October 5, 2009 (SHM) - The Society of Hospital Medicine (SHM) is announcing the launch of its new Glycemic Control Mentored Implementation (GCMI) project. Now in place in 30 hospitals across the country, the new program will improve early detection and treatment of hyperglycemia in hospitalized patients.Diabetes is the fifth leading cause of death in the United States and the fourth most common co-morbid condition complicating all hospital discharges. Hyperglycemia, or high blood sugar, in hospitalized patients complicates a variety of illnesses and is an independent risk factor for adverse outcomes.

GCMI, supported by funding from sanofi-aventis, US, LLC, utilizes mentors, glycemic control and quality improvement experts, to provide direct support to hospitalist-led healthcare teams. Each team enrolled in the two-year project receives a dedicated mentor, as well as web-based and print resources on glycemic control.

This project will address the use of both subcutaneous and intravenous administration of insulin, the two most common methods for managing glycemic levels in the hospital. Specific topics include:

• Access to subcutaneous insulin on the general medical/surgical floor
• Intravenous insulin infusion in the intensive care unit
• Transitioning patients from intravenous to subcutaneous insulin
• Transitioning patients home on insulin therapy

"Glycemic control is an important quality and patient safety issue that should be addressed in every hospital," said Jane Kelly-Cummings, RN, CPHQ, Senior Director of Quality Improvement for SHM. "GCMI addresses the pertinent clinical and system issues which will assist hospitals to improve the care of diabetic patients to decrease the incidences of hyper and hypoglycemia, whereby reducing the number of complications associated with this condition."

The following sites have been selected to participate in the new project:

• Abbott Northwestern Hospital- Minneapolis, MN
• Alexian Brothers Medical Center- Elk Grove Village, IL
• Baptist Hospital Saint Thomas Health Systems- Brentwood, TN
• Champlain Valley Physicians Hospital Medical Center- Plattsburgh, NY
• Cooper University Hospital- Camden, NJ
• Duke Raleigh Hospital- Raleigh, NC
• Emory University Hospital- Snellville, GA
• Exeter Hospital- Exeter, NH
• Healthcare Authority for Medical West- Bessemer, AL
• John C. Lincoln Hospital North Mountain- Phoenix, AZ
• Kaiser Sunnyside Medical Center- Clackamas, OR
• Kentfield Rehabilitation and Specialty Hospital- Kentfield, CA
• Kootenai Medical Center- Coeur d'Alene, ID
• Lakeland Regional Medical Center- Lakeland, FL
• Luther Hospital- Eau Claire, WI
• Memorial Medical Center- Springfield, IL
• Mercy Iowa City- Iowa City, IA
• Morton Plant Hospital- Clearwater, FL
• Multicare Health System Tacoma General Hospital- Tacoma, WA
• Oneida Healthcare Center- Oneida, NY
• Penrose-St. Francis Medical Center- Main Campus- Colorado Springs, CO
• Portland Veterans Affairs Medical Center- Portland, OR
• Poudre Valley Health System- Fort Collins, CO
• Providence Portland Medical Center- Portland, OR
• Sacramento Sutter Medical Center- Sacramento, CA
• St. Mary's Hospital- San Francisco, CA
• St. John's Mercy Medical Center- St. Louis, MO
• The George Washington University Medical Center- Washington, DC
• Thomas Jefferson University Hospital- Philadelphia, PA
• University of Virginia Medical Center- Charlottesville, VA

October 5, 2009 (EurekAlert) - To help draw attention to National Child Health Day (today), the Preventive Cardiovascular Nurses Association (PCNA) has released findings from a new national consumer survey and launched a campaign to educate families about heart disease, the leading cause of death in the U.S.he national survey revealed that more than three in five (61%) Americans incorrectly believe that the processes related to heart disease do not begin until adulthood.

Alarmingly, fewer than four in ten (38%) correctly surmise that people should be concerned about living a heart-healthy lifestyle to prevent a future heart attack beginning in childhood, and continuing throughout every life stage.

While the old adage says "an apple a day will keep the doctor away," a new study on heart disease shows that a more comprehensive approach to being heart-healthy is key.

According to the study, published in September in an advance online edition of the journal Circulation, even with the success of past heart disease awareness and education campaigns the trend toward reducing cardiovascular risk is now headed in a negative direction. The vast majority (92%) of Americans are still at risk, primarily because of the rise in obesity.

"This is a wake up call for parents and their children in particular," says Laura Hayman, Ph.D., RN, a member of the PCNA Board of Directors and a leading researcher on obesity and cardiovascular disease in children, adolescents, and families. "Some strides have been made; however, since more and more children are currently overweight, they are more likely at risk for obesity-related conditions later in life such as hypertension and type 2 diabetes."

As two Harvard professors noted in an accompanying editorial in the Circulation e-publication, millions of Americans enter adulthood already overweight and thus are putting themselves at risk for a lifetime of disease and early death. "Much potential exists to reverse ominous trends in cardiovascular risk factors and mortality in the United States, but this is unlikely to occur without making prevention of overweight and obesity a clear national priority," they stated.

Recent research has found that when children learn about heart-healthy eating habits, it can strongly influence their behavior to reduce heart disease risk later in life. Yet, according to the PCNA survey, less than one-third of Americans follow a diet that is healthy for their heart. Also, seven in ten (70%) would not want their kids to adopt their eating habits because they do not think they set a good example when it comes to food choices (26%) or some of the time they eat food that is not healthy (44%).

"We are at a critical juncture," explains Hayman. "It is imperative for parents to lead by example with an all encompassing hearty-healthy lifestyle, making the necessary changes both in diet and physical exercise."

Since the survey found that the majority of Americans are at risk of heart disease due to some lifestyle factor, such as being overweight or having high cholesterol, small incremental changes in diet and physical activity can have a lasting healthy effect.

To help parents learn how to make important lifestyle changes and become better role models for their children, to help reduce their risk of heart disease in the future, PCNA has launched a national education campaign called "Family at Heart."

October 5, 2009 (EurekAlert) - Functional food is the food industry's fastest-growing product group, its leading products including dairy products which contain probiotics, that is, bacteria promoting health. Valio's Lactobacillus rhamnosus GG (LGG®) is the most frequently studied and used probiotic. Under the supervision of researchers at the Institute of Biotechnology, and the Department of Basic Veterinary Sciences at the University of Helsinki, an international research team determined the genome sequences of LGG and a bacterium closely related to it. The results, published in the renowned PNAS journal, shed light on the origin of probiotic mechanisms and promote product development in the food industry.
Functional food includes products designed for daily use, which have been shown by clinical studies to have positive health effects. Scientific study results have particularly contributed to the success of dairy products containing probiotic bacteria. Many research publications have confirmed that these bacteria promote health and boosts immune system and improve digestion. Some probiotics can also alleviate the symptoms suffered by those with irritable bowel syndrome. As many as every fifth westerner suffers from this pain, also called spastic colon. Studies say that LGG probiotics are also an effective treatment method for reducing children's atopic symptoms, and the risk of respiratory infections.

In its recent publication, the research team showed that the protein component found by the team has a fundamental role in LGG binding with the human intestinal mucus. The team found out that the surface structures of LGG has a specific adhesion component. Remarkably, the binding feature has been assumed to be one of the most important characteristics of bacteria with health-benefiting effects. Moreover, the researchers assume that the protein structure in question enables the health-promoting effects of LGG and other probiotic bacteria, and the positive immune modulation produced by them.

The research is a prime example of productive co-operation between researchers and the food industry. According to Tuomas Salusjärvi, research manager for Valio, the successful sequencing provides valuable additional information to support the already existing research information. The safety of the LGG probiotic and its advantages to consumers can now be shown in an even better way than before. A significant research field has been established around probiotic bacteria. So far, thousands of scientific articles have been published on the subject. For this line of research, the findings of the genome, and the molecular mechanism possibly behind probiotics, is a downright breakthrough.

October 5, 2009 (EurekAlert) - A recent study by researchers from the University of Colorado looked at post-transplant care to determine whether primary care physicians (PCPs) or hepatologists are better suited to manage the overall health care of patients who received a liver transplant (LT). Researchers learned that hepatologists believe metabolic complications to be common in LT patients, but not well controlled. The hepatologists surveyed also felt that PCPs should be responsible for managing these conditions, but that this group was not taking an active role. Full details of this study appear in the October issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.In the U.S. approximately 6,000 liver transplants are performed annually. Since liver transplantation began in 1963, survival rates have increased dramatically with overall 1-year and 5-year patient survival rates at 86.9% and 73.6%, respectively. As long-term survival rates increase, metabolic complications such as cardiovascular diseases, diabetes, chronic renal insufficiency and bone disease become a concern to the welfare of LT patients.

Lisa Forman, M.D. and colleagues surveyed 280 hepatologists in programs that transplanted at least 8 adult livers during the 2004 study year. Of the 191 respondents, 86% were male with a mean age of 50 years and had been in practice for an average of 13 years. Close to half of the hepatologists who replied noted that they cared for 21-50 liver transplant patients each month, while only 2.1% stated that a PCP was a working member of the practice group's post-transplant team.

Researchers found that more than 70% of hepatologists surveyed noted hypertension, chronic renal insufficiency, diabetes, and osteoporosis were present in at least 25% of patients 1 year post-transplant. The majority of respondents felt that these metabolic complications significantly contributed to morbidity and mortality 10 years after liver transplantation. Based on survey responses, the most commonly cited barriers to control post-transplant complications were dietary non-adherence, adverse effects of immunosuppressive agents, and inadequate primary care.

Approximately 75% of respondents felt that metabolic complications should be managed by PCPs, but believe that PCPs are adequately managing these health issues in only 38%-51% of LT recipients. "While there are many factors which influence the management of metabolic health concerns, the transplant community needs to be aggressive in influencing aspects that are modifiable such as PCP involvement," stated Dr. Forman. "If PCPs are reluctant to treat LT patients, and hepatologists assume their overall care, perhaps transplant hepatology fellowships should include rotations in cardiology, endocrinology, rheumatology and nephrology to give fellows more exposure to the management of metabolic complications," she suggested.

"Despite the fact that this study was based on perception rather than hard data, it does serve as a basis for future studies," stated Bashar Aqel, M.D., from the Mayo Clinic in his editorial also published in the October issue of Liver Transplantation. The authors acknowledged this study was based on the perception of hepatologists without hard data collected on the prevalence of metabolic complications and noted that PCPs were not surveyed likely leading to a bias toward the hepatologist. "More research is needed to address the real prevalence of metabolic complications, adequacy of treatment and to identify the barriers to care in the treatment of metabolic complications after liver transplantation," added Dr. Aqel.

October 1, 2009 (EurekAlert) - A program that bundled two generic, low-cost drugs - a cholesterol-lowering statin and a blood pressure-lowering drug - and gave daily doses to 68,560 people with diabetes or heart disease for two years is estimated to have prevented 1,271 heart attacks and strokes in the first year following the study period, according to a Kaiser Permanente study published online in the American Journal of Managed Care.
Kaiser Permanente developed the ALL initiative (Aspirin, Lisinopril and Lipid-Lowering Medication) in 2003 to reduce heart attacks and strokes by aggressively enrolling patients with heart disease or patients over 55 with diabetes in a therapeutic program that included the use of a triad of medications: low-dose aspirin, lovastatin and lisinopril.

The three-year clinical observational study found that offering 40 milligrams of lovastatin and 20 milligrams of lisinopril daily for two years to people not already on both drugs reduced their risk of hospitalization for heart attack or stroke the following year by more than 60 percent. Aspirin was not part of the study because it was over-the-counter and its use could not be measured through pharmacy records. However, it was separately estimated that 75 percent of study participants were already taking aspirin. The study was conducted by Kaiser Permanente's Care Management Institute in Oakland, Calif., which synthesizes knowledge on the best clinical practices to develop evidence-based care programs at Kaiser Permanente.

While previous research and clinical trials have shown that statins and angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB) individually reduce heart attacks and strokes, this is the first study to evaluate whether a consistent process could be developed to deliver the combined drugs to large numbers of people with diabetes and/or heart disease in realistic settings across a health care delivery system. It is also the first study to evaluate how dramatically this program would affect clinical outcomes and hospitalization rates for heart attack and stroke.

The study followed 170,024 ethnically diverse Kaiser Permanente members in California with heart disease and/or diabetes for two years during the medication phase and for one year during the outcome monitoring phase. The study cohort was broken into three groups: 21,292 members in the high-exposure group who took the bundled drugs more than half of the time in 2004 and 2005 based on their prescription refill habits; a low-exposure group of 47,268 people who took the drug bundle less than half of the time during 2004 and 2005 based on their prescription refill habits, and a no-exposure group of 101,464 people who either took neither or just one type of the two tracked drugs during 2004 and 2005.

The researchers found that among the study population as a whole, there were 21 heart attacks and strokes per 1,000 people in 2006. Among the 47,268 people in the group that had low exposure to the drugs, there were 726 fewer heart attacks and strokes than in the no exposure group, equivalent to a reduction of 15 heart attacks and strokes per 1,000 people. Among the 21,292 people in the high- exposure group, there were 545 fewer heart attacks and strokes, equivalent to a reduction of 26 heart attacks and strokes per 1,000 people. The study estimated this effect to be a 60 percent savings of these events.

"Heart disease is the number one killer in the United States, and 23 million Americans have diabetes. This is a proven program that can be applied in many settings to reduce heart attacks and strokes, and at the same time decrease the cost of care for those events," said the study's lead author, R. James Dudl, MD, the diabetes clinical lead at Kaiser Permanente's Care Management Institute.

These findings validate the forecasts of the Archimedes Model. The Archimedes Model simulated the pathophysiology, treatments, and outcomes of coronary artery disease and diabetes and its complications at the individual level and aggregated the results to project population-level effects. The model forecasted that "bundled" cardioprotective medications aspirin, lisinopril, and lovastatin would reduce the risk of heart attack and stroke in a high-risk population by 71 percent. In 2002 Kaiser Permanente researchers used the Archimedes Model to project the effects of offering the combined pharmacotherapy and to develop a simple, inexpensive method for delivering it.

The Kaiser Permanente researchers conducted this observational study of its drug-bundling program as a clinical execution of the Archimedes modeling because the simulation model outcomes looked so promising, researchers said.

"The program's results confirm the Archimedes Model's predictions that these treatments can save lives and reduce health care costs," said David Eddy, MD, Ph.D., founder and chief medical officer emeritus of Archimedes, Inc.

Currently more than 256,000 Kaiser Permanente members in Hawaii, California, Oregon, Washington, Colorado, Ohio, Georgia, Maryland, Virginia, and Washington, D.C. are participating in the drug medication bundle program. Clinicians use Kaiser Permanente HealthConnect®, the world's largest civilian electronic health records system, to find high-risk patients not already on the medications and use the health provider's integrated delivery system to reach out to eligible members at every point of care.

As an example of how this program can be widely implemented in diverse populations and health care settings, this initiative has also been applied in community health centers through Kaiser Permanente's community benefit program. In underserved populations with varying levels of health literacy, the number of patients taking the bundle increased fourfold within a 12-month period.

"We have long known from clinical trials that aspirin, cholesterol-lowering therapies such as statins, and ACE inhibitors such as lisinopril reduce the risk of future heart attacks and strokes in patients who have had a prior cardiovascular event or who have diabetes. Our primary goal here was to increase the use of the drugs," said study co-author Jim Bellows, Ph.D., Kaiser Permanente Care Management Institute's director of the Center for Evaluation and Innovation. Bellows helped develop the evaluation of the program to bundle and deliver the two medications.

October 1, 2009 (EurekAlert) - Highlights of October's Ophthalmology, the journal of the American Academy of Ophthalmology, include good news on preserving vision in people with type 1 diabetes, a warning from the Cardiovascular Health Study for macular degeneration patients, and a report on how vision impacts well-being across the lifespan.
People diagnosed with type 1 diabetes (T1D) in recent years are less likely to develop diabetes-related vision loss than those diagnosed in earlier years, says a new study funded by the National Eye Institute, a division of the National Institutes of Health. Forecasts of visual impairment prevalence in T1D patients may need to be amended, the researchers suggest, since current predictions assume that the earlier incidence rates will continue. Ronald Klein, MD, MPH, and colleagues at the University of Wisconsin Department of Ophthalmology and Visual Sciences assessed visual acuity over 25 years in 955 people diagnosed with T1D in one of four time periods, with the earliest defined as "before 1960" and the latest as "1975 through 1979."

"Visual impairment in T1D patients may be decreasing for several reasons," Dr. Klein said. "Effective treatments for diabetic retinopathy (DR) and related macular edema became widely available in the 1970s, and earlier screening and detection of DR began in the 1980s. In the 1990s, we learned that intensive control of blood glucose could significantly impact DR progression in T1D, so physicians and patients began closely monitoring this factor and controlling it with diet, exercise and medication."

Key findings include: among participants who had T1D for 30 to 34 years at the time their eyes were examined for the study, impaired vision was found in 16 percent of those diagnosed from 1922 through 1959, compared with 9 percent of those diagnosed from 1970 through 1974; also, among patients who had T1D for 15 to 19 years at the time they were examined, impaired vision was found in only four percent of those diagnosed from 1975 through 1979.

September 30, 2009 (EurekAlert) - Less than half of men and women in Ontario who may be suffering from depression see a doctor to treat their potentially debilitating condition, according to a new women's health study by researchers at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES). What's more, many hospitalized for severe depression fail to see a doctor for follow-up care within 30 days of being discharged, and many head to hospital emergency departments for care. The findings suggest the need for a comprehensive care model involving a multidisciplinary team of health-care professionals, including family doctors and mental health specialists, to help women and men and better manage depression and improve their quality of life."As a leading cause of disease-related disability among women and men, depression puts a tremendous emotional and financial burden on people, their families and our health-care system," says Dr. Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study Project for an Ontario Women's Health Evidence-Based Report (POWER). "Many Ontarians with depression are not treated for their condition and those who are often receive less than desired care. While there is a lot that is known about how to improve depression, we need to apply this to our work with patients if we want to improve the diagnosis and management of depression. "This involves better co-ordination among primary care and mental health-care professionals in both community and hospital settings," added Dr. Bierman, a researcher at ICES.

Nearly half a million Ontarians, aged 15 and older, suffer from depression. Worldwide, an estimated 154 million people are afflicted by the condition, which is responsible for lost productivity, increased disability claims and greater use of health-care services.

Key findings of the POWER study released today include:

• Less than 50% of men and women with depression visited a doctor for care for their condition
• 33% of men and women discharged from hospital for severe depression did not see a doctor for a follow-up visit within 30 days
• 17% visited a hospital emergency room within 30 days of discharge from hospital while about 8% were readmitted to hospital
• Many older adults started on antidepressant medication did not receive the recommended number of follow-up visits to manage their condition.

The lack of co-ordinated care for patients suggests the need for a collaborative care-model involving a team of health-care professionals, including mental health professionals and primary care providers.

"Research shows that patients cared for using a collaborative model are more likely to see improvement in symptoms, are able to better manage their depression and avoid multiple visits for emergency care," said Dr. Elizabeth Lin, lead author of the chapter and a research scientist at the Centre for Addiction and Mental Health (CAMH). A study by CAMH released earlier this year also found collaborative care to be a less costly and more effective way of providing mental health treatments for people on short-term disability leave for a psychiatric disorder.

September 29, 2009 (Newswise) - A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death. Coronary artery calcium scans can be done without triggering excessive additional testing and costs, according to the multi-center EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) study, led by investigators at the Cedars-Sinai Heart Institute. The findings appear in today's issue of the Journal of the American College of Cardiology.Coronary artery calcium scans that detect plaque in the coronary arteries have been shown to be more effective than standard cholesterol and blood pressure measurements in identifying patients who are most vulnerable to heart disease. Currently, these scans are not covered by private insurance carriers, in part because of concerns that detection of low levels of cardiovascular disease will result in unnecessary and expensive further testing, including exercise imaging and invasive cardiac catheterization procedures. "Over half of patients who suffer heart attacks have no warning that they have heart disease until the heart attack occurs. If we knew the patients were at risk, current treatments could prevent the majority of these unnecessary events. We had to address the concerns about unnecessary testing and costs related to this potentially lifesaving procedure," said Daniel S. Berman, M.D., the study's principal investigator and chief of Cardiac Imaging at Cedars-Sinai's S. Mark Taper Foundation Imaging Center in Los Angeles.

In the EISNER study, supported by The Eisner Foundation, researchers performed coronary calcium scans on 1,361 volunteers at intermediate risk for coronary artery disease, and followed them over a four-year period, from May 2001 to June 2005. The objective was to determine the relationship between coronary artery calcium scores and subsequent cardiac events and to evaluate the performance of additional cardiac diagnostic testing. Coronary artery calcium scores of 0 indicate no plaque, 1-9 minimal, 10-99 mild, 100-399 moderate, 400-999 extensive, and 1,000 or more very extensive plaque.

Coronary artery calcium scores varied widely but the vast majority of the patients had low scores. More than half - 56.7 percent of subjects -- had scores of less than 10, and only 8.2 percent had scores higher than 400. There was a strong relationship between the coronary calcium scores and subsequent cardiac events. The unique finding of the EISNER study was that there was a marked difference in the number, type and frequency of medical tests and costs given a subject's coronary artery calcium score. Additional stress testing was infrequent and related costs were low among subjects with low coronary artery calcium scores. Both rose progressively as the coronary artery calcium score increased, particularly in the patients at highest risk-those with scores of greater than 1,000-found in only 2.2 percent of subjects (31). Importantly, catheter-based invasive coronary angiography was performed exclusively among subjects with high coronary artery calcium scores. And even then, only 19.4 percent of participants who were in the highest risk category underwent this expensive procedure associated with a small but definite risk.

Recent evidence has demonstrated that screening with coronary artery calcium is a better prognosticator of risk than the Framingham Risk Score-the traditional way of assessing risk based on blood testing and blood pressure--in middle aged and elderly patients. Yet controversy surrounds expansion of cardiac screening to include coronary calcium scanning imaging because of concerns that the extra costs may not outweigh the benefits. The findings of the EISNER study, the researchers note, is the first direct evidence that coronary artery calcium scanning could be an acceptable cost-effective screening test for coronary artery disease, since it is able to identify high risk subgroups in need of aggressive medical treatment, and patients who undergo additional testing constitute only a small fraction of the screened population.

September 28, 2009 (Newswise) - Dr. Pinchas Cohen, professor of pediatrics at the David Geffen School of Medicine at UCLA, has won a $2 million Transformative R01 (T-R01) award from the National Institutes of Health (NIH) to fund his innovative research on mitochondrial dysfunction.Considered the power generators of the cell, mitochondria convert oxygen and nutrients into chemical energy for the cell that fuels metabolic activities.

Mitochondrial dysfunction has been associated with many diseases, including Alzheimer's, cancer and diabetes, although its exact role in the development of these diseases remains controversial.

The new T-R01 program was specifically created under the NIH Roadmap for Medical Research to support exceptionally innovative, high risk, original or unconventional research projects that have the potential to transform a field of science. The selected projects tend to be inherently risky, but if successful, can profoundly impact a broad area of biomedical research.

Cohen's bold proposal will test the paradigm-shifting hypothesis that previously unrecognized molecules, he dubbed "mitochondrial-derived peptides" (MDPs), play an earlier unappreciated role in the regulation of cellular and organismal function, and that disregulation of MDPs is important in disease development.

Likewise, understanding the role of MDPs may lead to development of new therapeutic and diagnostic targets. Since Alzheimer's, cancer and diabetes particularly affect the elderly, these findings could have a significant impact as the world's aging population continues to grow. The first of these agents, which Cohen named "small humanin-like peptides," have already demonstrated promise in animal models of diabetes and cancer.

Cohen was one of only 42 researchers nationwide chosen for the T-R01 award. He also serves as chief of endocrinology at the Mattel Children's Hospital UCLA, as well as co-director of the UCSD/UCLA Diabetes and Endocrinology Research Center.

September 28, 2009 (EurekAlert) - Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.While other studies have found that patients with diabetes are more likely to have AF, this is the first large study-involving nearly 35,000 Kaiser Permanente patients over the course of seven years-to isolate the effect of diabetes and determine that it is an independent risk factor for women.

"The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm," said the study's lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes."

"AF is the most common arrhythmia in the world, and diabetes is one of the most common and costly health conditions. Our study points out that there is a connection between these two growing epidemics-one we should pay closer attention to, especially among women," says Sumeet Chugh, MD, co-author and associate director of the Cedars-Sinai Heart Institute in Los Angeles. "The gender differences need to be looked at more closely because they could have significant implications for how we treat diabetes in men and women."

Atrial fibrillation occurs when the two upper chambers of the heart beat irregularly and too fast, causing blood to pool and clot. If the clot travels out of the heart and becomes lodged in an artery or in the brain, it can cause a stroke. About 2.2 million Americans are diagnosed with AF; however, many more people have the condition but don't know it. Diabetes affects more than 23 million Americans-and, according to the study, nearly 4 percent, or 1 million, have atrial fibrillation.

The study involved 17,372 patients in Kaiser Permanente's diabetes registry in Oregon and Washington and an equal number of non-diabetic patients, matched for age and sex. Researchers used Kaiser Permanente HealthConnect®, the world's largest civilian electronic health records system, to identify the non-diabetic patients. The two groups were followed for an average of 7.2 years until Dec., 31, 2008, or until they died or left the health plan. At the start of the study 3.6 percent of the patients with diabetes had AF, vs. only 2.5 percent of the non-diabetic patients-a difference of 44 percent. During the study period, diabetics were more likely than non-diabetics to develop AF. But after controlling for other factors like obesity, high blood pressure and age, the increased risk was only significant among women. Women with diabetes were 26 percent more likely than their non-diabetic counterparts to develop AF.