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Seniors & Diabetes
High Blood Sugar Levels a Risk Factor for Heart
Disease
Diabetics and Non-Diabetics at Increased Risk
Sept. 13, 2005 – Even people without diabetes can
reduce their risk of coronary heart disease by lowering blood sugar
levels, according to researchers at the Johns Hopkins Bloomberg School
of Public Health and other institutions.
(Read
more about senior citizens and diabetes below this news story.)
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More Research |
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Study in
1999 Found Cardiovascular Risk with High Blood Sugar Below
Diabetes Level
Research
published in 1999 also found an association between high blood
sugar and cardiovascular risk that was below the level for
diabetes. The study followed 95,783 people for over 12 years and
concluded, “The progressive relationship between glucose levels
and cardiovascular risk extends below the diabetic threshold.”
American
Diabetes Association magazine -
Diabetes Care, Volume 22, Number 2, February 1999
Drug Reduces Cardiovascular Risk in Type 2
Diabetics
Sept. 13,
2005 - Data from the PROactive Study, presented Monday at the
41st meeting of the European Association for the Study of
Diabetes (EASD) demonstrated that ACTOS (pioglitazone HCl)
significantly reduced the combined risk of heart attacks,
strokes and death by 16% in high-risk patients with type 2
diabetes by lowering blood sugar levels.
“The
PROactive study is the first in the world to prospectively show
that a specific oral glucose lowering medication, namely
pioglitazone, can significantly improve cardiovascular outcomes
by helping to delay or reduce heart attacks, strokes and death
in high-risk patients,” said John Dormandy, M.D., professor of
Vascular Sciences at St. George’s Hospital, London, UK, and
chairman of the PROactive Study Steering Committee. “This
groundbreaking study gives new hope to people with type 2
diabetes who, despite their attempts to control blood glucose
and take medications, fear these life-threatening events.”
Actos, which
is promoted by Takeda Pharmaceutical Co. Ltd and Eli Lilly and
Co., belongs to a class of medicines called insulin sensitisers
that also includes GlaxoSmithKline Plc's Avandia.
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The researchers found that Hemoglobin A1c (HbA1c)—a
measure of long-term blood glucose level—predicts heart disease risk in
both diabetics and non-diabetics. An elevated blood glucose level is the
defining feature of diabetes, but until now it was unclear whether
elevated glucose levels contributed independently to increasing
heart-disease risk. The study is published in the September 12, 2005,
issue of
Archives of Internal Medicine.
“In persons with diabetes, we know that traditional
cardiovascular risk factors, such as hypertension and high cholesterol,
should be treated aggressively. Our results also suggest that improving
blood-glucose control may further reduce heart disease risk,” said
Elizabeth Selvin, PhD, MPH, lead author of the study and a postdoctoral
fellow in the Bloomberg School of Public Health’s
Department of Epidemiology.
“For non-diabetics, lifestyle modifications, such
as increased physical activity, weight loss and eating a healthful, low-glycemic,
index diet rich in fiber, fruit and vegetables, may not only help
prevent diabetes, but also reduce the risk of heart disease,” she said.
The researchers used data from the
Atherosclerosis Risk in Communities Study (ARIC), a community-based
cohort of almost 16,000 people from four states—North Carolina,
Mississippi, Maryland and Minnesota. HbA1c levels were taken from ARIC
study participants during clinical examinations in 1990-1992. ARIC
researchers tracked study participants for 10-12 years to acquire
coronary heart disease events, hospitalizations and deaths.
In participants with diabetes, the researchers
found a graded association between HbA1c and increasing coronary heart
disease risk. Each 1-percentage-point increase in HbA1c level was
associated with a 14 percent increase in heart disease risk. According
to the study authors, the current target for “good” glycemic control
established by the American Diabetes Association is an HbA1c value less
than 7 percent. However, the researchers’ analyses suggest that heart
disease risk begins to increase at values even below 7 percent.
They found that those study participants without
diabetes but who had “high normal” HbA1c levels (approximately 5 percent
to 6 percent) were at an increased heart disease risk, even after
accounting for other factors such as age, cholesterol level, blood
pressure, body mass index and smoking. Non-diabetic persons with HbA1c
levels of 6 percent or higher had almost a two-fold greater heart
disease risk compared to persons with an HbA1c level below 4.6 percent.
“There are large, on-going clinical trials which
should definitively answer the question of the effectiveness of blood
glucose-lowering medications in decreasing cardiovascular risk in
persons with type-2 diabetes. But our results suggest we should also be
concerned about elevated blood sugar levels in non-diabetics as well. An
important next step is to investigate strategies for lowering HbA1c in
persons without diabetes,” said Selvin.
The study authors were supported in part by grants
from the
National Heart, Lung, and Blood Institute.
Co-authors of the study are Elizabeth Selvin, Josef
Coresh, Sherita H. Golden, Frederick L. Brancati, Aaron R. Folsom and
Michael W. Steffes.
Senior Citizens and Type 2 Diabetes
Senior citizens are by far the most likely to be
diagnosed with Type 2 Diabetes, the form of diabetes found in almost 95
percent of cases.
Many scientists believe that as the body ages, the pancreas loses its
ability to keep up with the body's demands for insulin and simply starts
to burn out. Cells may become more resistant to insulin as the body
ages, as well. Some scientists believe the liver may increase glucose
production as people age.
Diabetes is a common condition in which the amount
of glucose (sugar) in the blood is too high because the body is unable
to use it properly. This is because the body's method of converting
glucose into energy is not working as it should.
We obtain glucose from the food that we eat: either
from sweet foods or from the digestion of starchy foods such as bread or
potatoes. The liver can also make glucose.
Normally a hormone called insulin controls the
amount of glucose in our blood. An organ, the pancreas, which lies just
behind the stomach, makes insulin. Insulin helps the glucose to enter
the cells, where it is used as fuel by the body. If the glucose is
unable to enter the cells it builds up in the blood. High levels of
glucose in the blood can lead to health problems.
After a meal is digested blood glucose levels rise
and insulin is released into the blood. When the blood glucose level
falls - for example, during physical activity - the level of insulin
falls. Insulin, therefore, plays a vital role in regulating the level of
blood glucose and, in particular, stopping the blood glucose from rising
too high.
When type 2 diabetes is diagnosed, the pancreas is
usually producing enough insulin, but for unknown reasons, the body
cannot use the insulin effectively, a condition called insulin
resistance.
Type 2 diabetes is associated not only with older
people, but with obesity, family history of diabetes, previous history
of gestational diabetes, physical inactivity, and ethnicity. About 80
percent of people with type 2 diabetes are overweight.
Facts about Diabetes:
American
Association of Clinical Endocrinologists (AACE)
Over 20 million Americans suffer from diabetes;
approximately one third of individuals with diabetes are undiagnosed. An
additional 41 million have pre-diabetes (impaired glucose tolerance
and/or impaired fasting glucose), a condition that often leads to
diabetes if left untreated.
There is an explosive epidemic of diabetes with a
41% increase in prevalence during the 1990s with a shift to a younger
age of onset. The prevalence of diabetes increased over 70% in adults
30-39 years of age.
The longer people live with uncontrolled diabetes,
the greater their risk for developing vascular complications, including
retinopathy, end-stage renal disease, neuropathy and coronary heart
disease. These complications are not only debilitating but expensive. In
2002, diabetes cost the U.S. over $132 billion.
Numerous studies have shown that significant
cardiovascular disease may develop years before the clinical onset of
diabetes. Hyperglycemia (high blood sugar) has been shown to have a
strong association with the subsequent development of cardiovascular
disease.
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