Diabetes News from dLife.com: Cardiovascular

Joslin Study Identifies Key Factor that Links Metabolic Syndrome; Finding May Help Millions at High Risk of Cardiovascular Disease

February 05, 2008

February 5, 2008 (Joslin) -- A new study led by researchers at Joslin Diabetes Center has identified insulin resistance in the liver as a key factor in the cause of metabolic syndrome and its associated atherosclerosis, disorders that put tens of millions of Americans at high risk of cardiovascular disease.

The findings, published in the February issue of Cell Metabolism, provide not only an understanding of how metabolic syndrome occurs, but also pinpoint a target for treatment of the condition. This represents the work of Sudha Biddinger, M.D., Ph.D., and a team led by C. Ronald Kahn, M.D., Head of the Joslin Research Section on Obesity and Hormone Action and the Mary K. Iacocca Professor of Medicine at Harvard Medical School.

"This is one of the first true insights into the role of the liver in the metabolic syndrome and provides guidance for future therapies," said senior investigator Dr. Kahn, an internationally recognized researcher in diabetes and metabolism. "Showing this connection between atherosclerosis and insulin resistance is one of the most dramatic findings I've seen in 35 years."

Metabolic syndrome is a collection of medical problems related to insulin resistance, including obesity, glucose intolerance, hypertension, lowered HDL ("good") cholesterol and elevated triglycerides. Together these are associated with an increased risk of atherosclerosis, the buildup of plaque in the coronary arteries that leads to heart attack and stroke.

The findings indicate that many of the most important features of the metabolic syndrome do have a common cause, thus challenging a joint position statement issued by the American Diabetes Association and the European Association for the Study of Diabetes that questioned the very existence of the metabolic syndrome (Diabetes Care. 2005;8:2289?2304).

"This study clearly indicates that metabolic syndrome is not merely a collection of abnormalities that should be considered and treated independently, as some experts have advocated," said Kahn and Biddinger. "Rather, it appears that metabolic syndrome is truly a group of closely linked disturbances in glucose and cholesterol metabolism that stem from a defect in insulin signaling in the liver."

Dr. Biddinger said the study sought to understand whether insulin resistance -- a condition where the pancreas makes insulin but the body doesn"t respond to it -- could increase the risk of atherosclerosis. "The fact that one-fourth of American adults have the metabolic syndrome is alarming. The fact that large numbers of children are now being diagnosed with the metabolic syndrome is even more alarming," said Biddinger. "These kids are at risk for having heart attacks in their 30s. We really need to understand the connection between the metabolic syndrome and atherosclerosis."

To try and find out, the researchers engineered mice by "knocking out" -- i.e. genetically eliminating -- insulin receptors in the liver. From this one site of insulin resistance alone, these mice developed many of the lipid abnormalities associated with metabolic syndrome. Furthermore, when fed a high-fat diet, the mice developed extremely high cholesterol, more than four times the levels found in normal mice fed the same diet. More importantly, all of the "knockout" mice developed atherosclerosis, while none of the normal mice did.

These findings "focus attention on the liver, since resistance in the liver is enough to cause these abnormalities," said Kahn. "By pinpointing the liver, it gives researchers a target for developing potential clinical treatments, such as finding a way to overcome insulin resistance in the liver or to change the way the liver responds to insulin resistance."

The research was funded in part by grants from the National Institutes of Health and The Iacocca Foundation. In addition to Drs. Biddinger and Kahn, other researchers participating in the study included: Antonio Hernandez-Ono, Christian Rask-Madsen, Joel T. Haas, José O. Alemán, Ryo Suzuki, Erez F. Scapa, Chhavi Agarwal, Martin C. Carey, Gregory Stephanopoulos, David E. Cohen, George L. King and Henry Ginsberg from the Joslin, Columbia University School of Medicine, Massachusetts Institute of Technology, and the Beth Israel Deaconess Medical Center.

Posted by dlifenews at 03:30 PM | Comments (2)

Diabetes Increases Risk of Heart Disease Death for Women

January 31, 2008

January 31, 2008 (Newswise) — The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.

Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease. Others can be modified and include:

• Smoking
• High blood pressure and cholesterol
• Diabetes
• Sedentary lifestyle
• Body weight

Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men.

“The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear,” explains Ane Cecilie Dale, M.D., the study’s lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. “But research in this field continues to go on.”

According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.

Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.

“Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible,” Dale said. “They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise.”

Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action. Without the support of health care professionals, patients can easily feel overwhelmed.

Posted by dlifenews at 10:21 AM | Comments (0)

Restless Legs Syndrome Doubles Risk of Stroke and Heart Disease

January 02, 2008

January 2, 2008 (EurekAlert) - People with restless legs syndrome (RLS) are twice as likely to have a stroke or heart disease compared to people without RLS, and the risk is greatest in those with the most frequent and severe symptoms, according to research published in the January 1, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

The study, the largest of its kind enrolling both men and women, involved 3,433 people with an average age of 68 who were enrolled in the Sleep Heart Health Study. Participants were diagnosed with RLS by detailed questionnaire and asked if they had been diagnosed with a variety of systemic diseases including cardiovascular disease and cerebrovascular disease. Of the participants, nearly seven percent of women and three percent of men had RLS.

The study found people with RLS were more than twice as likely to have cardiovascular disease or cerebrovascular disease. The results remained the same after adjusting for age, sex, race, body mass index, diabetes, high blood pressure, high blood pressure medication, HDL/LDL cholesterol levels, and smoking.

"The association of RLS with heart disease and stroke was strongest in those people who had RLS symptoms at least 16 times per month," said study author John W. Winkelman, MD, PhD, with Harvard Medical School in Boston. "There was also an increased risk among people who said their RLS symptoms were severe compared to those with less bothersome symptoms."

Winkelman says although this study does not show that RLS causes cardiovascular and cerebrovascular disease, a number of potential mechanics for such a process exist. “In particular, most people with RLS have as many as 200 to 300 periodic leg movements per night of sleep and these leg movements are associated with substantial acute increases in both blood pressure and heart rate, which may, over the long term, produce cardiovascular or cerebrovascular disease.

Winkelman says there are limitations to the study, including that the diagnosis of RLS was self-reported by questionnaire rather than by clinical interview.

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High Triglycerides, Other Cholesterol Raise Risk of Stroke

December 27, 2007

December 27, 2007 (EurekAlert) – People with high triglycerides and another type of cholesterol tested but not usually evaluated as part of a person’s risk assessment have an increased risk of a certain type of stroke, according to research published in the December 26, 2007, online issue of Neurology®, the medical journal of the American Academy of Neurology. “LDL or ‘bad’ cholesterol has been the primary target for reducing the risk of stroke, but these results show that other types of cholesterol may be more strongly linked with stroke risk,” said study author Bruce Ovbiagele, MD, of UCLA Medical Center in Los Angeles, CA, and member of the American Academy of Neurology.

The researchers analyzed the records of 1,049 people admitted to a university hospital with a stroke or mini-stroke over four years. Of those, 247 people had a large artery atherosclerotic stroke. This is a type of ischemic stroke caused by a blockage of blood flow to the brain. People with this type of stroke have blockage in the large arteries leading to the brain.

Those with high triglycerides and elevated “non-high density lipoprotein cholesterol” were more likely to have a large artery atherosclerotic stroke than those with low levels of these fats in the blood.

Those with the highest triglycerides were 2.7 times more likely to have this type of stroke than those with the lowest level. Triglycerides are fatty acids and are the most common type of fat in the blood. Those with the greatest non-high density lipoprotein cholesterol, which is neither the “good” nor the “bad” cholesterol, were 2.4 times more likely to have a large artery stroke.

“Because this type of cholesterol is included in the test that is normally ordered, and triglycerides are already reported, it would not be difficult to start paying closer attention to these factors in people at risk for large artery stroke,” Ovbiagele said.

The study found that people with high “bad” cholesterol did not have an increased risk of this type of stroke. Ovbiagele noted that it is still important to monitor bad cholesterol levels to reduce risk of heart disease and other types of stroke.

Posted by dlifenews at 01:56 PM | Comments (0)

Most Adults With Conditions that Increase Cardiovascular Disease Risk Have High Blood Pressure

December 11, 2007

December 11, 2007 (Newswise) — Nearly three-fourths of American adults with conditions such as coronary heart disease, stroke, diabetes or others that raise their risk for cardiovascular complications also have hypertension (high blood pressure), according to a report in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Although about 75 percent of these individuals are being treated for hypertension, only one-third to one-half are reaching blood pressure goals.

Blood pressure control remains a problem in the United States and around the world, according to background information in the article. “Recent estimates indicate little change in the prevalence of hypertension, and, although there seem to be some recent improvements in treatment and control rates, hypertension in many persons remains inadequately controlled,” the authors write.

Nathan D. Wong, Ph.D., of the University of California, Irvine, and colleagues analyzed data from adults participating in the National Health and Nutrition Examination Survey, a nationally representative survey conducted by the Centers for Disease Control and Prevention. In 2003 and 2004, 4,646 adults (representing 192 million nationwide) provided demographic and socioeconomic information and underwent laboratory and physiological testing (including blood pressure measurements).

A total of 1,671 (31.4 percent) of the participants had hypertension, defined as a systolic (top number) blood pressure of at least 140 milligrams of mercury (130 milligrams of mercury in those with diabetes or chronic kidney disease) or a diastolic (bottom number) blood pressure of at least 90 milligrams of mercury (80 milligrams of mercury in those with diabetes or chronic kidney disease), or as reporting use of a blood pressure–lowering medication. The condition was more common in older and black adults. A total of 68.5 percent of those with hypertension were being treated and 52.9 percent of those had their hypertension under control.

High blood pressure was found in most persons with cardiovascular diseases and related problems, including:

• 76.8 percent of those with diabetes
• 81.8 percent of those with chronic kidney disease
• 69.5 percent of those with stroke
• 71.4 percent of those with congestive heart failure, which occurs when the heart can’t pump enough blood to the rest of the body
• 73.7 percent of those with peripheral artery disease, or narrowed veins or arteries
• 73 percent of those with coronary artery disease
• 76.9 percent of those with two or more of these diseases

Among individuals with these conditions, 75 percent or more were being treated for hypertension, but only one-third to one-half of those in treatment reached goal levels for blood pressure (140/90 milligrams of mercury for most patients, or 130/80 milligrams of mercury for patients with diabetes or chronic kidney disease). Goal attainment rates were particularly low for persons with stroke (34.9 percent), heart failure (48.8 percent), peripheral arterial disease (46.7 percent) and coronary artery disease (50.3 percent).

With the lower goal for persons with diabetes and chronic kidney disease, only 35 percent and 23 percent, respectively, were controlled for their blood pressure. Those who were uncontrolled had systolic blood pressure that averaged at least 20 higher than the goal. “Poor control rates of systolic hypertension remain a principal problem that further compromises the already high cardiovascular disease risk” in these individuals, the authors write. “Moreover, given recently released recommendations to reduce the blood pressure goal to less than 130/80 milligrams of mercury for persons with coronary artery disease and other high-risk conditions, our hypertension control rates would be even lower and a greater distance from the goal for these persons if the new criteria are applied.”

“These high-risk persons with low rates of hypertension control represent an urgent need for intensified efforts to achieve blood pressure control,” they conclude.

(Arch Intern Med. 2007;167(22):2431-2436. Available pre-embargo to the media at http://www.jamamedia.org.)

Editor’s Note: This study was supported by a contract from Bristol-Myers Squibb to the University of California, Irvine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Posted by dlifenews at 09:38 AM | Comments (0)

Use of Diabetes Medication by Older Adults Associated With Increased Risk of Serious Heart Problems, Death

December 11, 2007 (Newswise) — Older patients treated with the diabetes medications known as thiazolidinediones (which include rosiglitazone) had a significantly increased risk of heart attack, congestive heart failure and death, compared with the use of other hypoglycemic drugs, according to a study in the December 12 issue of JAMA. The authors suggest that these results provide further evidence that this class of medication may cause more harm than good.

The thiazolidinediones (TZDs) rosiglitazone and pioglitazone are oral hypoglycemic agents used to treat type 2 diabetes and have been shown to improve glycemic control. “While improved glycemic control has been linked to better clinical outcomes in diabetes and TZDs have been suggested as having potential cardiovascular benefits, recent concerns have arisen regarding adverse cardiac effects of these drugs,” the authors write.

Some research has indicated that both rosiglitazone and pioglitazone may increase the risk of congestive heart failure (CHF), and that rosiglitazone may be associated with an increased risk of acute myocardial infarction (AMI; heart attack) and death. “These findings prompted a recent hearing by a U.S. Food and Drug Administration advisory panel regarding the safety of rosiglitazone; however the panel voted against removing rosiglitazone from the market because of insufficient data.”

Lorraine L. Lipscombe, M.D., M.Sc., of the Institute for Clinical Evaluative Sciences, Toronto, and colleagues evaluated the risks of CHF, heart attack, and all-cause death associated with the use of TZDs, compared with other oral hypoglycemic agents among patients age 66 years or older with diabetes. This older patient population has often been under-represented in trials of TZDs, even though they have a high prevalence of diabetes, and may be at greater risk of medication-related harms. The researchers analyzed data from health care databases in Ontario that included 159,026 individuals with diabetes who were treated with oral hypoglycemic agents and were followed for a median (midpoint) of 3.8 years, through March 2006. During this time, 7.9 percent of patients had a hospital visit for congestive heart failure (n = 12,491), 7.9 percent had a hospital visit for a heart attack (n = 12,578), and 19 percent died (n = 30,265).

Compared to oral hypoglycemic agent combination therapy users, current users of TZD monotherapy had a 60 percent increased risk of congestive heart failure; had a 40 percent increased risk of heart attack; and had a 29 percent increased risk of death. These increased risks associated with TZD use appeared limited to rosiglitazone.

“Our findings argue against current labeling of TZDs that warns against use only in persons at high risk of CHF, as we did not identify any subgroup of older diabetes patients who may be protected from adverse effects of TZDs,” the authors write. “These findings provide evidence from a real-world setting and support data from clinical trials that the harms of TZDs may outweigh their benefits, even in patients without obvious baseline cardiovascular disease.”

“Further studies are needed to better quantify the risk-benefit tradeoffs associated with TZD therapy and to explore whether the hazards associated with these agents are specific to rosiglitazone. In the interim, treatment decisions must remain individualized, with clinicians weighing the potential benefits and harms of TZD treatment, especially among high-risk elderly populations.”

Posted by dlifenews at 09:33 AM | Comments (0)

Most Adults with Conditions That Increase Cardiovascular Disease Risk Have High Blood Pressure

December 10, 2007

December 10, 2007 (EurekAlert) - Nearly three-fourths of American adults with conditions such as coronary heart disease, stroke, diabetes or others that raise their risk for cardiovascular complications also have hypertension (high blood pressure), according to a report in the December 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Although about 75 percent of these individuals are being treated for hypertension, only one-third to one-half are reaching blood pressure goals.

High blood pressure was found in most persons with cardiovascular diseases and related problems, including:

“These high-risk persons with low rates of hypertension control represent an urgent need for intensified efforts to achieve blood pressure control,” they conclude.

Posted by dlifenews at 12:13 PM | Comments (0)

For High Blood Pressure Patients, Preventing or Reducing Enlarged Heart May Decrease Risk for Diabetes

October 31, 2007

October 31, 2007 (Newswise) — High-blood-pressure patients treated for enlarged heart (left ventricular hypertrophy, LVH) who have regression or prevention of LVH may also have a better chance of preventing diabetes. Led by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the November Hypertension, a journal of the American Heart Association (AHA).

An estimated 20 percent of all high-blood-pressure patients, or 12 million Americans, have LVH and are at increased risk of developing diabetes.

The study reports a 38-percent reduced risk of developing diabetes for high-blood-pressure patients who demonstrated regression of LVH during treatment for high blood pressure, with a 26-percent reduced risk after adjusting for other risk factors for diabetes. The reduction in risk of diabetes was independent of treatment type and of the degree of blood pressure change in this population.

"A healthy heart is a prerequisite for the health of the body as a whole. Our previous research has shown that treating enlarged heart in high-blood-pressure patients reduces the risk for a variety of cardiovascular conditions. This new study finds an important new benefit -- namely a better chance of avoiding diabetes among patients who exhibit a reduction of their hypertrophy during treatment," says the study's principal investigator, Dr. Peter Okin, director of clinical affairs and professor of medicine in the Greenberg Division of Cardiology at Weill Cornell Medical College and attending physician at NewYork-Presbyterian/Weill Cornell.

An editorial about the study in the journal notes that "the study by Okin et al extends our knowledge and understanding of the importance of LVH reversal by showing the beneficial metabolic effects of treatment-induced regression of LVH in a large series of patients with hypertensive heart disease."

Unfortunately, for high-blood-pressure patients who already have diabetes, high blood pressure treatment is less effective at reducing their LVH compared to patients without diabetes. In addition, regression of LVH in hypertensive patients with diabetes does not appear to be associated with a reduction in cardiovascular events, according to a 2006 study by Dr. Okin and colleagues, making prevention of diabetes in patients with hypertension an important goal.

The study used data from the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study conducted between 1995 and 2001. In the blinded study, patients received daily 50 mg doses of either losartan or atenolol.

Co-authors of the current study included Drs. Richard B. Devereux of NewYork-Presbyterian/Weill Cornell and Weill Cornell Medical College, and physician-scientists from Merck Research Laboratories (Upper Gwynedd, Pa.), Sahlgrenska University Hospital/Östra (Sweden), Ullevål University Hospital (Norway) and Umeå University (Sweden).

The study was supported in part by a grant from Merck & Co. Inc., West Point, Pa.

Posted by dlifenews at 11:05 AM | Comments (0)

Preventing or Reducing Enlarged Heart May Decrease Risk for Diabetes

October 31, 2007 (EurekAlert) - High-blood-pressure patients treated for enlarged heart (left ventricular hypertrophy, LVH) who have regression or prevention of LVH may also have a better chance of preventing diabetes. Led by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the November Hypertension, a journal of the American Heart Association (AHA).

An estimated 20 percent of all high-blood-pressure patients, or 12 million Americans, have LVH and are at increased risk of developing diabetes.

Posted by dlifenews at 10:31 AM | Comments (0)

Women with High or Increasing Blood Pressure are Up to Three Times More Likely to Develop Diabetes

October 11, 2007

October 11, 2007 (EurekAlert) - One of the largest studies to investigate the relationship between blood pressure and type 2 diabetes has found that women who have high blood pressure levels are three times more likely to develop diabetes than women with low blood pressure levels. This effect was independent of body mass index and other conditions that are known to predispose people to cardiovascular disease and diabetes.

Writing in the European Heart Journal today [1], the authors say that clinicians should be aware of the relationships between blood pressure and type 2 diabetes to optimise the management of patients at increased risk for cardiovascular disease.

The researchers from the Brigham and Women’s Hospital, Harvard Medical School and the Harvard School of Public Health, USA, followed over 38,000 female health professionals for ten years. At the start of the study in 1993, all the women were free of diabetes and cardiovascular disease. Follow-up continued to the end of March 2004, at which point data were nearly 100% complete (97.2% for morbidity and 99.4% for mortality).

The lead author, Dr David Conen, a cardiologist and research fellow, explained: “Despite several studies finding a close relationship between hypertension and type 2 diabetes, little information exists on the relationship between blood pressure levels and the subsequent development of type 2 diabetes. Data for women are particularly limited. Finding an independent association between blood pressure and new-onset diabetes is important, because it suggests that women with increasing blood pressure levels should have their blood glucose levels monitored. Individuals at high risk for cardiovascular disease may benefit from early intervention.”

The researchers divided the women into four groups: those with optimal blood pressure (BP), below 120 mmHg systolic, 75 mmHg diastolic; those with normal BP (120-129 mmHg systolic, 75-84 mmHg diastolic); those with high normal BP (130-139 mmHg systolic, 85-89 diastolic); and those with established hypertension (at least 140 mmHg systolic, 90 mmHg diastolic, and/or self-reported history of hypertension or treatment for the condition).

After 10 years of follow-up 1.4, 2.9, 5.7 and 9.4% of women in the four categories respectively had developed type 2 diabetes. After adjusting for various factors such as age, ethnicity, smoking, alcohol intake, body mass index (BMI), exercise, family history of diabetes etc, the researchers found that women with hypertension had a three-fold risk of developing diabetes compared with women with optimal BP.

Dr Conen said: “We found that obesity was also a strong and independent risk factor for the development of type 2 diabetes. However, statistical analyses showed that the relationship between blood pressure and the onset of type 2 diabetes was similar among women who were normal weight, overweight or obese. There was a three-fold increase in risk from the lowest to the highest BP category within all three weight categories. This analysis showed that the association between blood pressure and diabetes was not explained by weight alone.”

Women who had an increase in BP during the study also had an increased risk of developing diabetes. Those whose BP rose but who remained within the range of normal BP had an increased risk of 26% compared to women who had stable or decreasing BP. Women who progressed to hypertension had a 64% increased risk.

Dr Conen said: “Compared with an overall rate of 4.5 events per 1,000 person-years, the incidence rates in the optimal BP category was 1.5 events per 1,000 person-years, showing that these women have a very low risk of developing diabetes. On the other hand, women with high normal BP had a much higher risk compared with women with normal BP, and the risk among those with established hypertension was substantial: after ten years almost 10% of these women had diabetes, a rate of ten events per 1,000 person-years. Taken together, our study demonstrates that BP and BP progression are strong predictors of incident type 2 diabetes, an effect independent of BMI and other components of the metabolic syndrome.” [2]

The authors suggest a possible mechanism for the relation between BP and diabetes may be endothelial dysfunction – a dysfunction of the normal biochemical processes carried out by the layer of cells that line the inner surfaces of blood vessels. “It may be a precursor of both hypertension and diabetes,” said Dr Conen. “Thus, the progression of endothelial dysfunction may cause worsening of both BP and blood glucose. This is in line with the fact that both BP and blood glucose occur together as part of the metabolic syndrome.”

He concluded: “Our findings provide strong evidence that BP and progression of BP are associated with an increased risk of diabetes. They highlight the fact that cardiovascular risk factors are interrelated and occur in clusters. Thus, an important message for physicians and future guidelines is that none of the cardiovascular risk factors should be looked at individually. The combination of all risk factors should be used to make treatment decisions.”

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Glycemic Control Medication Appears to Have Favorable Effect Regarding Risk of Cardiovascular Events

September 11, 2007

September 11, 2007 (EurekAlert) - A meta-analysis of previous research suggests that use of pioglitazone, a glycemic control medication for patients with type 2 diabetes, significantly reduces the risk of heart attack, stroke and death, but increases the risk for serious heart failure, according to an article in the September 12 issue of JAMA.

A. Michael Lincoff, M.D., and colleagues at the Cleveland Clinic, conducted a meta-analysis of research to evaluate the effect of pioglitazone on the incidence of ischemic cardiovascular complications for patients with type 2 diabetes. Previous evidence had been insufficient to evaluate this effect. This analysis included 19 randomized trials and 16,390 patients. Duration of pioglitazone use ranged from 4 months to 3.5 years.

The researchers found that heart attack, stroke or death occurred in 375 (4.4 percent) of 8,554 patients receiving pioglitazone and 450 (5.7 percent) of 7,836 patients treated with control therapy, an 18 percent relative reduction. These outcomes were all reduced by a similar magnitude with pioglitazone treatment. Serious heart failure was reported in 200 (2.3 percent) of pioglitazone-treated patients and 139 (1.8 percent) of control patients.

“These findings suggest that the net clinical cardiovascular benefit with pioglitazone therapy is favorable, with an important reduction in irreversible ischemic events that is not attenuated by the risk of more frequent heart failure complications,” the authors write.

Posted by dlifenews at 04:55 PM | Comments (0)

Long-Term Use of Glycemic Control Medication Rosiglitazone Associated With Increased Risk of Heart Attack and Heart Failure

September 11, 2007 (EurekAlert) - Patients with type 2 diabetes or impaired glucose tolerance who take the medication rosiglitazone appear to be at increased risk for a heart attack or heart failure, according to a meta-analysis article in this issue of JAMA.

Sonal Singh, M.D., of the Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues reviewed research to examine the risk of heart attack, heart failure and cardiovascular death with long-term rosiglitazone use. There have been recent reports of serious adverse events with rosiglitazone use, but information available to clinicians on the magnitude and public health impact of these events has been limited.

The researchers compiled data from four randomized trials that included 14,291 patients (n = 6,421 receiving rosiglitazone; n = 7,870 receiving control therapy). Follow-up for these studies was 1-4 years.

The pooled data from the trials indicated that rosiglitazone, compared with controls, significantly increased the risk of heart attack by 42 percent (94 of 6,421 patients who received rosiglitazone vs. 83 of 7,870 patients who received control therapy) and doubled the risk of heart failure (102 of 6,421 patients vs. 62 of 7,870 patients). Use of rosiglitazone was not associated with a significant increase in risk of cardiovascular death.

“Our findings have potential regulatory and clinical implications. These data suggest a reversal of the benefit-to-harm balance for rosiglitazone present at the time of approval. Thus, currently there appear to be much safer treatment alternatives. Regulatory agencies ought to reevaluate whether rosiglitazone should be allowed to remain on the market. Health plans and physicians should not wait for regulatory actions. They should avoid using rosiglitazone in patients with diabetes who are at risk of cardiovascular events, especially since safer treatment alternatives are available,” the authors conclude.

Posted by dlifenews at 04:53 PM | Comments (0)

Onset of Diabetes Higher in Patients Who Have Had Heart Attacks

August 24, 2007

August 24, 2007 (EurekAlert) - People who have had heart attacks are at higher risk of developing both new-onset diabetes and the pre-diabetes condition impaired fasting glucose (IFG), conclude authors of an Article published in this week's edition of The Lancet.

Dr Dariush Mozaffarian, Harvard Medical School and Harvard School of Public Health, Boston, USA, Dr Roberto Marchioli, Consorzio Mario Negri Sud, Italy and colleagues studied 8291 Italian patients who had had a heart attack within the previous three months, and were free of diabetes. Incidence of new-onset diabetes and IGF were measured at 0.5, 1.0, 1.5, 2.5, and 3.5 years follow-up. Data for body-mass index, other risk factors, dietary habits, and medications were updated during the follow up, and a Mediterranean diet score was given to each patient based on their consumption of raw and cooked vegetables, fruit, fish and olive oil.

The researchers found one third of patients with a recent heart attack developed diabetes or IFG (blood glucose 6.1 mmol/L or more), during the 3.5 years of follow up; this rose to two-thirds when the lower IFG cut-off point of 5.6mmol/L or more blood glucose was used. Patients with a recent heart attack were up to four-and-a-half times more likely to develop diabetes (3.7%) compared with the general population (0.8-1.6%), and more than 15 times more likely to develop IFG (27.5% versus 1.5%).

Independent risk factors associated with new-onset diabetes or IFG included older age, high blood pressure, use of beta-blockers, lipid-lowering medications (protective), and diuretic use. Independent life-style risk factors included higher body mass index, (BMI), greater BMI gain during follow-up, current smoking (which increased risk by 60%), a lower Mediterranean dietary score, and wine consumption of more than one litre per day. Data for physical activity were unavailable, but people who could not perform exercise testing were at higher risk of both diabetes and IFG.

The authors conclude: "Our findings suggest that incidence of IFG and diabetes is high in the years after myocardial infarction, suggesting that acute myocardial infarction could be a pre-diabetes risk-equivalent. Our findings also suggest that smoking cessation, prevention of weight gain, and consumption of typical Mediterranean foods could substantially lower this risk, which has important implications for counseling patients soon after they have a myocardial infarction -- an opportune time to institute lifestyle changes in patients motivated by a life-changing event."

In an accompanying Comment, Dr Lionel Opie, Hatter Cardiovascular Research Institute, University of Cape Town, South Africa, says: "These findings further tie the knot between myocardial infarction and hyperglycaemia -- each causes the other." He adds that, of the lifestyle factors, "major interest lies in the potential protective effect of the Mediterranean diet."

Posted by dlifenews at 01:39 PM | Comments (0)

Manufacturers of Some Diabetes Drugs to Strengthen Warning on Heart Failure Risk

August 15, 2007

Companies Will Include Boxed Warning on Drug Label

August 15, 2007 (FDA) - The U.S. Food and Drug Administration today announced manufacturers of certain drugs approved to treat Type 2 diabetes have agreed to add a stronger warning on the risk of heart failure, a condition that occurs when the heart does not adequately pump blood. The information will be included in the form of a "boxed" warning—FDA's strongest form of a warning. The upgraded warning emphasizes that the drugs may cause or worsen heart failure in certain patients.

After a review of postmarketing adverse event reports, FDA determined that an updated label with a boxed warning on the risks of heart failure was needed for the entire thiazolidinedione class of antidiabetic drugs. This class includes Avandia (rosiglitazone), Actos (pioglitazone) Avandaryl (rosiglitazone and glimepiride), Avandamet (rosiglitazone and metformin), and Duetact (pioglitazone and glimepride). These drugs are used in conjunction with diet and exercise, to improve blood sugar control in adults with type 2 (non-insulin-dependent) diabetes. FDA had asked the drug's manufacturers, GlaxoSmithKline and Takeda, to address these concerns.

"Under FDA's postmarketing surveillance program, we carefully monitor new safety information for marketed drugs and take appropriate action when necessary to inform patients and health care providers of new information," said Steven Galson, M.D., M.P.H., director of FDA's Center for Drug Evaluation and Research. "This new boxed warning addresses FDA's concerns that despite the warnings and information already listed in the drug labels, these drugs are still being prescribed to patients without careful monitoring for signs of heart failure."

FDA's review of adverse event reports found cases of significant weight gain and edema—warning signs of heart failure. In some reports, FDA noted, continuation of therapy has been associated with poor outcomes, including death.

The strengthened warning advises health care professionals to observe patients carefully for the signs and symptoms of heart failure, including excessive, rapid weight gain, shortness of breath, and edema after starting drug therapy. Patients with these symptoms who then develop heart failure should receive appropriate management of the heart failure and use of the drug should be reconsidered. People who have questions should contact their health care providers to discuss alternative treatments.
The warning also states that these drugs should not be used by people with serious or severe heart failure who have marked limits on their activity and who are comfortable only at rest or who are confined to bed or a chair.

FDA's review of Avandia and possible increased risk of heart attacks is ongoing. On July 30, 2007, FDA's Endocrine and Metabolic Advisory Committee and the Drug Safety and Risk Management Advisory Committee recommended that Avandia continue to be marketed, and further recommended that information be added to the labeling for risk of heart attacks (ischemic risks).

For more information, visit:
Rosiglitazone maleate (marketed as Avandia, Avandamet, and Avandaryl) Information
Pioglitazone HCl (marketed as Actos and Duetact) Information

Posted by dlifenews at 11:26 AM | Comments (1)

Abnormal Fat Metabolism Underlies Heart Problems in Diabetic Patients

August 10, 2007

August 10, 2007 (EurekAlert) — Heart disease hits people with diabetes twice as often as people without diabetes. In those with diabetes, cardiovascular complications occur at an earlier age and often result in premature death, making heart disease the major killer of diabetic people. But why is heart disease so prevalent among diabetics?

To help answer that question, researchers at Washington University School of Medicine in St. Louis have been analyzing the fat (lipid) composition of heart tissue from laboratory mice with diabetes. They have found that heart cells of diabetic mice lose an important lipid from cellular components that generate energy for the heart, and their latest research shows this happens at the very earliest stages of diabetes.

"Diabetic hearts run mostly on fats for fuel because glucose isn't readily available to them," says Richard Gross, M.D., Ph.D., director of the Division of Bioorganic Chemistry and Molecular Pharmacology and professor of medicine, of chemistry and of molecular biology and pharmacology. "Unfortunately, this change in metabolism distorts the lipid composition of cell membranes causing abnormal physical properties and cellular dysfunction."

The important lipid that the researchers found to be decreased in diabetes is cardiolipin. "Cardiolipin" literally means heart fat, and the term was coined because cardiolipin was first discovered in beef hearts and is one of the most abundant lipids in heart tissue. This lipid has unusual physical properties that are essential for the operation of the energy-producing cell structures called mitochondria.

When mitochondria lose a lot of their cardiolipin, they malfunction. Their malfunction not only interferes with the energy supply of heart muscle cells, it also increases the amount of damaging oxygen-containing substances in the cells, creating unhealthy conditions that can lead to heart problems.

Interestingly, a rare genetic disorder — Barth syndrome — held a key to identifying cardiolipin decrease in diabetic hearts. Children born with Barth syndrome have weak hearts and often die young from heart failure. These children have mutations that prevent cells from producing enough cardiolipin. The connection between cardiolipin and heart disease in Barth syndrome led the Washington University researchers to wonder if cardiolipin was also affected in diabetic hearts.

But in order to measure cardiolipin, the researchers needed a way to distinguish it from the numerous other lipids found in heart cells. Fortunately, Gross and his colleagues have been developing and refining a highly sophisticated set of techniques that allow them to separate and quantify thousands of different lipids based on their subtle structural differences. The set of techniques has been termed "shotgun lipidomics" because they very rapidly determine which lipids are in tissues and blood.

"Shotgun lipidomics provide a precise way to measure changes in heart lipid content," says first author Xianlin Han, Ph.D., assistant professor of medicine. "We found a dramatic depletion of cardiolipin in heart muscle as early as five days after diabetes was induced in mice."

"These results suggest that cardiolipin alterations underlie heart dysfunction in diabetic heart disease and may be a useful biomarker for diagnosing cardiovascular disease in diabetes," Gross says. "Measuring alterations may be a way to tell the severity of heart disease and to evaluate how well therapies work. In addition, these findings suggest potential new therapeutic approaches."

Even though the research team found a depletion of an important type of lipid in diabetic heart tissue, diabetic heart muscle cells actually take in excess lipids. But as these lipids enter cells they activate lipid-digesting enzymes. In previous studies, Gross and colleagues identified a particular lipid-digesting enzyme that becomes more active in diabetic heart muscle and contributes to the breakdown of cardiolipin.

Recently, Gross and his colleague David Mancuso, Ph.D., member of the division, found that mice engineered to produce too much of this enzyme in their hearts developed defects in mitochondrial function which became worse when they were fasted — a condition that, like diabetes, causes the heart to use lipids for fuel. A 16-hour fast caused significant problems with the mouse hearts' ability to pump blood, again implicating altered lipid metabolism, cardiolipin scarcity and mitochondrial impairment in heart disease using lipid as predominant fuel.

Gross adds that in addition to the effects on mitochondria, many of the membranes in heart cells, which are built from fatty molecules, are also adversely affected by the diabetic heart's abnormal lipid metabolism. Furthermore, because fatty molecules are part of cells' signaling mechanisms, numerous aspects of cellular physiology become altered.

"The pieces of the puzzle of diabetic heart disease are now rapidly falling into place," Gross says. "By exploiting the novel technology of shotgun lipidomics, we have identified the increased activation of certain lipid-digesting enzymes and the decrease of cardiolipin as central aspects of this disorder. We hope that these kinds of studies will enable physicians to diagnose diabetic cardiovascular disease sooner and treat it earlier."

Posted by dlifenews at 12:05 PM | Comments (0)

Diabetes Drugs Increase Risk of Heart Failure, Research Shows

July 30, 2007

July 30, 2007 (EurekAlert) – A class of drugs commonly used to treat type 2 diabetes may double the risk of heart failure, according to a new analysis by researchers at Wake Forest University School of Medicine and colleagues.

Based on a review of research studies and case reports involving more than 78,000 patients, the authors concluded that the risk of heart failure may be up to 100 percent higher (depending on the type of study) in patients taking thiazolinediones (which includes Avandia® and Actos®). These drugs are known to enhance insulin sensitivity. The authors estimated that one additional patient with type 2 diabetes would develop heart failure for every 50 patients taking the drugs over a 26-month period.

The results were published online in May 2007 by Diabetes Care and will appear in the August print issue.
“These drugs are currently used by more than 3 million diabetic patients in the U.S. alone, suggesting that several thousand could be harmed,” said Sonal Singh, M.D., lead author and an assistant professor in internal medicine at Wake Forest.

Earlier this year, one of the drugs in this class (Avandia®) was linked to an increased risk of heart attack and death from cardiovascular causes.

The current analysis looked at a potential link between the drugs and heart failure, which is the inability of the heart to meet the body’s demands. Heart failure is a very common condition in the elderly and one of the costliest to society. Common symptoms include shortness of breath and the inability to exercise including, in some cases, even to walk short distances.

The authors hypothesize that fluid retention caused by the drugs may trigger heart failure in susceptible people.

Heart failure occurred equally at high and low doses. In fact, heart failure even occurred in some patients who were taking doses below those commonly prescribed. The medium time for the onset of heart failure was 24 weeks after beginning drug therapy.

The adverse reaction was not limited to the elderly – one-quarter of cases occurred in people younger than 60. Heart failure occurred equally among men and women.

The product label for both drugs warns against their use in patients with more severe cases of heart failure. The label also cautions about the increased risk of heart failure if used in combination with insulin. However, the current analysis found that the risk wasn’t confined just to patients on insulin, and it occurred even among patients without any risk factors for heart failure. “Our findings support current efforts by the FDA to add a black box warning to the labeling for those agents,” said co-investigator Curt Furberg, M.D., Ph.D., from Wake Forest.

“The occurrence of heart failure several months after initiation of treatment suggests a long-term effect of the drugs, which may not be avoided by beginning with low doses,” said Singh.

The authors called for additional research to evaluate whether there are differences between drugs in the class and how to best manage patients who experience heart failure while on the drugs.

Posted by dlifenews at 09:33 AM | Comments (3)

Diet and Regular Soft Drinks Linked to Increase in Risk Factors for Heart Disease

July 24, 2007

July 24, 2007 (American Heart Association) — Drinking more than one soft drink daily — whether it’s regular or diet — may be associated with an increase in the risk factors for heart disease, Framingham researchers reported in Circulation: Journal of the American Heart Association.

“We were struck by the fact that it didn’t matter whether it was a diet or regular soda that participants consumed, the association with increased risk was present,” said Ramachandran Vasan, M.D., senior author of the Framingham Heart Study and professor of medicine at Boston University School of Medicine. “In those who drink one or more soft drinks daily, there was an association of an increased risk of developing the metabolic syndrome.”

Metabolic syndrome is a cluster of cardiovascular disease and diabetes risk factors including excess waist circumference, high blood pressure, elevated triglycerides, low levels of high-density lipoprotein (HDL “good” cholesterol) and high fasting glucose levels. The presence of three or more of the factors increases a person’s risk of developing diabetes and cardiovascular disease.

Prior studies linked soft drink consumption to multiple risk factors for heart disease. However, this study showed that association not only included drinking regular calorie-laden soft drinks, but artificially sweetened diet sodas as well, researchers said.

“Moderation in anything is the key,” said Ravi Dhingra, M.D., lead author of the study and an instructor in medicine at Harvard Medical School. “If you are drinking one or more soft drinks a day, you may be increasing your risk of developing metabolic risk factors for heart disease.”

The Framingham study included nearly 9,000 person observations made in middle-aged men and women over four years at three different times.

In a “snapshot in time” at baseline, the researchers found that individuals consuming one or more soft drinks a day had a 48 percent increased prevalence of the metabolic syndrome compared to those consuming less than one soft drink daily.

In a longitudinal study of participants who were free of metabolic syndrome at baseline (6,039 person observations), consumption of one or more soft drinks a day was associated with a 44 percent higher risk of developing new-onset metabolic syndrome during a follow-up period of four years.

The researchers also observed that compared to participants who drank less than one soft drink daily, those who drank one or more soft drinks a day had a:

• 31 percent greater risk of developing new-onset obesity (defined as a body mass index [BMI] of 30 kilograms/meter2 or more);
• 30 percent increased risk of developing increased waist circumference;
• 25 percent increased risk of developing high blood triglycerides or high fasting blood glucose;
• 32 percent higher risk of having low HDL levels.
• A trend towards an increased risk of developing high blood pressure that was not statistically significant.

Researchers then analyzed a smaller sample of participants on whom data on regular and diet soft drink consumption was available from food frequency questionnaires. Participants who consumed one or more drinks of diet or regular soda per day had a 50 to 60 percent increased risk for developing new-onset metabolic syndrome, said Dhingra, who is also an attending physician at Alice Peck Day Memorial Hospital in New Hampshire. “It didn’t matter whether it was a diet or regular soft drink.”

“Results also don’t appear to be driven by the dietary pattern of soft drink users, i.e, by other food items that are typically consumed along with soft drinks,” Vasan said. “We adjusted in our analyses for saturated fat and trans fat intake, dietary fiber consumption, total caloric intake, smoking and physical activity, and still observed a significant association of soft drink consumption and risk of developing the metabolic syndrome and multiple metabolic risk factors.”

One explanation is that the fructose corn syrup in regular soft drinks causes weight gain, and can lead to insulin resistance and diabetes, Vasan said. “But then you would expect to see an association with regular soft drinks, but not diet soft drinks. Our findings suggest that this is not the case.”

Another possible explanation is that consuming more liquids is associated with a lesser degree of dietary compensation. Usually if you eat a large meal, then you’re inclined to eat a smaller amount at the next meal, Vasan said. But liquids don’t have the same degree of compensation as solids. If you drink a large amount of liquids at a meal, you are more likely to eat a larger amount at the next meal (compared to what you would eat had you consumed more solids at the prior meal).

Other theories are that the high sweetness of diet and regular soft drinks makes a person more prone to eat sweet items, or the caramel content in soft drinks may promote development of advanced glycation end products, complexes of sugars that can result in insulin resistance and can cause inflammation in experimental studies.

“These are all theories, and experts debate their importance,” Dhingra said. “Our study was observational, and so right now all we demonstrate is an association. We have not proven causality.”
Dhingra and Vasan called for further studies to replicate the results and to understand the mechanisms driving this association before recommendations can be made.

Other researchers included Thomas J. Wang, M.D.; Caroline S. Fox, M.D.; Lisa Sullivan, Ph.D.; Ralph B. D’Agostino, Ph.D.; James B. Meigs, M.D., M.P.H.; J. Michael Gaziano, M.D., M.P.H. and Paul F. Jacques, Ph.D.

Posted by dlifenews at 02:41 PM | Comments (1)

Diabetes, Depression Together Increase Risk for Heart Patients

March 10, 2007

March 9, 2007 (EurekAlert) -- Having both depression and type 2 diabetes increases the risk of death for heart patients. Each factor had been known to increase the risk of heart disease deaths by itself, but together they’re even more deadly.

In an analysis of more than 900 patients with established coronary artery disease, Duke University Medical Center psychologists found that those with both type 2 diabetes and symptoms of depression were more likely to die than heart patients without those conditions.

The study showed that among type 2 diabetes patients, having high depression scores increased the risk of dying by 20 to 30 percent compared to patients with similar depression scores but no type 2 diabetes.

"We found a trend showing that the probability of death increases as the level of depression increases in diabetic patients with coronary artery disease," said Duke researcher Anastasia Georgiades, Ph.D. She presented the results of the Duke analysis on Friday, March 9, 2007, at the annual meeting of the American Psychosomatic Society, in Budapest, Hungary. "Our data appear to show an important interaction between type 2 diabetes and depression, meaning that physicians should closely monitor their heart patients who have both of these disorders.

"There is some sort of synergistic effect between type 2 diabetes and depression that we don’t fully understand," Georgiades said. "In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association."

The research was supported by the National Heart, Lung, Blood Institute.

The researchers followed 933 heart patients for more than four years and correlated the 135 deaths that occurred during that period with the presence of type 2 diabetes and depression alone and together.

Georgiades said there are some possible explanations for the link between depression and diabetes.

"Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise and numerous appointments with their doctor," she said. "It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk."

Depression has also been linked to other cardiovascular risk factors such as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity.

Posted by dlife at 02:50 PM | Comments (1)

Even 'High Normal' Glucose Levels May Increase the Risk of Hospitalization for Heart Failure

March 06, 2007

March 6, 2007 (EurekAlert) - Fasting glucose levels may independently predict the risk of being hospitalized with congestive heart failure in heart attack survivors and others who are at high risk of developing the disorder, researchers reported in Circulation: Journal of the American Heart Association.

Drawing on data from 31,546 high-risk patients participating in two international trials, researchers found that even small increases in fasting glucose raised the risk of congestive heart failure in both diabetes patients and those whose blood sugar fell within the normal range.

"This illustrates that blood glucose by itself is a continuous risk factor for developing heart failure because all of these patients were free of heart failure when they enrolled in the trials," said Claes Held, M.D., Ph.D., lead author of the study.

"However, these are only associations," said Held, an associate professor of cardiology at the Karolinska Institutet in Stockholm, Sweden. "They do not prove that elevated blood glucose causes heart failure. To demonstrate a causal relationship, you would have to do a study that showed lowering blood glucose levels would reduce the incidence of heart failure."

About 5.2 million Americans evenly divided between males and females suffer from heart failure, according to the American Heart Association. Each year about 550,000 new cases are diagnosed and about 57,700 people die from it. Heart failure is a debilitating condition in which the heart fails to pump an adequate supply of blood throughout the body. Established heart failure risks include uncontrolled high blood pressure, diabetes and heart attack.

To examine the relationship between blood glucose levels and congestive heart failure, Held and colleagues performed an interim analysis on the blinded data from the ONgoing Telmisartan Alone and in combination with the Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND) trials. Both were randomized, controlled, parallel clinical studies testing drug regimens aimed at reducing fatal and nonfatal cardiovascular events. ONTARGET had 25,620 patients enrolled and TRANSCEND had 5,926, and both included patients with and without diabetes. Researchers obtained fasting blood glucose levels for patients when they entered the trials and periodically thereafter.

"We know that diabetes is a strong risk factor for cardiovascular disease including heart failure, but these studies included patients with and without diabetes," Held said. "This was a great opportunity to evaluate a broad population of high-risk individuals and study the association between blood glucose and cardiovascular disease, regardless of the diabetic state."

Patients in the two trials were average age 67 at entry, and 69 percent were men. Thirty-seven percent had been previously diagnosed with diabetes and 3.2 percent were diagnosed with the disease at the time of entry.

Patients were assigned to five groups based on their entry fasting blood glucose levels, measured in millimoles per liter of blood, or mmol/L. The lowest group had an average fasting blood glucose of 4.6 mmol/L and the highest had an average reading of 8.5 mmol/L.

The mmol/L is the international standard unit for measuring blood glucose. In the United States, blood glucose levels are usually reported in milligrams per deciliter, mg/dL. Multiplying the number of mmol/L by 18 converts the number to mg/dl.

Researchers analyzed data from patients with an average follow-up of 2.4 years. During this time there were:

• 1,067 cardiovascular deaths
• 926 heart attacks
• 823 strokes
• 668 hospitalizations for congestive heart failure

When the researchers examined fasting blood glucose levels alone as a risk factor by adjusting for other known risk factors, they found that, for all patients, an increase of 1 mmol/L above a patient's entry glucose level increased the risk of hospitalization for congestive heart failure by 5 percent.

Similarly, a 1 mmol/L rise increased the risk of congestive heart failure hospitalization or cardiovascular death by 9 percent for all patients, by 3 percent for patients without diabetes and by 5 percent for patients with diabetes.

"Even in the normal range, our results indicate that elevated blood glucose is associated with the risk of heart failure," Held said. "You can look at blood glucose much like blood pressure or cholesterol. Even if you have normal blood glucose, there is a gradual increase in risk wherever you start on the scale. If the blood sugar is "high normal" there is a higher risk than those with "low normal fasting blood glucose levels."

He and colleagues suggested several potential mechanisms for rising glucose levels which increase the risk of developing congestive heart failure.

"Individuals with disturbances in their glucose regulation usually have more coronary artery disease, which is a well known underlying risk factor for heart failure," Held said. "That is a strong explanation for our findings but the others are more speculative and hypothetical."

Posted by dlife at 01:40 PM | Comments (2)