, so they should be read as the researchers' view, not settled fact. That is why the drug link is not a reason to take losartan. The human data show only that people on these drugs were more likely to have brown fat. They do not show that the drug created it, or that taking it would improve anyone's health. Losartan is a prescription medicine for people with a medical need. The study frames its result as a platform for drug repurposing, not as a recommendation. The mental health finding also needs care. Gómez-Banoy told News-Medical that metabolically healthy people tend to have lower rates of psychiatric disease, so brown fat may simply track with better metabolic health. The coverage also reports that SSRI antidepressants were associated with dampened brown fat activity, and that the researchers want to look at possible downsides, including osteoporosis and skin disease. None of those points is in the abstract. Anyone taking an SSRI should not read this as a reason to change treatment. Other limits matter too. The patients were being monitored for cancer, so they may not represent the general public. This is also where the argument is weakest: an association in a single hospital cohort cannot say whether brown fat improves health, whether it is a marker of it, or whether drugs shape it. The abstract does not settle these questions, so they remain open. For now, the practical message is modest. Brown fat looks like a marker of metabolic health, and this study gives researchers a way to measure it at scale. Watch for work that tests whether activating brown fat in people improves health outcomes, and whether other drugs flagged in the data do the same. Senior author Paul Cohen told News-Medical, "This is just a start." The next advance would distinguish a marker of healthier physiology from a way to influence it. That difference determines what the observation can become. Sources: Nature (2026), News-Medical (Rockefeller University release; study in Nature) Nature (2026): https://doi.org/10.1038/s41586-026-11162-7 News-Medical (Rockefeller University release; study in Nature): https://www.news-medical.net/news/20261014/Common-blood-pressure-drug-boosts-brown-adipose-tissue-activity-and-metabolism.aspx ---

OCTOBER 14, 2026 A normal blood pressure reading at the doctor's office may not tell the whole story for people in their late seventies and beyond. In a preliminary study of 758 older adults, those whose office readings were normal but whose home readings were high had about a 70% higher risk of falling than those whose readings were high in both places. A person's blood pressure belongs to a day, not only to a visit. Preliminary findings about home readings and falls ask whether the wider pattern can reveal something clinically useful. This is an observational study in people, so it shows an association, not a cause. It was presented as a research abstract at the American Heart Association's Hypertension Scientific Sessions 2026 on October 9. It has not been peer reviewed or published in a journal. The details here come from the American Heart Association Newsroom's release on that abstract. We did not have the abstract itself. The pattern is called masked hypertension. Blood pressure looks normal in a clinic but runs high at home. Its mirror image is "white coat" hypertension, where readings are high at the clinic but lower at home. Sustained hypertension means readings are high in both settings. According to the newsroom release, the participants came from the Atherosclerosis Risk in Communities (ARIC) study, which began enrolling people in 1985 in four U.S. communities. They were aged 78 to 98, with a median age of 83. About 59% were women and 17% identified as Black. Some 82% were already taking blood pressure medication. Office blood pressure was measured three times after five minutes of seated rest. Home readings were taken morning and evening on eight non-consecutive days in 2023. Of the 758 adults, 34.5% had sustained high blood pressure, 17.0% had white coat hypertension, 15.4% had masked hypertension and 33.2% had normal readings. Participants reported their falls during annual phone calls. Over a median follow-up of 350 days, 23.4% said they had fallen at least once in the previous 12 months. Masked hypertension was linked to a 70% higher fall risk than sustained hypertension. White coat hypertension was linked to a lower fall risk than high readings in both settings. When the researchers treated the gap between office and home readings as a continuous measure, a lower office reading relative to the home reading went with more falls. That may seem backwards. Low blood pressure is usually seen as the fall risk. Karol E. Watson, M.D., Ph.D., of UCLA, who was not involved, told the newsroom the study "doesn't explain why the fall risk was higher." She said it may point to blood pressure variability and how well older adults regulate their pressure through the day. That is her interpretation, not a finding. The study is background for current advice. The 2025 joint guideline on high blood pressure, published in Circulation, replaces the 2017 version. The part of the guideline we could see, its abstract, describes it as a "living, working document" for clinicians. According to the AHA newsroom, the guideline recommends annual blood pressure checks for all adults. It also recommends home monitoring to help confirm an office diagnosis and to guide care. The guideline abstract does not give those details. There are limits. Falls were self-reported. The study followed people for under a year. It cannot show that treating masked hypertension would prevent falls. Talk to your clinician before changing any medication, including starting or stopping it. "Home blood pressure measurement can add helpful health information for older adults," said presenting author Frances Wang, Ph.D., of Beth Israel Deaconess Medical Center. She hopes patients will share home readings with their health care team. The next step is publication of the full analysis in a peer-reviewed journal. That will show how the numbers were calculated and whether other groups find the same pattern. The next study needs to establish what action, if any, improves outcomes. More context is valuable when it helps make care more accurate. Sources: Circulation (2025), American Heart Association Newsroom (Hypertension Scientific Sessions 2026) Circulation (2025): https://doi.org/10.1161/cir.0000000000001356 American Heart Association Newsroom (Hypertension Scientific Sessions 2026): https://newsroom.heart.org/news/elderly-adults-with-masked-high-blood-pressure-had-higher-risk-of-falls ---