Each month we present many articles on diabetes and heart disease hoping that you will take head and live a cardio-protective lifestyle with heart healthy food, exercise and weight loss if necessary. Now we have even more ammunition in our arsenal to get you moving in that direction so please read on. The April 15, 2008 issue of Circulation, the American heart Association’s journal, shares that for people with diabetes the likelihood of having a major heart-related event is as high as for non-diabetics who have previously suffered a heart attack. The Danish research team found that compared with men without diabetes or a prior heart attack, those with diabetes were 2.32-times more likely to experience a stroke, heart attack or death from cardiovascular causes, and those with a prior heart attack were 2.48-times more likely. For women, the corresponding risks were raised 2.48-and 2.71-times. Furthermore, when people with diabetes do have a heart attack, “they are twice as likely to die as non-diabetics". The researchers conclude that diabetic patients should be given statins and other medications that have been shown to help prevent cardiovascular events in this group.
In the same cardio-protective vein the April 2 issue of JAMA brings us the following information about Actos verses Amaryl. The Cleveland Clinic researchers say that this is the first time a diabetes medication has been shown to slow atherosclerosis. The biggest news here is that Actos appears safe, does not increase cardiovascular risk, and may even reduce it. The authors stated that the exact mechanisms for the decreases associated with Actos were unclear, although several biomarkers linked to atherosclerosis progression were impacted by the drug, including a 16 percent increase in HDL or “good" cholesterol, and a 15 percent reduction in triglyceride levels, and 45 percent drop in C-reactive (CRP) levels. It is still not clear if the benefits associated with Actos extend to other medications in that class of drugs. “You’ve got to take into consideration the benefit of preventing heart attacks may be greater than the few people who get heart failure," the author states.
U.S and European scientists have found six more genes that make people more susceptible to developing type 2 diabetes, in a study they say may help prevent and treat the chronic condition. In the study in Nature Genetics researchers from 40 centers analyzed the genetic data more than 70,000 people. The finding extends the total number of genes linked to the disease to 16 and provides clues to how biological mechanisms that control blood sugar levels go awry when people get type 2 diabetes, the researchers say. Mark McCarthy a diabetes researcher at the University of Oxford stated that none of the genes that they found were preciously on the radar screen. One of the surprising finds was a link between type 2 diabetes and a gene called JAZF1, which researchers recently showed a role in prostate cancer. They also believe the genes—which also include the CDC123-CAMK1D, TSPAN8-LGR1,THADA, ADAMTS9 and NOTCH2 genes—are involved in regulating the number of insulin-producing cells in the cells, McCarthy said.
Each month we share information about the importance of exercise in controlling diabetes. Sometimes we receive e-mail about aged patients who no longer can run, place squash or ski so here is very good news. The dance-like exercise tai chi, practiced by ten of millions of people in China and around the world, can help curb the systems of type 2 diabetes, say a pair of studies. In separate experiments concluded in Australia and Taiwan, diabetes patients who performed tai chi for a few hours a week over a three-month period showed significant health improvement compared to control groups. Other forms of moderate exercise have been shown to help keep the disease in check. But “these Chinese exercises may be easier to learn than gym-based exercises and not require any complicated or expensive equipment", conclude the University of Queensland team, led by Wendy Brown. Experiments in Taiwan led by Kuender Yang assessed the impact of a 12-week program of tai chi exercises on T-helper cells among patients with type 2 diabetes and healthy people of the same age. At the end of the program, levels of glycated hemoglobin-excess sugar carried by red blood cells-fell significantly in the diabetic patients. Tai chi may prompt a fall in blood glucose levels or improve blood glucose metabolism, which in tern sparks a drop in inflammatory response, the researchers conjecture. Participants said they slept better, had more energy, felt less pain and fewer food cravings while on the programs.
A once-daily injection of Sanofi-Aventis’s insulin drug Lantus controls blood sugar as effectively as Eli Lilly’s Humalog which need to be taken three times daily researchers have reported. The study of 418 people with type 2 diabetes in 69 sites across Europe and Australia also found that Lantus was associated with a lower risk of potentially dangerous low blood sugar level. The research was published in the journal Lancet. “We conclude that Lantus provides a simple and effective option that is more satisfactory to patients than if (Humalog) for early initiation of insulin therapy", Reinhard Bretzel of Justus-Liebig-Universitat in Germany and colleagues wrote. During the 44-week trial researchers randomly assigned volunteers to receive one of the types of injections. Lantus reduced blood sugars levels to 7 percent from 8.7 percent while the average Humalog decrease was to 6.8 percent form 8.7 percent. Rates of hypoglycemia were also lower for people using Lantus, Mounting to 5.2 patients per year compared to 24 patients per year with Humalog. An additional benefit was that Lantus patients were more satisfied with their treatment, likely because of the convenience of fewer daily injections.
Abstracts are next and we start with an article from Archives of Internal Medicine 2008;168 (&):713-720, titled Adherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women written by Teresa T. Fung, ScD et al. The link between diabetes and heart disease is strong and we as editors of this web site continue to stress diet and life style changes to promote health. The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure, but little is known about its long-term effect on cardiovascular end points. The objective of the study was to assess the association between this diet adherence score and risk of coronary heart disease (CAD) and stroke in women. In this prospective study, diet was assessed 7 times during 24 years of follow-up (1980-2004) with validated food frequency questionnaires. A DASH score based on 8 food and nutrient components (fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, red and processed, sweetened beverages, and sodium) was calculated. The Cox proportional hazard model was used to adjust for potential confounders. The study population comprised 88,517 female nurses aged 34 to 59 years without a history of cardiovascular disease or diabetes in 1980. The main outcome measures were the numbers of confirmed incident cases of nonfatal myocardial infarction, CHD death, and stroke. The researchers documented 2139 cases of incident nonfatal infarction, 976 CHD deaths, and 3105 cases of stroke. After adjustment for age, smoking, and other cardiovascular risk factors, the relative risks of CHD across the quintiles of the DASH score were 1.0, 0.99, 0,87, and 0.76. The magnitude of risk difference was similar for nonfatal myocardial infarction and total CHD. The DASH score was also significantly associated with lower risk of stroke. Cross-sectional analysis in a subgroup of women with blood samples showed that the DASH score was significantly associated with lower plasma levels of C-reactive protein and interleukin. The researchers concluded that adherence to the DASH-style diet is associated with a lower risk of CHD and stroke among middle-aged women during 24years of follow-up.
Reduction in Blood Pressure with Statins, Results from the UCSD Statin Study. A Randomized Trial by Beatrice A. Golomb, M.D., PhD et al can be found in the Archives of Internal Medicine 2008;168 (7):721-727. The researchers performed a randomized, double-blind, placebo-controlled trial with equal allocation to simvastatin, 20 mg; pravastatin sodium, 40 mg; or placebo for 6 months. Nine hundred seventy-three men and women without cardiovascular disease or diabetes mellitus, with low-density lipoprotein cholesterol screening levels of 115 to 190 mg/dL, had assessment of systolic and diastolic BP (SBP and DBP, respectively). Blood pressure values were compared for placebo vs. statins by intention-to-treat (ITT) analysis. Additional analyses were preformed that (1) were confined to subjects with neither high baseline BP nor receiving BP medications, to exclude groups in whom BP medications or medication changes may have influenced results, and (2) separately evaluated simvastatin and pravastatin (vs. placebo). The time course of BP changes after statin initiation and the effect of stopping statins on BP were examined. The researchers found that statins modestly but significantly reduced BP relative to placebo, by 2.2 mm for SBP and 2.4 mm Hg for DBP in ITT analysis. Blood pressure reductions ranged from 2.4 to 2.8 mm HG for both SBP and DBP with both simvastatin and pravastatin, in those subjects with full follow-up, and without potential for influence by BP medications (i.e., neither receiving nor meriting BP medications). The concluded that reductions in SBP and DBP occurred with hydrophilic and lipophilic statins and extended to normotensive subjects. These modest effects may contribute to the reduced risk of stroke and cardiovascular event reported on statins.
Don’t forget that those of us with diabetes have very high risk levels for heart disease and studies indicate that we can benefit from lowering our blood pressure and controlling our LDL and HDL as well as our lipoproteins. Please talk to your physician about this subject; it’s a life saver.
BSP
