Heart Disease and Diabetes

This a series of columns that will concentrate on Heart Disease and Diabetes. The progenitor of these diseases is the Metabolic Syndrome. There will be a Medical Forum in October discussing this matter followed by a series of lectures given by Mary Anne Molinari RN and Lynn Turnbull RN both of whom are medical educators.

The Mediterranean Diet and Diabetes (November 2008)

Sticking to a diet which includes fruit, vegetables, fibre and healthier fats could protect against type two diabetes, a study suggests. More than 14,000 Spanish volunteers were quizzed about eating habits, then checked over four years to see
who developed the condition. The results pointed to an 83% lower risk for those who followed the diet, the British Medical Journal reported. The idea that it could also reduce the risk of diabetes is a logical step -- olive oil is already known to
 improve blood sugar control and lower blood pressure.

Siestas Are Good for You (October 2008)

An afternoon nap 'is good for heart'. Taking 40 winks in the middle of the day may reduce the risk of death from heart disease, particularly in healthy men, say researchers. A six-year Greek study found that those who took a 30-minute siesta at least three times a week had a 37% lower risk of heart-related death. The researchers took into account ill health, age, and whether people were physically active. Experts said napping might help people to relax, reducing their stress levels. It is known that countries where siestas are common tend to have lower levels of heart disease, but studies have shown mixed results. The researchers in the Greek study looked at 23,681 men and women aged between 20 and 86. The subjects did not have a history of heart disease or any other severe condition. Participants were also asked if they took midday naps and how often, and were asked about dietary habits and physical activity.

The researchers found those who took naps of any frequency and duration had a 34% lower risk of dying from heart disease than those who did not take midday naps. Those who took naps of more than 30 minutes three or more times a week had a 37% lower risk. Among working men who took midday naps, there was a 64% reduced risk of death compared with a 36% reduced risk among non-working men. There were not enough female deaths to compare figures. The researchers said taking a siesta may reduce stress, hence the more notable finding in working men. This study has four advantages - it's large, prospective, limited to healthy people and we have been very careful to control for physical activity. Also if backed by other trials, taking a siesta would be an interesting way of reducing heart disease as it had no side effects. The only important factor was that people should not reduce the amount of physical activity they did in the rest of the day. People who feel stressed might be more tempted to have less healthy behavior, such as smoking, eating a poor diet, drinking too much alcohol and not getting enough exercise. This would add to their risk of suffering a heart-related death.

Diabetes: Underrated, Insidious and Deadly (September 2008)

In a set of recent focus groups, participants were asked to rank the severity of various health problems, including cancer, heart disease and diabetes. On a scale of 1 to 10, cancer and heart disease consistently ranked as 9s and 10s. But diabetes scored only 4s and 5s. But diabetes is anything but minor. It wreaks havoc on the entire body, affecting everything from hearing and vision to sexual function, mental health and sleep. It is the leading cause of blindness, amputations and kidney failure, and it can triple the risk for heart attack and stroke.

Diabetes results when the body cannot use blood sugar as energy, either because it has too little insulin or because it cannot use insulin. Type 2 diabetes, which accounts for 90 to 95 percent of cases, typically develops later in life and is associated with obesity and lack of exercise. Type 1 diabetes, which is often diagnosed in children, occurs when the immune system mistakenly destroys cells that make the insulin. The disconnect between perception and reality is particularly worrisome at a time when national diabetes rates are surging. Just last week, the Centers for Disease Control and Prevention announced that the number of Americans with diabetes had grown to about 24 million, or 8 percent of the population. Almost 25 percent of those aged 60 and older had diabetes in 2007. And the C.D.C. estimates that 57 million people have abnormal blood sugar levels that qualify as pre-diabetes.

To be sure, diabetes is treatable, and an array of new medications and monitoring tools have dramatically improved the quality of care. But keeping the illness in check requires constant vigilance and expensive care, along with lifestyle changes like losing weight, exercising regularly and watching your carbohydrates. But some patients say they are too busy to take better care of themselves, and many low-income patients can’t afford regular care. Even people with health insurance struggle to keep up with the co-payments for frequent doctor visits and multiple medications. Ultimately, diabetes can take a toll from head to toe. In the brain, it raises the risk not only for depression but also for sleep problems and stroke. It endangers vision and dental health. This month, The Annals of Internal Medicine is reporting that the disease more than doubles the risk of hearing loss. Moving down the body, diabetes can lead to liver and kidney disease, along with serious gastrointestinal complications like paralysis of the stomach and loss of bowel control. Last year the journal Diabetes Care reported that in a sample of nearly 3,000 patients with diabetes, 70 percent had nonalcohol fatty liver disease. Poor circulation and a loss of feeling in the extremities, called neuropathy, can lead to severe ulcers and infections; each year in the United States, there are about 86,000 diabetes-related amputations. Diabetes can also take a toll on relationships. By some estimates, 50 percent to 80 percent of men with diabetes suffer from erectile dysfunction. Experts say women with diabetes often lose their libidos or suffer from vaginal dryness. The challenge for doctors is to convince patients that diabetes is a major health threat. For years, the message from the American Diabetes Association has been one of reassurance that the disease is treatable. Now, beginning in 2009, the association plans to reframe its message to better communicate the seriousness of the disease.

What Is Metabolic Syndrome? (August 2008)

Metabolic syndrome is the name for a group of risk factors linked to overweight that increase your chance for heart disease and other health problems such as diabetes and stroke. The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are behaviors or conditions that increase your chance of getting a disease. In this article, “heart disease” refers to coronary heart disease. The five conditions listed below are metabolic risk factors for heart disease. A person can develop any one of these risk factors by itself, but they tend to occur together. Metabolic syndrome is diagnosed when a person has at least three of these heart disease risk factors:

1. A large waistline. This is also called abdominal obesity or “having an apple shape.” Excess fat in the abdominal area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.

2. A higher than normal triglyceride level in the blood (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.

3. A lower than normal level of HDL cholesterol (high-density lipoprotein cholesterol) in the blood (or you’re on medicine to treat low HDL). HDL is considered “good” cholesterol because it lowers your chances of heart disease. Low levels of HDL increase your chances of heart disease.

4. Higher than normal blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is recorded as two numbers, usually written one on top of or before the other, such as 115/75. The top or first number, called the systolic blood pressure, measures the pressure in the bloodstream when your heart beats. The bottom or second number, called the diastolic blood pressure, measures the pressure in your bloodstream between heartbeats when the heart is relaxed.
5, Higher than normal fasting blood sugar (glucose) (or you’re on medicine to treat high blood sugar). Mildly high blood sugar can be an early warning sign of diabetes.

The more of these risk factors you have, the greater your chance of developing heart disease, diabetes, or a stroke. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

 A high level of LDL cholesterol (low-density lipoprotein cholesterol; considered “bad” cholesterol) and smoking, for example, are key risk factors for heart disease, but they aren’t components of metabolic syndrome. Even a single risk factor raises your risk for heart disease, and every risk factor should be lowered to reduce the risk.

The chance of developing metabolic syndrome is closely linked to being overweight or obese and to a lack of physical activity. Another cause is insulin resistance. Insulin resistance is a condition in which the body can’t use its insulin properly. Insulin is a hormone the body uses to help change blood sugar into energy. Insulin resistance can lead to high blood sugar levels and is closely linked with being overweight or obese. Genetics (ethnicity and family history) and older age are other important underlying causes of metabolic syndrome.

About 47 million adults in the United States (almost 25 percent) have metabolic syndrome, and the numbers continue to grow. The increasing number of people with this condition is connected to the rise in obesity rates among adults. In the future, metabolic syndrome may overtake smoking as the leading risk factor for heart disease. It’s possible to prevent or delay metabolic syndrome, mainly with lifestyle changes. A healthy lifestyle is a lifelong commitment. Successfully controlling metabolic syndrome takes a long-term effort and teamwork with your health care providers.