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Archive - 01 - 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 weightDiabetes 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 studys 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.
Reductions in kidney injury and mortality risk question thinking on 'stress diabetes'January 30, 2008 (EurekAlert) For critically ill patients, intensive insulin therapy (IIT) to keep blood sugar (glucose) at normal levels reduces the risk of acute kidney injury, reports a study in the March Journal of the American Society of Nephrology.The new research builds on previous randomized trials, including more than 2,700 patients, which reached the "startling" conclusion that IIT reduces the risk of death in critically ill patients, according to lead author Dr. Miet Schetz of University of Leuven, Belgium. In those studies, one group of patients received IIT, with insulin given continuously to maintain normal glucose levels. The other group received conventional insulin therapy, in which blood glucose levels are allowed to rise above normal.Dr. Schetz and colleagues re-analyzed the trial data, focusing on differences in the rates of acute kidney injury (AKI) between the two treatment groups. Acute kidney injury is a common and serious complication among patients admitted to the intensive care unit (ICU). It occurs in five to 30 percent of patients, with death rates exceeding 40 percent.The re-analysis showed that AKI developed in 4.5 percent of patients assigned to IIT, compared to 7.6 percent of those receiving conventional insulin therapy. The reduction in AKI was greatest when glucose levels remained within the normal range.Intensive insulin therapy was more effective in protecting against AKI in patients admitted to the ICU after surgery (surgical ICU), compared to critically ill patients who did not undergo surgery (medical ICU). "This difference can be explained by the fact that IIT is a preventive strategy that cannot heal damage that is already present," explains Dr. Schetz. The medical ICU patients were much sicker to begin with and may have already had kidney damage.For many years, the medical community has considered high blood sugar levels in critically ill patientscalled "stress diabetes"as a beneficial reaction of the body to ensure adequate energy supply to the organs during severe illness. The new research grew out of studies led by Dr. Greet Van den Berghe, exploring the hormonal changes induced by critical illness. Subsequent trials found that strict glucose control with IIT reduced the risk of death in both surgical and medical ICU patients. Rates of organ failure were also lower with IIT compared to conventional insulin therapy. (Dr. Van den Berghe is a co-author of the new study.)The new analysis builds on these results by confirming that IIT reduces the risk of AKI in critically ill patients, especially after surgery. This finding is especially important, because intensive insulin therapy is the first medical treatment that has been clearly shown to protect the kidney of critically ill patients," Dr. Schetz adds.More research is needed to clarify how IIT acts to protect the kidneyswhether by preventing direct kidney damage caused by high blood sugar, or through indirect effects. Regardless of the mechanism, Dr. Schetz concludes, "Since AKI is associated with increased morbidity and mortality, the goal should be to prevent its development."
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