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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease

Hemoglobin A1c in Nondiabetic Patients Predicts Coronary Artery Disease | Heart and Vascular Health | Scoop.it

Objective: To examine the association between hemoglobin A1c (HbA1c) and the presence, severity, and complexity of angiographically proven coronary artery disease (CAD) in nondiabetic patients.
Patients and Methods: We performed a single-center, observational, cross-sectional study of 1141 consecutive nondiabetic patients who underwent coronary angiography from January 1, 2011, through
December 31, 2011. The study population was divided into 4 interquartiles according to HbA1c levels (<5.5%, 5.5%-5.7%, 5.8%-6.1%, and >6.1%).
Results: Patients with higher HbA1c levels tended to be older, overweight, and hypertensive, had higher blood glucose levels, and had lower glomerular filtration rates. Higher HbA1c levels were associated in a graded fashion with the presence of CAD, disease severity (higher number of diseased vessels and presence of left main and/or triple vessel disease), and disease complexity. After adjustment for major conventional cardiovascular risk factors, compared with patients with HbA1c levels less than 5.5%, the odds ratios of occurrence of CAD in the HbA1c quartiles of 5.5% to 5.7%, 5.8% to 6.1%, and greater than 6.1% were 1.8 (95% CI, 1.2-2.7), 3.5 (95% CI, 2.3-5.3), and 4.9 (95% CI, 3.0-8.1), respectively.
Conclusion: The HbA1c level has a linear incremental association with CAD in nondiabetic individuals. The HbA1c level is also independently correlated with disease severity and higher SYNTAX scores. Thus,
HbA1c measurement could be used to improve cardiovascular risk assessment in nondiabetic individuals.

Seth Bilazarian, MD's insight:

The HgbA1c is a blood test that evaluates blood sugar levels over the last 3 months.  Diabetic patients & physicians use the test to evaluate whether diabetes is in good control and value the measure as more useful than one blood sugar measurement to guide recommendations on diet and medication.  The test can also be used for the diagnosis of diabetes (6.5% is the level).

These authors in India found that even below the diabetic level there is significant risk that can be evaluated stepwise in both the presence of blockages in the coronary arteries but also how severe the blockages are that might increase the need for coronary bypass surgery.

The graphic show that starting at 5.5% each 0.5% increase linearly raises the risk.

If validated, this might be one more way to help patients evaluate risk and might find its way in to future risk calculators.

 

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10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes | Heart and Vascular Health | Scoop.it

During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes.

Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002).

Conclusions

Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number.

Seth Bilazarian, MD's insight:

Amazing! Twenty five years ago the UKPDS published the follow-up of metformin in diabetes showing a benefit on heart attack and death even years after patients came off the drug.  Despite years of basic science and clinical research and billions of dollars spent on development of new therapies we still don't have a single other diabetes drug that reduces heart attack risk. Many drugs have been developed for blood sugar control but all have shown no benefit over placebo for reduction of heart attack risk for diabetics.  Only metformin.

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Bypassing Diabetes

Bypassing Diabetes | Heart and Vascular Health | Scoop.it

Though existing research has shown that gastric bypass surgery resolves type 2 diabetes, the reason has remained unclear. A research team at Boston Children’s Hospital, has identified the small intestine—widely believed to be a passive organ—as the major contributor to the body’s metabolism, based on a study in rats. The report appears in the July 26, 2013, issue of Science.

Weight loss and improved diabetes often go hand in hand, but type 2 diabetes often disappears even before weight loss occurs after gastric bypass. To investigate why this happens, The team spent one year studying rats and observed that after gastric bypass surgery, the small intestine changes the way it processes glucose. The team saw the intestine using and disposing of glucose, thereby regulating blood glucose levels in the rest of the body and helping to eliminate type 2 diabetes.

Seth Bilazarian, MD's insight:

In practice the dramatic shedding of daibetic medications by patients immediately after bariatric surgery (such as gastric bypass or banding) is remarkable.

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Michael Wiener's curator insight, August 14, 2013 7:58 PM

If this was performed on rats successfully, hopefully it could work on humans, as well... 100%

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Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza (saxagliptin)

Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza (saxagliptin) | Heart and Vascular Health | Scoop.it

AstraZeneca and Bristol-Myers Squibb Announce Top Line Results for SAVOR-TIMI-53 Cardiovascular Outcomes Trial of Onglyza(R) (saxagliptin) PRINCETON, N.J. & WILMINGTON, Del., Jun 19, 2013

In this study of adult patients with type 2 diabetes with either a history of established cardiovascular disease or multiple risk factors, Onglyza met the primary safety objective of non-inferiority, and did not meet the primary efficacy objective of superiority, for a composite endpoint of cardiovascular death, non-fatal myocardial infarction or non-fatal ischaemic stroke, when added to a patient’s current standard of care (with or without other anti-diabetic therapies), as compared to placebo. These preliminary SAVOR-TIMI-53 data are being analyzed and the study results will be submitted to the European Society of Cardiology (ESC) for potential presentation at the ESC Congress in September.

Seth Bilazarian, MD's insight:

My comment:  we have struggled to move the ball forward for diabetes care and prevention of heart attacks.  Despite more than a dozen oral drug options that improve blood sugar control, we lack evidence that this approach lowers the risk of strokes and heart attacks.  Blood pressure control and cholesterol treatment are proven strategies for risk reduction, but there remains scant evidence that improving blood sugar control makes a difference.  (It may make a difference on other important issues like diabetic eye and kidney concerns).

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Walnut Consumption Is Associated with Lower Risk of Type 2 Diabetes in Women

Walnut Consumption Is Associated with Lower Risk of Type 2 Diabetes in Women | Heart and Vascular Health | Scoop.it

Walnuts are rich in polyunsaturated fatty acids and have been shown to improve various cardiometabolic risk factors.This trial investigated association between walnut intake & type 2 diabetes in the Nurses’ Health Study which followed 58,063 women aged 52–77 years old from 1998–2008 and
79,893 women aged 35–52 y in NHS II (1999–2009) without diabetes, cardiovascular disease, or cancer at baseline.
Consumption of walnuts and other nuts was assessed every 4 years using food questionnaires. A total of 5930 new type 2 diabetes cases during 10 y of follow-up were detetected. Walnut consumption was associated with a lower risk of type 2 diabetes for participants consuming 1–3 servings/mo (1 serving = 28 g), 1 serving/wk, and  >2 servings/wk of walnuts: were 0.93,  0.81 and 0.67 compared with women who never/rarely consumed walnuts. Further adjustment for updated BMI slightly attenuated the association and the HRs were 0.96, 0.87 & 0.76 , respectively.

The consumption of total nuts and other tree nuts was also inversely associated with risk of type 2 diabetes, and the associations were largely explained by BMI. Our results suggest that higher walnut consumption is associated with a significantly lower risk of type 2 diabetes in women.

Seth Bilazarian, MD's insight:

These results suggest higher walnut consumption is associated with a significantly lower risk of type 2 diabetes in women. Walnuts are rich in healthy fatty acids which have been shown to reduce inflammation in the body and protect against heart disease, cancer and arthritis. Whether walnuts stand alone among tree nuts is uncertain (peanuts are NOT tree nuts).  Practically the benefits from walnuts may be form the appetite filling aspects of eating nuts as a snack and the avoidance of less healthy snacks that are nutritionally poor options because of the high calories and salt intake (like chips).

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Wider Testing to Head Off Diabetes

Wider Testing to Head Off Diabetes | Heart and Vascular Health | Scoop.it

Take Home Message:  Knowing your numbers including your blood sugar is valuable especially for overweight patients.  Unlike the person profiled in this article I find patients to be very responsive to this early warning sign and generally enthusiastic about efforts to reduce the risk of progresing to diabetes.

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Health-care providers are stepping up efforts to identify the millions of Americans believed to have prediabetes, a condition that can lead to full-blown diabetes, using the HgbA1cto check a greater number of hospital patients.  Prediabetes, typically defined as blood sugar that is higher than normal (over 100)  but not yet in the diabetes range (over 125).  NIH estimates that as many as 79 million Americans age 20 and older—or roughly one in three adults—have prediabetes. That figure dwarfs the 26 million Americans who have Type 2 diabetes, including seven million people believed to have the disease but don't know it.

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Fish oil for Cardiovascular Outcomes in Diabetics

Fish oil for Cardiovascular Outcomes in Diabetics | Heart and Vascular Health | Scoop.it

Take Home Message:  In an era of evidence based medicine the Fish Oil strategy continues to disappoint for cardiovascular disease prevention. The main beneficiary of these repeated trials are the researchers.  Fish oil can be omitted, especially by patients who take many other medicines to help reduce the pill  burden.  Eat fish instead.

 

Daily supplementation with 1 g of n–3 fatty acids in daibetics did not reduce the rate of cardiovascular events over 6 years in patients at high risk for cardiovascular events.

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Preventable Deaths from Heart Disease & Stroke infographic

Preventable Deaths from Heart Disease & Stroke infographic | Heart and Vascular Health | Scoop.it

Important progress has been made, but more is needed to continue to save lives, particulalry for people under 65 yeras.  Black men are at the highest risk of dying early fromheart disease and stroke.  Counties in Southern states have the greratest risk overall.

Seth Bilazarian, MD's insight:

Nearly 800,000 Americans die each year from heart disease and stroke.  Most of the major risk factors can be manged or prevented: high blood pressure, high cholesterol, diabetes, smoking, unhealthy diet, physical inactivity and obesity.

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Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US

Trends in Prescribed Drugs Treating Diabetes, Hypertension, and High Cholesterol for Persons under Age 40 in the US | Heart and Vascular Health | Scoop.it
From 2000 to 2010, the number of people in the U.S. civilian noninstitutionalized population under age 40 obtaining at least one outpatient prescription anti-diabetic or anti-hypertensive increased.From 2000 to 2010, the total number of outpatient prescriptions for persons under age 40 increased for anti-diabetics, anti-hypertensives, and statins—41%, 49%, & 179%, respectively.Comparing 2000 with 2010, for persons under age 40 in the U.S. civilian noninstitutionalized population inflation adjusted total expenses increased for anti-diabetics (126%) and for statins (97%).From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-diabetic increased 61% from $77 to $124.From 2000 to 2010, for persons under age 40, the inflation adjusted average cost per drug purchase of a prescription anti-hypertensive and statin decreased.
Seth Bilazarian, MD's insight:

Despite the rise in obesity and incident diabetes and other associated risk factors such as high blood pressure and high cholesterol in children and young adults the treatment rates have increased very little over 10 years. Despite the known long term hazards there is a lack of data on treatment in patients less than 40 years old and therefore real hesitancy to treat by physicians.

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Avoiding Hypoglycemia at All Costs Is Crucial for Some With Diabetes

Avoiding Hypoglycemia at All Costs Is Crucial for Some With Diabetes | Heart and Vascular Health | Scoop.it

After 20 years of urging clinicians to maintain absolute intensive glycemic targets in patients with diabetes to reduce microvascular complications of the disease, the American Diabetes Association (ADA) and the Endocrine Society are now advising clinicians that for some patients, preventing hypoglycemia is more important than tight glycemic control.

Seth Bilazarian, MD's insight:

The strategy of tight blood sugar control (glycemic control) has repeatedly failed to show benefit for heart attack prevention.  The increasing recognition that periods of low blood sugar (hypoglycemia) may have significant hazard is leading guideline writers to rethink a "one size fits all goal" (e.g. HgbA1c < 6.5 for all).  Some patient populations (older patients with heart disease) may be better off with looser control and therefore less episodes of hypoglycemia.  For now however clinicians are stuck in the middle since many "quality initiatives" include tight control as a measure of physicians' quality.  This question will take several years to sort out in clinical trials.

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Hot Dogs, Bacon And Red Meat Tied To Increased Diabetes Risk

Hot Dogs, Bacon And Red Meat Tied To Increased Diabetes Risk | Heart and Vascular Health | Scoop.it
People who upped their red meat intake saw their risk of Type 2 diabetes rise by nearly 50 percent.
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newagealternatives's comment, June 26, 2013 2:57 PM
These days, everything causes cancer.
Ellen Diane's comment, June 26, 2013 3:00 PM
yup
shelbylaneMD's curator insight, August 18, 2013 11:54 AM

Doesn't look ike a donut or cake either. 

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Diabetes Study Ends Early With a Surprising Result

Diabetes Study Ends Early With a Surprising Result | Heart and Vascular Health | Scoop.it
Diet and weight loss did not prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes.

A large federal study of whether diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes has ended two years ahead of schedule because the intensive program did not help.  Many have assumed diet and exercise would help, in part because short-term studies had found that those strategies lowered blood sugar levels, blood pressure and cholesterol levels. Still, medical experts said there were many benefits to diet and exercise even if they did not reduce cardiovascular disease in people with diabetes.

About 25 million Americans have Type 2 diabetes. Many are overweight or obese. On average, the disease increases heart disease risk by 2 to 2 &frac12; times.  Study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

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Weight Training Reduces Risk of Type 2 Diabetes Mellitus in Men

Weight Training Reduces Risk of Type 2 Diabetes Mellitus in Men | Heart and Vascular Health | Scoop.it

Take Home Message: Physicians have recommended a MINIMUM of 150 minues of exercise weekly for diabetic risk reduction but the role resistance training or weight lifting is not certain.  In this study, weight training was associated with a significantly lower risk of Type 2 Diabetes (T2DM), independent of aerobic exercise. Combined weight training & aerobic exercise conferred a greater benefit.

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Association of weight training with risk of T2DM in US men & to assess the influence of combining weight training and aerobic exercise, a prospective cohort study of 32 002 men from the Health Professionals Follow-up Study from 1990-2008. Weekly time spent on weight training & aerobic exercise (including brisk walking, jogging, running, bicycling, swimming, tennis, squash, and calisthenics/rowing) was obtained from questionnaires at baseline and biennially during follow-up. 

During 508 332 person-years of follow-up (18 years)

=> 2278 new cases of T2DM

=> dose-response relationship: increasing time spent on weight training or aerobic exercise and lower risk of T2DM (P < .001 for trend)

=> Engaging in weight training or aerobic exercise for at least 150 minutes per week was independently associated with a lower risk of T2DM of 34% (95% CI, 7%-54%) and 52% (95% CI, 45%-58%), respectively.

+> Men who engaged in aerobic exercise & weight training for at least 150 minutes per week had the greatest reduction in T2DM risk (59%; 95% CI, 39%-73%)

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