Diabetics can avoid problems with attention to heart risks

Even if they haven't been diagnosed with heart disease, diabetics with classical heart-risk factors like smoking and elevated “bad” cholesterol are at heightened risk of serious heart-related “events” and death, according to a new study.

Among people with diabetes but not heart disease, researchers linked more than a third of cardiovascular “events”—such as heart attack and stroke—and 7 percent of deaths to inadequate control of heart risk factors.

That means those cardiac events and deaths might have been avoided with better control of the known risk factors, the study team writes in Diabetes Care.

“The take home message from this study is that adults with diabetes can reduce their risk of cardiovascular events, and patients should work together with their provider to set a care plan including goals and strategies to reduce modifiable risk factors,” said lead author Gabriela Vazquez-Benitez, a research investigator at HealthPartners Institute for Education and Research in Minneapolis, Minnesota.

“This can include regular care visits, screening, laboratory, weight, and blood pressure,” she told Reuter’s Health in an email.

The risk factors for cardiovascular problems in diabetes are well known and include high blood pressure, smoking and poor control of blood sugar. If more attention were paid to these risk factors, the rate of cardiovascular problems and death could be substantially reduced, the study team argues.

There are nearly 25 million Americans with diabetes and if current trends continue, more than one in three adults are projected to develop the disease.

Stroke and coronary heart disease are the major causes of complications, deaths and healthcare costs in adults with diabetes, they write.

The authors point out that medical advances have improved the health of people with diabetes, especially when it comes to cardiovascular problems. But for people with diabetes as a group, the burden of cardiovascular problems remains very high.

In their study, Vazquez-Benitez and her team analyzed data on nearly 860,000 adults with diabetes.

They looked at rates of major cardiovascular complications such as heart attacks and heart failure, as well as deaths from all causes, plus four risk factors: blood pressure, levels of LDL cholesterol, smoking and blood sugar levels over the months.

The authors emphasize that overall rates of major cardiovascular complications and deaths were “substantially higher” in people with diabetes who already had heart disease, compared to those without it.

But delaying diabetes complications is possible, Vazquez-Benitez said, not only for cardiovascular events but for problems like nerve damage and kidney disease.

“Although there is a genetic component of diabetes, there are modifiable risk factors that can reduce risk of heart attack, stroke and death,” said Deborah Greenwood, a registered nurse and president of the American Association of Diabetes Educators. Lowering blood sugar, LDL cholesterol and blood pressure, as well as quitting smoking can greatly reduce risk, she said.

All adults over 45 should be screened for diabetes so it can be diagnosed and treated early, said Greenwood, who was not involved in the study. For most people with so-called pre-diabetes, she pointed out, losing 5 to 7 percent of body weight and doing 150 minutes of physical activity per week could avert progression to full-blown diabetes.

She also emphasized the importance of participating in diabetes self-management education and partnering with a credentialed diabetes educator to change behaviors and improve modifiable risk factors. “A diabetes educator will work with you to develop a plan specifically tailored to your individual needs, preferences and lifestyle to ensure success,” Greenwood said. — Reuters

Yoga may benefit heart health as much as aerobics

Those sun salutations and downward dogs could be as good for the heart as cycling or brisk walking, and easier to tolerate for older people and those with health challenges, according to a new review of existing research.

Based on 37 clinical trials, researchers found that doing yoga lowered blood pressure, cholesterol, heart rate and other cardiovascular risk factors in increments comparable to those seen with aerobic exercise.

“Taken together, these improvements could facilitate and complement a regimen toward better cardiovascular health,” said Paula Chu, a doctoral candidate in health policy at Harvard University in Cambridge, Massachusetts, who led the study.

She and her co-authors caution in the European Journal of Preventive Cardiology, however, that larger studies are needed to understand how yoga improves health, how much of it is ideal and if there are differences in benefits from various types of yoga before the practice becomes a standard prescription for heart disease.

Nonetheless, yoga’s benefits have been long suspected, said Dr. Larry Phillips, a cardiologist at NYU Langone Medical Center in New York.

“I think what we’ve seen is with yoga and the relaxation and behavior modification that goes along with it, there is a benefit to all patients, but especially those with heart disease,” said Phillips, who was not involved in the new analysis.

“Here we are able to see there are more measurable benefits than we’ve seen before,” he told Reuters Health.

Yoga originated in India more than 5,000 years ago, and has become a popular mind-body therapy in the West. Yoga’s breath control and body postures are believed to help nourish self-awareness, control stress and develop physical strength and balance.

The more traditional Hatha style of yoga is the most widely practiced in the U.S. But many specialized yoga “products,” such as hot yoga, power yoga and yoga retreats are part of a billion-dollar yoga industry.

One study estimates that 15 million Americans have practiced yoga at least once, according to Chu and her co-authors.

They focused on yoga’s effects on cardiovascular disease, as well as risk factors including high blood pressure, high blood sugar, excess abdominal fat and abnormal cholesterol levels that make up a profile—known as metabolic syndrome—that often leads to heart disease and diabetes.

The study team analyzed 37 randomized, controlled trials involving 2,768 people through December 2013. The trials either looked at yoga compared to no exercise or to aerobic exercises. Participants’ average age was 50 and they were followed for anywhere from 12 weeks to one year.

Those who did yoga had significant improvements in a range of risk factors. Systolic blood pressure (the top number) dropped by an average of 5.21 mm Hg, and diastolic pressure (the bottom number) dropped 4.9 mm HG. LDL “bad” cholesterol fell by an average 12.14 mg/dl and HDL “good” cholesterol rose by an average 3.20 mg/dl. Average heart rate was lower by a little over 5 beats per minute and weight loss averaged a bit over 5 pounds.

These changes were similar to the improvements seen among people who did aerobic exercise instead.

There were no changes, though, in fasting glucose levels or A1C, a measure of long-term blood sugar control in diabetics.

Chu and her colleagues note that one weakness of the results is that the analyzed trials included various types of yoga that were practiced for different amounts of time. These included Silver yoga (for seniors), Iyengar yoga (a form of Hatha that emphasizes correct postures), Viniyoga (which includes chanting) and Vinyasa (breath-synchronized movements.)

There were also a wide range of populations, from the young and healthy to older people with histories of heart disease, Chu told Reuters Health.

“We are not recommending anyone ditch their medicines or established medical or physical practices,” she said. “Individuals can talk to their doctors about whether yoga is a viable option for them.”

Yoga classes may be offered at health clubs, spas, senior centers and in other settings. Individual classes at stand-alone yoga centers tend to range from $15 to $30.

Phillips said he encourages his patients to develop a healthy lifestyle and exercise regimen, which could include yoga. He urges people to find a class that is appropriate for their comfort level and ability.

“I think the effects of relaxation do decrease stress levels and have a benefit to the heart,” said Phillips, adding that he had found doing yoga boosted his own mood and energy level. — Reuters

A low-sodium diet is still the best bet – study

NEW YORK - Eating less than one teaspoon of salt per day remains the ideal goal for Americans, according to a new study.

Most research has linked high sodium consumption with greater risks of stroke and cardiovascular disease. Evidence has shown that men and women age 51 or older, African Americans or those with hypertension, diabetes or chronic kidney disease face especially high risks.

But when several studies produced findings suggesting diets could be too low in sodium, the US Institute of Medicine (IOM) asked experts to review studies on the health effects of sodium.

The data "weren't entirely convincing," said Nancy Cook, lead author of the current study published in the journal Circulation, and a member of that expert panel.

Cook is a statistician at the Brigham and Women's Hospital and Harvard Medical School in Boston.

In an attempt to resolve the conflicting information, Cook and her team analyzed data from a previous large study called the Trials of Hypertension Prevention (TOHP) designed to look at high blood pressure. The TOHP followed the field's "gold-standard" technique of measuring salt consumption in 24-hour urine samples.

Other salt consumption studies have used single urine collections or overnight samples, neither of which provide as much consistency and accuracy as samples that participants collected throughout an entire day and night.

"The quality of the sodium measures (in TOHP) is probably better than any other study out there," Cook said.

"We found there were no adverse effects with lower amounts of sodium and benefits continued to be seen at the lowest sodium levels," she said. The findings match up with most evidence available.

"People should realize—and it may be difficult to do with all of the conflicting information in the press—that quality differs from study to study," Cook said. "When you get down to the details, some studies are more reliable than others."

Main food culprits containing high sodium include bread, cured meat, pizza, poultry, soup, cheese and snacks, wrote Lyn Steffen of the University of Minnesota School of Public Health in Minneapolis in an editorial that accompanied the new study.

On the nutritional facts panel on food packaging, if the sodium amount per serving is 5 percent daily value, then that is a low-sodium product, Steffen said. Products with 20 percent daily value are high-sodium.

Even though modern lifestyle is busy, Dr. Graham MacGregor of Queen Mary University and chairman of the World Action on Salt and Health lobby group, suggested a solution: "If you cook fresh vegetables, potatoes, pasta and rice with fresh meat or fish, make more than you can consume, you can then put portions in the freezer and use this on different occasions so that the food can be instantly ready."

In restaurants, the challenge to eat less salt can be greater. "You can request that no salt be added," Cook said.

"If you suddenly cut all sodium from your meals, then things will taste bland," Cook said. "So it's important to lower sodium gradually and get accustomed to lower amounts of salt."

As the body adjusts to lower sodium levels, then foods with high sodium may be less appealing, she said. — Reuters

source: gmanetwork.com

Extra fiber tied to lower risk of stroke — UK study

NEW YORK - People who get more fiber in their diet are less likely to have a stroke than those who skimp on the nutrient, according to a new review of existing research.

"A few people in the past have looked at the relationship between fiber and cardiovascular disease, which includes coronary heart disease and stroke," senior author Victoria Burley told Reuters Health.

But this is the first time all the available results from long-term studies have been pulled together into one analysis, said Burley, a senior lecturer in nutritional epidemiology at the University of Leeds in the UK.

Burley and her coauthors pooled the results of eight studies conducted since 1990 that included close to 500,000 participants. Those people reported on their dietary fiber consumption and were followed for anywhere from eight to 19 years.

The researchers found the risk of suffering a first stroke fell by 7 percent for every 7-gram increase in dietary fiber people reported each day - so that those who ate the most fiber had the lowest chance of stroke, according to findings published in the journal Stroke.


The average U.S. woman gets 13 grams of fiber per day, and the average man gets 17 grams - well below the Institute of Medicine recommendation of 24 and 35 grams, respectively.

An extra 7 grams could come from two slices of whole wheat bread and a serving of fruit, for example, Burley said. But even less than that - just 2 or 3 extra grams per day - might affect stroke risk.

Americans suffer almost 800,000 strokes annually, and strokes cause one out of every 18 U.S. deaths, or 130,000 per year, according to the Centers for Disease Control and Prevention. Most happen when a clot blocks blood flow in a brain vessel.

"Stroke is a very common and chronic disease in our society because the risk factors are growing," Dr. Dean Sherzai, a neurologist at Loma Linda University in California, told Reuters Health.

The new results are important because at the moment there are limited treatments and preventive measures available for stroke, but diet changes such as adding more fiber are relatively easy, said Sherzai, who was not involved in the study.

The report didn't look at the effects of different types of fiber on people of specific ages - so it's possible some may glean more benefit from eating extra fiber than others, he added.

The findings don't prove fiber directly prevents strokes. Researchers also don't know why fiber would be linked to a lower risk, although they have some ideas.

"There could be all sorts of things going on," Burley said.

Foods high in fiber tend to be low-calorie and help people maintain a healthy weight, which reduces stroke risk, she said. Fibrous foods also have vitamins, minerals and antioxidants including polyphenols and flavonoids, which make blood vessels more elastic.

The findings should serve as more encouragement for people to get their daily recommended fiber, Burley said. She'd like to see fiber back on the agenda - since it sometimes falls to the wayside in low-carbohydrate or gluten-free diets.

"Sometimes things like this just aren't deemed sexy enough," Sherzai said. — Reuters

source: gmanetwork.com