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diabetes

Helpful Tips for Those Living with Diabetes

  • Posted Nov 13, 2018
  • hchadmin

 

It's not easy finding out that you or a loved one has diabetes. However, educating yourself about this disease is the first step toward feeling better and living a longer and healthier life.

According to the Centers for Disease Control and Prevention (CDC), 30.3 million Americans – 9.4 percent of the U.S. population – are living with diabetes. Another 84.1 million have prediabetes, a condition that if not treated often leads to type 2 diabetes within five years. November is American Diabetes Month and Holy Cross Hospital would like to help you Live Your Whole Life by providing some helpful tips for managing diabetes.

The American Diabetes Association (ADA) offers the following suggestions to help navigate treatment if you or a loved one has been diagnosed:
•    Create a health care team. Finding the right team of skilled health professionals will help you manage your diabetes and get the most out of your care. Ask your doctor to help you build a team to assist you in reaching your goals and feeling better. As part of the care management resources available to you, you may receive an outreach call from a nurse. When a nurse calls, please be sure to return the call and take advantages of the services offered to you.

•    Be the star player on your team. Self care is the best way to maintain your good health. You can help keep yourself well by eating right, staying active, taking your medicine, monitoring your blood glucose and making and keeping doctor appointments.

•    Keep a close eye on your blood glucose levels. Your doctor may want you to start checking your glucose (or blood sugar) levels at home. If so, you will need a small machine called a blood glucose meter. Your health care team can help you find the best meter for your needs. Keeping your blood glucose levels in a healthy range is key to controlling your diabetes.

•    Take your prescribed medications. To help keep your blood glucose in the target range, it’s vital that you take your medications as prescribed by your doctor. If you believe you’re having side effects, be sure to call your doctor or pharmacist.

As you know, developing and maintaining a relationship with a primary care physician (PCP) who can coordinate your care is vital to your good health. A PCP typically specializes in Family Medicine, Internal Medicine or General Practice. If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

When you’re being treated for a disease or condition, it may not always be easy to decide where to go for care. For anything that is considered a life-threatening situation (like chest pain, major injuries or sudden and severe pain) it’s best to go to the emergency room.  For less severe matters that still require immediate attention, if you can’t get in to see your PCP, going to an urgent care facility can save you time and money.

Even if you require emergency or urgent care for your health situation, it’s always best to have a relationship with a PCP who knows your history and understands what is happening with your health over time.

As your trusted health partner for life, Holy Cross Hospital is committed to helping you Live Your Whole Life by nurturing well-being through body, mind and spirit.

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Live Healthier and Lower Your Risk for Type 2 Diabetes

  • Posted Oct 30, 2018
  • hchadmin

Did you know that by simply living a healthier lifestyle, you could dramatically reduce the possibility of developing type 2 diabetes? 

In fact, recent studies by the U.S. National Institutes of Health (NIH) report that by engaging in physical activity, eating a healthier diet, maintaining an appropriate body weight, limiting alcohol consumption and not smoking you can cut your risk of diabetes by as much as 80 percent.

November is American Diabetes Month and Holy Cross Hospital would like to take this opportunity to encourage you to care for yourself, and your loved ones, by reminding you of the importance of preventive care.  

NIH studies show that having a body weight appropriate for your height and age by itself reduced the risk of developing diabetes by 60 to 70 percent. Eating a healthier diet reduced the risk by about 15 percent and not smoking lowered the risk by about 20 percent.

Here are some tips from the NIH and the National Diabetes Education Program to help you make gradual lifestyle changes that can help you prevent type 2 diabetes:


If you are overweight, set a weight loss goal you can meet (check with your doctor before starting any weight loss plan). 

Aim to lose about 5 to 7 percent of your current weight and keep it off 

Keep track of your daily food intake and physical activity in a logbook and review it daily 

For support, invite family and friends to get involved


Make healthier food choices every day. 

Keep healthier snacks, such as fruit and vegetables, at home and at work

Pack healthier lunches for you and your family

Choose low-fat dairy products

Eat whole-grain cereals, breads, crackers, brown rice, pasta or oatmeal

Select lean meats and poultry

Choose more fish, beans, peas, nuts and seeds as protein sources

 

Strive to become more physically active. It’s easy to build physical activity into your day:

Take a brisk walk during lunchtime

Take the stairs instead of the elevator or park farther away from your office

Join a community program like the YMCA as a family and choose activities that everyone can enjoy

 

Restrict alcohol consumption. Your risk of developing type 2 diabetes rises with an increase in alcohol consumption. Limit yourself to no more than one drink a day.

If you smoke, quit (and don’t quit quitting). Smokefree.gov offers some great tips and a step-by-step guide on how to begin.


Be sure to embrace a healthy spirit. According to the American Diabetes Association (ADA), high levels of stress can have negative effects on your blood sugar levels. That’s why it’s important to practice good relaxation techniques. The ADA recommends the following: 

Breathing exercises – Sit or lie down and uncross your legs and arms. Take in a deep breath. Then push out as much air as you can then relax your muscles. Do these exercises for a minimum of five minutes at least once a day.

Replace negative thoughts with positive ones – If a negative thought is going through your mind, replace it with something that makes you happy or peaceful. You may also visualize a favorite nature scene to lessen anxiety and promote more serenity. 

Last, but not least, getting annual physicals and tests from your doctor is key in sustaining your health and helping prevent diseases like diabetes. Having a primary care physician (PCP) who can coordinate your care is vital to your good health. A PCP typically specializes in Family Medicine, Internal Medicine or General Practice. 

If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions.

As your trusted health partner for life, Holy Cross Hospital is committed to providing resources that promote well-being though body, mind and spirit and is dedicated to helping you Live Your Whole Life.

[Disclaimer: Trinity Health is a Catholic healthcare facility that is firmly committed to maintaining fidelity to its Catholic identity by closely conforming to the Ethical and Religious Directives for Catholic Health Care Services (ERDs).  Smokefree.gov and the links it provides are independent sites and have no obligation to provide information that is always congruent with the ERDs. Trinity Health cannot guarantee their content and ask your discretion when using information from this site.]

 
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Live Healthier and Lower Your Risk for Type 2 Diabetes

  • Posted Oct 24, 2017
  • hchadmin

Did you know that by simply living a healthier lifestyle, you could dramatically reduce the possibility of developing type 2 diabetes? 

In fact, recent studies by the U.S. National Institutes of Health (NIH) report that by engaging in physical activity, eating a healthier diet, maintaining an appropriate body weight, limiting alcohol consumption and not smoking you can cut your risk of diabetes by as much as 80 percent.

November is American Diabetes Month and Holy Cross Hospital would like to take this opportunity to encourage you to care for yourself, and your loved ones, by reminding you of the importance of preventive care.  

NIH studies show that having a body weight appropriate for your height and age by itself reduced the risk of developing diabetes by 60 to 70 percent. Eating a healthier diet reduced the risk by about 15 percent and not smoking lowered the risk by about 20 percent.

Here are some tips from the NIH and the National Diabetes Education Program to help you make gradual lifestyle changes that can help you prevent type 2 diabetes:

If you are overweight, set a weight loss goal you can meet (check with your doctor before starting any weight loss plan). 

Aim to lose about 5 to 7 percent of your current weight and keep it off 

Keep track of your daily food intake and physical activity in a logbook and review it daily 

For support, invite family and friends to get involved


Make healthier food choices every day. 

Keep healthier snacks, such as fruit and vegetables, at home and at work

Pack healthier lunches for you and your family

Choose low-fat dairy products

Eat whole-grain cereals, breads, crackers, brown rice, pasta or oatmeal

Select lean meats and poultry

Choose more fish, beans, peas, nuts and seeds as protein sources


Strive to become more physically active. It’s easy to build physical activity into your day:

Take a brisk walk during lunchtime

Take the stairs instead of the elevator or park farther away from your office

Join a community program like the YMCA as a family and choose activities that everyone can enjoy


Restrict alcohol consumption. Your risk of developing type 2 diabetes rises with an increase in alcohol consumption. Limit yourself to no more than one drink a day.

If you smoke, quit (and don’t quit quitting). Smokefree.gov offers some great tips and a step-by-step guide on how to begin.

Be sure to embrace a healthy spirit. According to the American Diabetes Association (ADA), high levels of stress can have negative effects on your blood sugar levels. That’s why it’s important to practice good relaxation techniques. The ADA recommends the following: 

Breathing exercises – Sit or lie down and uncross your legs and arms. Take in a deep breath. Then push out as much air as you can then relax your muscles. Do these exercises for a minimum of five minutes at least once a day.

Replace negative thoughts with positive ones – If a negative thought is going through your mind, replace it with something that makes you happy or peaceful. You may also visualize a favorite nature scene to lessen anxiety and promote more serenity. 

Last, but not least, getting annual physicals and tests from your doctor is key in sustaining your health and helping prevent diseases like diabetes. Having a primary care physician (PCP) who can coordinate your care is vital to your good health. A PCP typically specializes in Family Medicine, Internal Medicine or General Practice. 

If you don’t have a PCP, finding one is easy! Just visit your insurance carrier’s website, look for the “find a doctor” area and follow the instructions or click here.

Holy Cross is committed to providing resources that promote well-being though body, mind and spirit and is dedicated to helping you Live Your Whole Life.

[Disclaimer: Trinity Health is a Catholic healthcare facility that is firmly committed to maintaining fidelity to its Catholic identity by closely conforming to the Ethical and Religious Directives for Catholic Health Care Services (ERDs). 

Smokefree.gov and the links it provides are independent sites and have no obligation to provide information that is always congruent with the ERDs. Trinity Health cannot guarantee their content and ask your discretion when using information from this site.]

 
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Sound bites that hurt (Part IV)

  • Posted Feb 02, 2012
  • Alan Niederman, MD, FACC, FACP

photo from tampabay.com

Now let's move from sound bites to full-fledged out-and-out incredible.  I will cop to the fact that I generally don't watch TV and never commercials since I record everything I watch.  News I get from the sites that I read on the web.  When I want a laugh, I will watch some Fox "News" in the hospital. The Food Channel is pure America.  It would be funny if it wasn't so scary that these people are really eating all of this.  One guy tries to go to all the places where you have to eat 20 lb hamburgers and tries to match the records. I spent 15 years eating southern cooking in Atlanta when I sojourned there during school and training.  It struck me as good, and at times, wholesome.  There are some southern dishes that I never did get, or eat.  Not that it's not good, it just doesn't jibe with my tastes. For years, Paula Deen has been cooking and promoting a style of food which no one can sensibly consider good for you.  As I have often said, it's not what you eat, it's how much.  Clearly, with some of her recipes, if you just eat two bites you are okay but not if you eat it all day everyday and don't exercise 20 hours of the day. Guess what?  She did. I am sorry for her, but here is the problem.  When she developed type 2 diabetes, which means that she is not insulin dependent,  she did not say anything.  She just went on selling crack to crackheads.  It's like you sell matches to an arsonist.  It's really surreal if you think about it.  She had a recipe for a hamburger which used two glazed doughnuts as a bun. I saved the best for last.  She only revealed that she had been a diabetic for three years after she signed a deal with the maker of the drug Victoza, Novo Nordisk.  She is now prominently featured at the top of their website. Victoza is one of many drugs that are being used now for type 2 diabetes.  It is injectable and is not insulin.  What it does is basically make you stop eating faster, so that you begin to lose weight and have better control of your diabetes.  Only in America can we develop a drug to make you stop eating.  Do we as a nation have no willpower left?  Are we truly at the mercy of our stomachs? Indeed, on her web site at Pauladeen.com, she is now claiming to make the same recipes but not as fat or with as much salt.  I guess she is skipping the doughnuts and going back to bread buns; maybe whole grain. Frank Bruni is a columnist for the New York Times.  I first started following him when he was the chief restaurant critic for the Times: a very prestigious job.  I became more interested in him when I found out that as a child, he was obese.  He wrote a book about his ordeal titled Born Round. He had quite a bit to say about Ms. Deen (NYT, January 21,2012).  As he says, "this is a profound, unsettling act of withholding."  Apparently the wages of sin is a TV show and a drug endorsement deal. In the article, he also discussed how famous chefs (at least some of them) stay thin.  It seems they religiously workout to burn calories and eat a great deal of salad and chicken.  What a novel idea. Be careful what you watch on TV.  Be careful what you eat.  We will not make as much money on our disease as Ms.Deen.  I wish her health and common sense.


Sound bites that hurt (Part II)

  • Posted Jan 26, 2012
  • Alan Niederman, MD, FACC, FACP

As I wrote in my last blog, this paradoxical result of patients developing diabetes taking a statin is not news to us.  Published in Lancet in 2010 (Lancet2010; DOI:10.1016/S0140-6736(09)61965-6) is a meta-analysis of this issue.

A meta-analysis is not a study, but it can provide important information and hypothesis-generating work.  Randomized clinical trials can then be fashioned to prove or disprove the hypothesis.  The more alike the trials included in the analysis, the more valuable it becomes.

This meta-analysis analyzed 13 trials each with at least 1,000 patients who were divided into two arms that were identical and followed for at least a year.  91,410 patients were included in the analysis.  During the four-year followup, 4,278 patients or 4.6% developed diabetes.  2,226 patients were treated with statins and 2,052 with placebo.  The difference was 9%.  In English, I have to treat 255 patients with a statin for four years for one of them to develop diabetes.  Those 255 patients had 5.4 deaths or myocardial infarctions avoided in those four years.

Death, myocardial infarction reduction or diabetes?  You decide.  Now let me mention that thiazide diuretics, beta blockers and the beloved niacin all increase the risk of diabetes in patients taking them to some extent.

Let me close this portion of the blog with the following: patients who have had a cardiovascular event need statins regardless of what they do.  Patients who have moderate or high risk should be on statins and carefully followed to determine their glucose status.  Everyone needs to eat better and exercise more.

If you are at low risk, a study such as calcium scoring will determine your cholesterol burden, and patients should be placed on statin when appropriate.

That is the information beyond the sound bite.

Now, let’s address the sound bite contention that Pradaxa causes myocardial infarctions.  This discussion is also very complex, and when reduced to a sound bite, does not benefit anyone.

Some facts: When Pradaxa at 150 mg twice a day is compared to warfarin, embolic events are 1.11%/yr vs. 1.69%/yr.  Hemorrhagic stroke is 0.10%/yr vs 0.38%/yr.  Ischemic stroke is 0.92/yr vs 1.20%/yr.
Major bleeding is 3.11%/yr vs 3.36%/yr.  Death is 3.64/yr vs 4.13%/yr.  The reduction in mortality is approximately 10%. This data is what caused the FDA to approve the drug.

Added to this are warfarin’s very real problems.  I will not dwell on all of them here, but they include -- and are not by any means limited to -- only 55% of eligible patients who receive the drug for various reasons, and this number increases as patients get older.   When warfarin is used, it is often ineffective.  During the first year, warfarin is therapeutic 58% of the time.  The lack of adequate therapy is often due to patient non-compliance with dose and/or food or drug interactions. Warfarin is, however, inexpensive.

Does Pradaxa cause more myocardial infarctions?


Sound bites that hurt (Part 1)

  • Posted Jan 25, 2012
  • Alan Niederman, MD, FACC, FACP

I knew it was going to be a long day when I started to get messages that statins cause diabetes.

There is an adage in TV journalism that “if it bleeds, it leads.”  The more grotesque something can be made the better.  Partial truths in medicine do not count.  This is not Presidential politics.  Patients for some reason often make health decisions based upon what they hear on the news, or worse, what their friends tell them.

I blame doctors for most of this.  I believe that people would rather hear it from medical professionals, but not many of us will give them the time to explain complex topics simply.  Some doctors can’t, some doctors won’t.  As I have said before, it’s the major reason that I spend the time to write my blog.

I certainly have things to write about at this time.  I will start by explaining why statins don’t cause diabetes, and then I will move on to why Pradaxa does not cause heart attacks.  Finally, I will touch on Paula Dean and why as Soupy Sales used to say “people who live in glass houses shouldn’t throw stones.”

First, it is important to understand that randomized clinical trials test only the hypothesis that is being tested.  In the case of statins, the hypothesis is that if you take them, you have less of a risk for an ischemic event than if you do not.  The risk reduction increase with increasing doses of statin that decrease the level of LDL cholesterol.

This topic has been widely discussed and understood for some time among those of us who follow these sort of issues.  The report which engendered the current rash of news stories is possibly the worst of the studies to quote.  The study was published in the Arch Intern Med 2012 (DOI: 10.1001/archintermed.2011.625).  It reports results from the WHI or Women’s Health Initiative.  This study encompasses 153,840 postmenopausal women 50-79 years old.  Data was collected at baseline and year three, and the data is from 2005.

Only 7% of the women in this study were taking statins.  Of those taking statins, at baseline 71% developed an “increased risk” of diabetes.  After adjustment for “confounding variables” the risk was 48%. (My quotation marks)

First of all, the absolute numbers are not provided.  What is meant by that is the following example: Plavix was approved because it had a reduction of stroke risk by 20%.  What is not understood is that the risk of stroke in the control group was 1.8%.  The risk in the Plavix group was 1.3%.  This is a 20% reduction but you need to treat 200 patients to get one benefit.  The largest use of Plavix, stent protection, has nothing to do with this study.  It was the study that was used by the FDA to approve Plavix and then we used Plavix however we wanted.

What was the real risk of developing diabetes?  What was the characteristics of this group?  What was it about this 7% that made their doctors put them on  a statin in the first place?  Were they more likely to develop diabetes anyway?  Did their weight increase over the time of the study?  Was there any offsetting benefit by the use of statin?  None of these questions are answered only that “statins cause diabetes.”

Some more pertinent facts next.


My body made me do it. Or how I learned to hate (Ghrelin Part II)

  • Posted Nov 03, 2011
  • Alan Niederman, MD, FACC, FACP

It’s that time of year again.  Over the holiday period, most people put on some weight.  Too many trays of cookies and pies and too many meals.  It’s just one of the challenges of the season.

The study that I cited in my last blog was done in Australia, and although small, points out some very interesting observations.  Like all good studies, it will serve as a starting point to perhaps begin to conquer our war on fat.

Remember this isn’t about fitting into your pants.  This is a huge problem for the United States and all developing countries.  Diabetes and obesity are condemning us to years of higher healthcare costs and significant morbidity and mortality in our affected population.

These researchers enrolled 50 obese patients without diabetes in a year long study.  They were given a 500 - 550 calorie diet for 8 weeks (YUM).  They used the substance Optifast and 2 cups of low starch vegetables for the three meals.  After weeks 9 - 10 those patients that lost 10% of their body weight were reintroduced to ordinary food, and at week 10, the Optifast was stopped.

After week 10 the participants received individual advice and counseling from dietitians with the aim of maintaining the weight loss.  They were also advised to exercise 30 minutes a day.  They were seen every two months and contacted often.  Remember, these are motivated individuals.

Mean weight lose at the end of 10 weeks was 29.7 lb. +/- 1.1 lb..  This was 14.0% of their initial weight.  Only 34 participants completed the one year study.  At the beginning of the study, the baseline weight was 208 lb., and at the end it was 212 lb.    Yes, at one year they had managed to get fatter.

Why does this happen?  Can it be stopped?  Is it possible to lose weight, or are we doomed?  It seems that our hormones doom us to gain the weight back.  They force us to eat by increasing our appetite.  Ghrelin actually stimulates the appetite so you will eat and produce more fat.  Leptin which is an adipocyte (fat) hormone drops as does the production of fat stores, and this drop also stimulates hunger to produce more fat, which raises the Leptin levels.  Furthermore, this perturbation of our hormonal system lasts for a year or longer.

This brings up the concept of body weight “set point.” Somehow, the body decides it “needs” to be fat and enlists an army of agents to keep and maintain this set point even if it is killing us.

These findings will point us in directions to push back on this.  If we can find a way to block these hormones maybe they will suppress appetite effectively.  How do we change the set point?  Can we envision a time when you can chose your weight, and it will be dialed in?

I for one chose to fight on.  If you hold to a diet that you incorporate into your lifestyle and exercise continuously, your body must at some point re-adapt to a different set point, veal parmigiana be dammed.

One can only hope...and try.


Another question about Pradaxa

  • Posted Aug 02, 2011
  • Alan Niederman, MD, FACC, FACP

A question was posted on my blog concerning Pradaxa pacemakers and dosing.  It brings up several good points and some information readers and -- judging from the question -- doctors need to know.

The writer asked whether Pradaxa interferes with a pacemaker.  Pacemakers and patients with defibrillators are common in patients who have atrial fibrillation because of the many pathways that lead to the condition.  Pacemakers are not affected in anyway by Pradaxa.  Pacemakers are not effected in anyway by anything we do unless specific instructions are given to it.  The only way to affect a pacemaker or defibrillator is to expose it to magnetic forces as that drives the device to a preprogrammed mode and inactivates some functionality of the device.  There are drugs that can affect the heart and its conduction system, and this might make the device do either wanted or unwanted actions.

The question poses two more issues which are more concerning.  The writer states that her mother was placed on the 75mg dose so that it would cause “less bleeding.”  First, many patients on anticoagulation have retinopathy secondary to diabetes and have had retinal bleeds.  Medicine has risks and balances.  There are choices.  Most patients would prefer losing vision in one eye to a debilitating stroke.  The option is of course theirs but that is what the ophthalmologists say.  You cannot adjust the intensity of Pradaxa by lowering the dose.  The only factor regarding the dose that counts is your kidney function.  If you have normal kidney function and take 75 mgs as a dose, you are not going to be affected by the drug.  If you have poor kidney function and take a dose of 150 mgs, you are going to be at severe risk of bleeding.  You must take the proper dose if you want the effect of the drug.

So the answer to the question is depending on her renal function and whether the patient wants a stroke or an eye bleed.  In the vast majority of cases it’s neither.

But, is 75 mgs a “real dose?”  How did we get to this point?  Pradaxa was approved based on the data from a study known as RE-LY.  The doses used in that study were 150 mg twice a day and 110 mg twice a day.  Huh?  Where did the 75mg dose come from?

The data in the study showed that the 150 mg dose was superior to the 110 mg dose in preventing strokes but caused more bleeding.  The bleeding with the 150 mg dose was similar to warfarin but still lower.  The FDA made the decision to accept more bleeding and less strokes as the better choice for the United States.  In particular, the data for those patients 75 years old or greater provided important information as these patients are very common.  Stroke with the 150 mg dose was 1.3 per 100 patient years and with the 110 mg dose, 2.4 per 100 patient years.  Bleeding was 5.3 vs. 5.7 with the lower dose.  In English, this means that the stroke rate was better but the bleeding the same, so don’t let people choose to have a stroke.

The 75mg dose was “made up” by the FDA using real data concerning the pharmacokinetic and pharmacodynamic modeling.  It was not in their words “based on efficacy and safety data” N Engl J Med 2011; 364:1788-1790.

So there we have it.  The FDA made these choices for us, and this is what we have to go on.  I do not know of a plan to test the 75 mg dose for “safety and efficacy."  Why would the company do it?

One last word today.  I received a troubling e-mail from a reader regarding her husband who was on Pradaxa.  He was to have a cardiac transplant, was on Pradaxa and received the call for the operation.  This operation is very time sensitive and must be done immediately.  As I have blogged about before, you cannot reverse Pradaxa’s effect.  The transplant took place on Pradaxa and the patient eventually died from the complications of managing the bleeding.

This serves as a warning.  If you have a time sensitive condition, it is probably best to be on warfarin.  It works and can be reversed.  My sympathies are with her.


More fun with statins

  • Posted Jun 30, 2011
  • Alan Niederman, MD, FACC, FACP

In keeping with the topic of statins, we have another piece of foolishness that was fussed over this past week in the lay press.  It involves the interaction that statins have with diabetes.  For some time now there has been a belief in some quarters that high dose statin therapy can lead to diabetes.  This signal originally showed up in the JUPITER study of Crestor that I have blogged about in the past.  Obviously, if true, we would like to know this.

Published in JAMA 2011; 305:2556-2564, this damned-if-I-don’t-and-damned-if-I-do study shows that the use of high dose statins to achieve target LDL levels of 70 is associated with a 12% increase in diabetes when compared to more moderate doses.

How did these individuals arrive at this information?  They used a total of five studies in a meta-analysis which contained a total of 32,752 patients who did not have diabetes at baseline.  These patients were followed from 2 to 5 years.

As in most of my blogs, there is a kicker -- a moment where the unreality of what I do on a daily basis kicks in.  Although it has been heralded in the press that now “statins cause diabetes,” here is the point of the paper that the press missed.  Your risk of developing diabetes from high dose statin is one in 498Your risk of not having a cardiovascular event is one in 155.  In English, it means that your benefit of not having a heart attack, stroke, or revascularization is far greater than your risk of developing diabetes.

Remember Austin Powers?  “What will it be MI or diabetes?”  Most people when presented with the facts will choose to take the high dose and eat less.  The numbers clearly favor that approach.

One other factoid  relates to my last blog.  When simvastatin 80 mg was compared to atorvastatin (Lipitor) 80 mg,  the risk of diabetes was the same but the benefit was a 22% vs. 5% risk reduction for cardiovascular events favoring Lipitor.  You maybe getting what you pay for with the statins.

This whole problem of cost vs. benefit will diminish when Lipitor becomes generic later this year.  Talk with your doctor to make certain you are on the proper statin at the proper dose for your condition.


Ancient History and an Answer We Never Had: Part II

  • Posted Feb 24, 2011
  • Alan Niederman, MD, FACC, FACP

Ancient history and an answer we never had...

...until now.

The common assumption is that if obesity has an increase in cardiovascular events -- and death from them -- then it is because of a toxic brew of hypertension, increased lipids and diabetes.  Well, you know what assume really stands for?  Assume stands for the contraction makes an a** out of u and me.  Until the group of patients in the WOSCOPS study was followed, no randomized study answer was at hand.

Even the answer that WOCCOPS found is interesting.  As published online (on Valentine’s Day no less) at Heart 2011; DOI:10.1136/hrt.2010.211201 the researchers excluded any subject with an event in the first two years.  After 14.7 years of follow up 1027 nonfatal cardiovascular events occurred and 214 fatal cardiovascular events occurred.

The groups were analyzed in two ways.  The first included age and statin treatment and the second included all known risk factors plus BMI with the reference being a BMI of 25 to 27 kg/m2.  The researches found that the risk of nonfatal events did not matter what your BMI was.  However, fatal cardiovascular events were significantly increased in those white men with a BMI of 30 to 39.9 kg/m2.

Remember, this study was done in white men so these results are not transferable to any other group.  This however is the first published randomized long term follow up of any group that shows an increased cardiovascular mortality of any sort and represents a milestone and who knows if it will ever be repeated or if another group is right behind this.

If it is not diabetes, lipids or hypertension what causes this increase?  This is pure speculation but one man’s speculation is another man’s results.  The authors speculate that obesity leads to an increase in inflammation and that this increase in inflammation causes this effect.  We have many studies which center on this phenomenon and the drug Crestor was the subject of a study showing a decrease in cardiovascular events in those patients with “normal” LDL and an increase in CRP, which many physicians believe is a marker of generalized inflammation.  The treatment of patients with statin and aspirin often reduces the CRP level.  I blogged about this study in the past and it is known as the Jupiter trial.

I doubt that we have the basic research knowledge to figure this out at the present time.  This, like the genetics of cardiovascular disease is most likely for the future.  What this data does is provides another basis to urge patients and people in general to start losing weight in an effective and long term way.  Recently as I have blogged about in the past every new drug that has come to FDA for approval that had to do with weight lose was turned down as too toxic for widespread use.  Gastric bypass and gastric lap banding seem to be the best options.

I am fond of saying “it’s not nice to fool with Mother Nature."  There are often unpredictable results when we attempt to fool the body into doing something it doesn’t want to do.  We are left with the unpleasant and often spoken ugly truth that we just have to EAT LESS.

Oh my.  What is a lover of Veal Parm to do?  Maybe just eat two bites?  Statins won’t protect you.  It’s apparently up to each and every one of us to make the best of it.

Good Luck.


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About Holy Cross Hospital

Holy Cross Hospital is a nonprofit, Catholic hospital in Fort Lauderdale, Florida, dedicated to innovative, high quality and compassionate care. For nearly six decades, Holy Cross has continuously expanded its services to provide leading-edge care for their patients in Florida and for those from elsewhere in the United States. Holy Cross also offers an International Services program to ensure that patients from outside the U.S. receive the care they need.

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