…according to this article at Diabetes Care. The study population was the Nurses Health Study. The longer the sulfonylurea was used, the stronger the association with coronary heart disease. CHD is by far the most common cause of heart attacks. On the bright side, the drugs were not linked to stroke risk. Remember, correlation is not causation, blah, blah, blah…
I rarely start my patients on sulfonylureas these days.
Steve Parker, M.D.
Filed under Drugs for Diabetes, Heart Disease
Intentional weight loss didn’t have any effect either way on risk of death, according to recent research out of Baltimore. Surprising, huh?
Obesity tends to shorten lifespan, mostly due to higher rates of cancer and cardiovascular disease like heart attacks and strokes. Doctors and dietitians all day long recommend loss of excess weight, figuring it will reduce the risk of obesity-related death and disease. Many of them are unaware that’s not necessarily the case. It’s called the “obesity paradox“: some types of overweight and obese patients actually seem to do better (e.g., live longer) if they’re above the so-called healthy body mass index of 18.5 to 24.9. For instance: those with heart failure, coronary artery disease, and advanced kidney disease.
It’s never really been clear whether the average obese person (body mass index over 30) improves his longevity by losing some excess weight. That’s what the study at hand is about.
Methodology
Baltimore-based investigators followed the health status of 585 overweight or obese older adults over the course of 12 years. Half of them were randomized to an intentional weight loss intervention. All of them had a high blood pressure diagnosis. Average age was 66. Average body mass index was 31. Details of the weight-loss intervention are unclear, but it was probably along the lines of “eat less, exercise more.”
What Did They Find?
The weight-loss group lost and maintained an average of 4.4 kg (9.7 lb) over the 12 years of the study. This is about 5% of initial body weight, the minimal amount thought to be helpful for improvement in weight-related medical and metabolic problems. Most of the weight loss was over the first three years.
The men assigned to the weight-loss program had about half the risk of dying over the course of the study, compared to the men not assigned to weight loss. The authors don’t seem to put much stock in it, however, stating that “…no significant difference overall was found in all-cause mortality between older overweight and obese adults who were randomly assigned to an intentional weight-loss intervention and those who were not.”
Comments
With regards to the men losing weight, we’re only talking about 100-150 test subjects, a relatively small number. So I understand why the researchers didn’t make a big deal of the lower mortality: it may not be reproducible.
This same research group did a similar study of 318 arthritis patients and intentional weight loss, finding a 50% lower death rate over eight years.
The authors reviewed many similar studies done by other teams, noting increased death rates from weight loss in some studies, and lesser death rates in others.
When the studies are all over the place like this, it usually means there’s no strong association either way. Nearly all the pertinent studies were done on relatively healthy, middle-aged and older folks. The most reliable thing you can say about the issue is that loss of excess fat weight doesn’t increase your odds of premature death.
Remember that patients with coronary heart disease, congestive heart failure, or advanced kidney disease tend to live longer if they’re overweight or at least mildly obese. It’s the obesity paradox. Will they live longer or die earlier if they go on a weight-loss program? We don’t know.
We do know that intentional weight loss helps:
Maybe that’s enough.
Reference: Shea, M.K., et al. The effect of intentional weight loss on all-cause mortality in older adults: results of a randomized controlled weight-loss trial. American Journal of Clinical Nutrition, 94 (2011): 839-846.
Filed under Weight Loss
Canadian and U.S. researchers report that moderate alcohol consumption seems to reduce 1) the incidence of coronary heart disease, 2) deaths from coronary heart disease, and 3) deaths from all causes. Reduction of death from all causes is a good counter-argument to those who say alcohol is too dangerous because of deaths from drunk driving, alcoholic cirrhosis, and alcohol-related cancers such as many in the esophagus.
Remember, we’re talking here about low to moderate consumption: one drink a day or less for women, two drinks or less a day for men. That’s a max of 12.5 grams of alcohol for women, 25 g for men. No doubt, alcohol can be extremely dangerous, even lethal. I deal with that in my patients almost every day. Some people should never drink alcohol.
The recent meta-analysis in the British Medical Journal, which the authors say is the most comprehensive ever done, reviewed all pertinent studies done between 1950 and 2009, finally including 84 of the best studies on this issue. Thirty-one of these looked at deaths from all causes.
Compared with non-drinkers, drinkers had a 25% lower risk of developing coronary heart disease (CHD) and death from CHD. CHD is the leading cause of death in develop societies.
Stroke is also considered a cardiovascular disease. Overall, alcohol is not linked to stroke incidence or death from stroke. The researchers did see strong trends toward fewer ischemic strokes and more hemorrhagic strokes (bleeding in the brain) in the drinkers. So the net effect was zero.
Compared with non-drinkers, the lowest risk of death from any cause was seen in those consuming 2.5 to 14.9 g per day (one drink or less per day), whose risk was 17% lower. On the other hand, heavy drinkers (>60 g/day) had 30% higher risk of death.
In case you’re wondering, the authors didn’t try to compare the effects of beer versus wine versus distilled spirits.
On a related note, scientists at the Medical University of South Carolina found that middle-aged people who took up the alcohol habit had a lower risk of stroke and heart attack. Wine seemed to be more effective than other alcohol types. They found no differences in overall death rates between new drinkers persistent non-drinkers, perhaps because the study lasted only four years and they were following only 442 new drinkers.
This doesn’t prove that judicious alcohol consumption prevents heart attacks, cardiac deaths, and overall deaths. But it’s kinda lookin’ that way.
References: Ronksley, Paul, et al. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. British Medical Journal, 2011;342:d671 doi: 10.1136/bmj.d671
Filed under Alcohol, coronary heart disease
Remember about a year ago the report that hardening-of-the-arteries was found in Egyptian mummies? The heart arteries were also involved. Princess Ahmose-Meryet-Amon is officially the first person in history diagnosed with coronary heart disease.
This finding is noteworthy in view of the common view that atherosclerosis is a disease of modern civilization (usually referring to the last one or two hundred years).
You’ll find more details at this May 17 post at CardioBrief.
We’ll know more if these researchers ever publish their findings in a peer-reviewed scientific journal.
Filed under Uncategorized
The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.
Reuters and other news services have covered the story.
The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.
How Was the Study Done?
The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.
On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.
Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]
Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.
They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.
Results
The Authors’ Conclusion
Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.
My Comments
I agree with the authors’ conclusion.
We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.
In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.
For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.
Reference: Chrysohoou, C., et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. American Journal of Clinical Nutrition 2010. DOI: 10.3945/ajcn.2009.28982
Comments Off on Heart Patients: Mediterranean Diet to the Rescue!
Filed under Alcohol, coronary heart disease, Health Benefits, Mediterranean Diet
Gary Taubes’s new book, Why We Get Fat: And What To Do About It, comes on the market later this month. I give it five stars per Amazon.com’s ranking system (I love it).
At the start of my medical career over two decades ago, many of my overweight patients were convinced they had a hormone problem causing it. I carefully explained that’s rarely the case. As it turns out, I may have been wrong. And the hormone is insulin.
Mr. Taubes wrote this long-awaited book for two reasons: 1) to make the ideas in his 2007 masterpiece (Good Calories, Bad Calories) more accessible to the public, and 2) to speed up the process of changing conventional wisdom on overweight. GCBC was the equivalent of a college-level course on nutrition, genetics, history, politics, science, physiology, and biochemistry. Many nutrition science geeks loved it while recognizing it was too difficult for the average person to digest.
Paradigm Shift
The author hopes to convince us that “We don’t get fat because we overeat; we overeat because we’re getting fat.” We need to think of obesity as a disorder of excess fat accumulation, then ask why the fat tissue isn’t regulated properly. A limited number of hormones and enzymes regulate fat storage; what’s the problem with them?
Mr. Taubes makes a great effort convince you the old “energy balance equation” doesn’t apply to fat storage. You remember the equation: eat too many calories and you get fat, or fail to burn up enough calories with metabolism and exercise, and you get fat. To lose fat, eat less and exercise more. He prefers to call it the “calories-in/calories-out” theory. He admits it has at least a little validity. Problem is, the theory seems to have an awfully high failure rate when applied to weight management over the long run. We’ve operated under that theory for the last half century, but keep getting fatter and fatter. So the theory must be wrong on the face of it, right? Is there a better one?
So, Why DO We Get Fat?
Here is Taubes’s explanation. The hormone in charge of fat strorage is insulin; it works to make us fatter, building fat tissue. If you’ve got too much fat, you must have too much insulin action. And what drives insulin secretion from your pancreas? Dietary carbohydrates, especially refined carbs such as sugars, flour, cereal grains, starchy vegetables (e.g., corn, beans, rice, potatoes), liquid carbs. These are the “fattening carbs.” Dozens of enzymes and hormones are at play either depositing fat into tissue, or mobilizing the fat to be used as energy. It’s an active process going on continously. Any regulatory derangement that favors fat accumulation will CAUSE gluttony (overeating) or sloth (inactivity). So it’s not your fault.
What To Do About It
Cut back on carb consumption to lower your fat-producing insulin levels, and you turn fat accumulation into fat mobilization.
Before you write off Taubes as a fly-by-night crackpot, be aware that he’s received three Science-in-Society Journalism Awards from the National Association of Science Writers. He’s a respected, professional science writer. Having read two of his books, it’s clear to me he’s very intelligent. If he’s got a hidden agenda, it’s well hidden.
One example illustrates how hormones control growth of tissues, including fat tissue. Consider the transformation of a skinny 11-year-old girl into a voluptuous woman of 18. Various hormones make her grow and accumulate fat in the places we now see curves. The hormones make her eat more, and they control the final product. The girl has no choice. Same with our adult fat tissue, but with different hormones. If some derangement is making us grow fatter, it’s going to make us more sedentary (so more energy can be diverted to fat tissue) or make us overeat, or both. We can’t fight it. At not least very well, as you can readily appreciate if look at the people around you at any American shopping mall.
This’N’That
Taubes’s writing is clear and persuasive. He doesn’t beat you over the head with his conclusions. He lays out a logical series of facts and potential connections and explanations, helping you eventually see things his way. If insulin controls fat storage by building and maintaining fat tissue, and if carboydrates drive insulin secretion, then the way to reduce overweight and obesity is carbohydrate-restricted eating, especially avoiding the fattening carbohydrates. I’m sure that’s true for many folks, perhaps even a majority.
If you’re overweight and skeptical about this approach, you could try out a very-low-carb diet for a couple weeks or a month at little expense and risk (but not zero risk). If Mr. Taubes and I are right, there’s a good chance you’ll lose weight. At the back of the book is a university-affiliated low-carb eating plan.
If cutting carb consumption is so critical for long-term weight control, why is it that so many different diets—with no focus on carb restriction—seem to work, if only for the short run? Taubes suggests it’s because nearly all diets reduce carb consumption to some degree, including the fattening carbs. If you reduce your total daily calories by 500, for example, many of those calories will be from carbs. Simply deciding to “eat healthy” works for some people: stopping soda pop, candy bars, cookies, desserts, beer, etc. That cuts a lot of fattening carbs right there.
Losing excess weight or controlling weight by avoiding carbohydrates was the conventional wisdom prior to 1960, as documented by Mr. Taubes. Low-carb diets for obesity date back almost 200 years. The author attributes many of his ideas to German internist Gustav von Bergmann (1908).
Taubes discusses the Paleolithic diet, mentioning that the average paleo diet derived about a third of total calories from carbohdyrates (compared to the standard American diet’s 55% of calories from carb). My prior literature review found 40-45% of paleo diet calories from carbohydrate. I’m not sure who’s right.
Minor Bone of Contention RE: Coronary Heart Disease
Mr. Taubes provides numerous scientific references to back his assertions. I checked out one in particular because it didn’t sound right. Some background first.
Reducing our total fat and saturated fat consumption over the last 40 years was supposed to lower our LDL cholesterol, thereby reducing the burden of coronary heart disease, which causes heart attacks. Instead, we’ve experienced the obesity epidemic as those fats were replaced by carbohydrates. Taubes mentions a 2009 medical journal article by Kuklina et al, in which Taubes says Kuklina points out the number of heart attacks has not decreased as we’ve made these diet changes. Kuklina et al don’t say that. In fact, age-standardized heart attack rates have decreased in the U.S. during the last decade.
Furthermore, autopsy data document a reduced prevalence of anatomic coronary heart disease in people aged 20-59 from 1979 to 1994, but no change in prevalence for those over 60. The incidence of coronary heart disease decreased in the U.S. from 1971 to 1998 (the latest reliable data). Death rates from heart disease and stroke have been decreasing steadily over the last 40 years in the U.S.; coronary heart disease death rates are down by 50%. I do agree with Taubes that we shouldn’t credit those improvements to reduced total and saturated fat consumption. [Reduced trans fat consumption may play a role, but that’s off-topic.]
I think Mr. Taubes would like to believe that coronary artery disease is either more severe or unchanged in the last few decades because of low-fat, high-carb eating. That would fit nicely with some of his theories, but it’s not the case. Coronary artery disease is better now thanks to a variety of factors, but probably not diet (setting aside the trans-fat issue).
Going Forward
Low-carb dieting was vilified over the last half century partly out of concern that the accompanying high fat consumption would cause premature heart attacks, strokes, and death. We know now that total dietary fat and saturated fat have little to do with coronary heart disease and atherosclerosis (hardening of the arteries), which sets the stage for a resurgence of low-carb eating.
I advocate Mediterranean-style eating as the healthiest, in general. It’s linked with prolonged life and lower risk of heart disease, stroke, dementia, diabetes, and cancer. On the other hand, obesity is a strong risk factor for premature death and development of heart disease, stroke, diabetes, and cancer. If consistent low-carb eating cures the obesity, is it healthier than the Mediterranean diet? Maybe so. Would a combination of low-carb and Mediterranean be better? Maybe so. I’m certain Mr. Taubes would welcome a decades-long interventional study comparing low-carb with the Mediterranean diet. But that’s probably not going to happen in our lifetimes.
Gary Taubes rejects the calories-in/calories-out theory of overweight that hasn’t done a very good job for us over the last 40 years. Taubes’s alternative ideas deserve serious consideration.
Update December 18, 2010: I found Mr. Taubes’s reference for stating that Paleolithic diets provide about a third of calories from carbohydrate (22-40%), based on modern hunter-gatherer societies). See References below.
References:
Coronary heart disease autopsy data: American Journal of Medicine, 110 (2001): 267-273.
Reduced heart attacks: Circulation, 12 (2010): 1,322-1,328.
Reduced incidence of coronary heart disease: www.UpToDate.com, topic: “Epidemiology of Coronary Heart Disease,” accessed December 11, 2010.
Death rates for coronary heart disease: Journal of the American Medical Association, 294 (2005): 1,255-1,259.
Cordain, L., et al. Plant-animal subsistance ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 71 (2000): 682-692.
Disclosure: I don’t know Gary Taubes. I requested from the publisher and received a free advance review copy of the book. Otherwise I received nothing of value for this review.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary or exercise changes.
Update April 22, 2013:
As mentioned above, WWGF was based on Taubes’ 2007 book, Good Calories, Bad Calories. You may be interested in a highly critical review of GCBC by Seth at The Science of Nutrition.
Filed under Book Reviews, coronary heart disease, Fat in Diet, Mediterranean Diet
The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.
Reuters and other news services have covered the story.
The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.
How Was the Study Done?
The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.
On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.
Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]
Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.
They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.
Results
The Authors’ Conclusion
Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.
My Comments
I agree with the authors’ conclusion.
We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.
In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.
For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.
Reference: Chrysohoou, C., et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. American Journal of Clinical Nutrition, May 10, 2010. doi:10.3945/ajcn.2009.28982
Filed under coronary heart disease, Health Benefits, Mediterranean Diet
Women double their risk of developing coronary heart disease if they have high consumption of carbohydrates, according to research recently published in the Archives of Internal Medicine.
Men’s hearts, however, didn’t seem to be affected by carb consumption. I mention this crucial difference because I see a growing trend to believe that “replacing saturated fat with carbohydrates is a major cause of heart disease.” If true, it seems to apply only to women.
We’ve known for a while that high-glycemic-index eating was linked to heart disease in women but not men. Glycemic index is a measure of how much effect a carbohydrate-containing food has on blood glucose levels. High-glycemic-index foods raise blood sugar higher and for longer duration in the bloodstream.
High-glycemic-index foods include potatoes, white bread, and pasta, for example.
The study at hand includes over 47,000 Italians who were interrogated via questionnaire as to their food intake, then onset of coronary heart disease—the cause of heart attacks—was measured over the next eight years.
Among the 32,500 women, 158 new cases of coronary heart disease were found.
Researchers doing this sort of study typically compare the people eating the least carbs with those eating the most. The highest quartile of carb consumers and glycemic load had twice the rate of heart disease compared to the lowest quartile.
The Cleave-Yudkin theory of the mid-20th century proposed that excessive amounts of refined carbohydrates cause heart disease and certain other chronic systemic diseases. Gary Taubes has also written extensively about this. Theresearch results at hand support that theory in women, but not in men.
Practical Applications
Do these research results apply to non-Italian women and men? Probably to some, but not all. More research is needed.
Women with a family history coronary heart disease—or other CHD risk factors—might be well-advised to put a limit on total carbs, high-glycemic-index foods, and glycemic load. I’d stay out of that “highest quartile.” Don’t forget: heart disease is the No. 1 killer of women.
See NutritionData’s Glycemic Index page for information you can apply today.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary or exercise changes.
References: Sieri, S., Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., Pellegrini, N., Palli, D., Masala, G., Sacerdote, C., Veglia, F., Tumino, R., Frasca, G., Grioni, S., Pala, V., Mattiello, A., Chiodini, P., & Panico, S. (2010). Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study Archives of Internal Medicine, 170 (7), 640-647 DOI: 10.1001/archinternmed.2010.15
Barclay, Alan, et al. Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies [of mostly women]. American Journal of Clinical Nutrition, 87 (2008): 627-637.
Filed under Carbohydrate, coronary heart disease, Glycemic Index and Load
Diabetes mellitus for years has been linked with cardiovascular disease such as heart failure and coronary heart disease (blocked arteries in the heart, and the leading cause of death in the Western world). How scared should diabetics be?
An article in the Archives of Internal Medicine gives us one answer.
Researchers from the Netherlands and Harvard examined medical records of 5,209 people (mostly white, 64% men) enrolled in the Framingham (Massachusetts, USA) Heart Study. This cohort has been examined every other year for more than 46 years.
Study subjects who had diabetes at age 50 were identified; health outcomes going forward were then analyzed, with particular attention to lifespan and cardiovascular disease. “Cardiovascular disease” in this context means coronary heart disease, stroke, congestive heart failure, intermittent claudication (leg pain during exertion caused by blocked arteries), and transient ischemic attack (stroke-like symptoms that resolve within 24 hours).
Results
Compared to those in the cohort free of diabetes, having diabetes at age 50 more than doubled the risk of developing cardiovascular disease for both women and men.
Compared to those without diabetes, having both cardiovascular disease and diabetes approximately doubled the risk of dying, regardless of sex.
Compared to those without diabetes, women and men with diabetes at age 50 died 7 or 8 years earlier, on average.
[Specific causes of death were not reported.]
Take-Home Points
We’d likely see longer lifespans and less cardiovascular disease if we could prevent diabetes in the first place. How do we do that? Strategies include regular physical activity, avoidance or reversal of overweight and obesity, and low-glycemic-index diets.
The Mediterranean diet it linked to reduced heart attacks and strokes, and longer lifespan. That’s why I’ve been working for the last year and a half to adapt it for diabetics.
We have better treatments for cardiovascular disease and diabetes and these days, so the death rates and illness numbers shouldn’t be quite so alarming. Up-to-date management of diabetes and cardiovascular disease will prevent some acute disease events—such as heart attacks and strokes—and prolong life.
References:
Franco, O., Steyerberg, E., Hu, F., Mackenbach, J., & Nusselder, W. (2007). Associations of Diabetes Mellitus With Total Life Expectancy and Life Expectancy With and Without Cardiovascular Disease Archives of Internal Medicine, 167 (11), 1145-1151 DOI: 10.1001/archinte.167.11.1145
Knowler, W.C., et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346 (2002): 393-403.
Tuomilehto, J., et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344 (2001): 1,343-1,350.
Filed under coronary heart disease, Diabetes Complications, Stroke
To reduce coronary heart disease, we need to focus on reducing consumption of refined carbohydrates rather than fat and cholesterol, according to Dr. Frank Hu.
Dr. Hu is not a wild-eyed, bomb-throwing radical. He’s a Harvard professor of nutrition and epidemiology with both M.D. and Ph.D. degrees. High-glycemic-index carbs in particular are the bad boys, he writes in an editorial published in the American Journal of Clinical Nutrition earlier this year.
Additional details are at my April 26, 2010, post at the Self/NutritionData Heart Health Blog.
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Bible Verse of the Day
Diabetic Mediterranean Diet 