Heart,
Stroke Risk Starts Early in Persons With Type 1 Diabetes
Study
finds odds much higher than previously thought
The
risk that young people with type 1 diabetes—a condition in which
the body's immune system destroys the cells in the pancreas that produce
insulin—will die of stroke or other cardiovascular disease is
much higher than previously believed, a British study finds.
In
the 20-to-39 age group, the risk of cardiovascular death for persons
with type 1 diabetes was more than fivefold higher in
men and sevenfold higher in women than in the general population, says
a report in a recent issue of Stroke, a journal of
the American Heart Association.
The
finding is "not entirely surprising," says Susan P. Laing, an epidemiologist
at the Institute of Cancer Research in England, who led the study. But
while previous studies have documented the increased risk among people
with type 2 diabetes, in which the body produces some insulin, this
is the first study to produce hard numbers about the risk of cardiovascular
death in young people with type 1 diabetes, she says.
"Physicians
need to be much more aware that young diabetics will be having more
cardiovascular risk than the general population," Laing says.
The
subject already is of concern to the American Diabetes Association,
says Dr. Francine R. Kaufman, an endocrinologist at Children's Hospital
in Los Angeles who is president of the association.
"Just
last week at a postgraduate course I said that it is important to start
to look at cardiovascular risk factors at adolescence or even earlier,"
Kaufman says.
The
American Diabetes Association has put together an expert
panel to consider recommendations about lipids such as cholesterol in
persons with type 1 diabetes ages 12 and older, she says.
"Physicians
need to be sure that the levels are normal," Kaufman says. "If not,
they should consider intervention, such as lipid-lowering agents."
High
Blood Pressure Also a Concern Among Young People
Another
risk factor of special concern in young people is high blood pressure,
she says, although there also is the need to monitor and intervene in
the case of other risk factors, such as smoking.
"The
risk begins earlier than has been thought, and we need to do good intervention
in this cohort," Kaufman says.
The
British study, called the Diabetes UK Cohort, included 23,751 patients
diagnosed with type 1 diabetes under the age of 30. The researchers
followed the patients for an average of 17 years, recording deaths from
stroke, heart attacks, and other cardiovascular diseases and comparing
the rate of their occurrence with that of the general population.
In
all, cardiovascular disease accounted for 4 percent of all deaths under
the age of 40 and 8 percent over the age of 40—much higher than
among people without diabetes.
"These
observations emphasize the vital need to identify and treat known cardiovascular
disease factors in young people with diabetes," Laing says.
Always
consult your physician for more information.
Managing
Type 2 Diabetes Sharply Cuts Heart Risk
Halves
chances of heart attack or stroke, study says
The
measures that experts recommend for preventing cardiovascular disease
in people with type 2 diabetes really do work, a carefully controlled
Danish study finds.
Those
who lowered their blood pressure and "bad" LDL cholesterol, raised their
"good" HDL cholesterol, exercised regularly, avoided smoking, and took
the proper medications had almost half the risk of a heart attack, stroke,
or other cardiovascular problems as those who had less intensive medical
care, the study, which appears in a recent issue of the The
New England Journal of Medicine, reports.
Since
all these measures are known to reduce risk, why do such a study?
"This
study was started 10 years ago, and at that time there was no evidence
that people with type 2 diabetes would benefit from treatment at all,"
says study leader Dr. Oluf Pedersen, director of the Steno Diabetes
Center in Copenhagen. "Diabetes treaters were indifferent and uncertain
about the outcome."
In
addition, Pedersen says, while there have been many studies evaluating
the effect of individual risk-reducing measures—lowering blood
pressure or cholesterol, promoting exercise, abstaining from smoking—"nobody
has previously evaluated the total impact of integrated treatment of
type 2 diabetes."
Type
2 diabetes, the most common type of diabetes, is a condition in which
the body either makes too little insulin or cannot properly use the
insulin it makes to convert blood glucose to energy. Type 2 diabetes
may be controlled with diet, exercise, and weight loss, or may require
oral medications and/or insulin injections.
The
eight-year study assigned 80 patients with type 2 diabetes to conventional
care and another 80 to intensive care designed to meet specific goals
for a number of risk factors—for example, keeping blood pressure
below 130/80 and keeping LDL cholesterol below 100 milligrams per deciliter.
People in the intensive care group were also advised to take a dietary
supplement that included vitamins E and C and folic acid, and they were
given an ACE inhibitor drug to prevent kidney disease. After nearly
eight years, 24 percent of those in the intensive care group had a major
cardiovascular event (heart attack, stroke or the like), compared to
44 percent of those getting conventional treatment, the report says.
"We
were not hoping for so great an impact," Pedersen says, based on the
results of studies of individual risk factors. "It is important to have
this kind of evaluation. Most national health experts recommend this
kind of treatment, but its effects have never been evaluated."
The
study results are "reaffirming the things we pretty much do," says Dr.
Eugene J. Barrett, a professor of medicine at the University of Virginia
and president-elect of the American Diabetes Association.
"There's nothing startling here. It says that if you pay attention to
each of the cardiovascular risk factors, you will have a major effect
on the clinical outcome."
However,
what is possible in a small study is not always achievable in everyday
practice, Barrett acknowledges. "The issue with any set of practice
guidelines is what people recognize as optimum and what can be done
in the real world."
Both
physicians and patients must work to put the recommended preventive
measures into action, Barrett says.
Always
consult your physician for more information.
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