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.
|
February 2003
Heart,
Stroke Risk Starts Early in Persons With Type 1 Diabetes
High
Blood Pressure Also a Concern Among Young People
Managing
Type 2 Diabetes Sharply Cuts Heart Risk
Persons
With Diabetes Need to Watch Their Eyes
Online
Resources
In Other Diabetes Health
News:
Persons
With Diabetes Need to Watch Their Eyes
Study recommends
screening program for diabetic eye disease
A United Kingdom study
proposes recommendations on how often to screen for diabetes-related
eye disease.
The study, published in
a recent issue of The Lancet, included more than
7,500 people with diabetes. It provides information about the incidence
of diabetic eye disease and also offers recommendations for how
often people with diabetes should have their eyes checked.
Diabetic retinopathy is
the most common eye disease in persons with diabetes.
Diabetic retinopathy, the
leading cause of blindness in American adults, is caused by changes
in the blood vessels of the retina. In some people with diabetic
retinopathy, retinal blood vessels may swell and leak fluid, while
in others, abnormal new blood vessels grow on the surface of the
retina. These changes may result in vision loss or blindness.
The researchers say their
screening recommendations would be 95 percent effective in detecting
sight-threatening retinopathy.
The study proposes the
following:
-
persons with diabetes who have
no retinopathy have their eyes checked every three years
-
persons with no retinopathy who
use insulin or have had diabetes for more than 20 years should
be screened every year
-
persons with background retinopathy
should be screened every year
-
persons with mild preproliferative
retinopathy should be screened every four months
Always consult your physician
for more information.
Online
Resources
(Our Organization is not
responsible for the content of Internet sites.)
American
Association of Diabetes Educators
American
Diabetes Association
American
Heart Association
Centers
for Disease Control and Prevention (CDC)
Journal
of the American Medical Association (JAMA)
The
Lancet
National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The
New England Journal of Medicine
Stroke
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