Michael.Massing + mortality   182

Glycemic control and vascular complications in type 2 diabetes mellitus - UpToDate
[tl;dr: Glycemic control improves microvascular outcomes in type 2 diabetes, including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation; and showed a beneficial effect of intensive therapy on the development of more advanced clinical outcomes in renal disease and its precursors in the one study with long-enough follow up to assess effect. Cardiovascular risk benefit "has not been established as clearly" for type 2 as for type 1.]

Although the role of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study (UKPDS), its role in reducing cardiovascular risk has not been established as clearly for type 2 diabetes....

improving glycemic control improves microvascular outcomes, as illustrated by the findings of a meta-analysis of randomized trials (34,912 participants) [5]. There was a reduction in the risk of microvascular complications (a composite outcome including progression of nephropathy, manifestation and progression of retinopathy, and retinal photocoagulation) in the intensive compared with standard glycemic control group (relative risk [RR] 0.88, 95% CI 0.82-0.95). There were significant reductions in risk for each of the individual components.

In other meta-analyses of trials (over 28,000 adults) evaluating the benefits of intensive versus conventional glycemic control specifically on renal outcomes, there was a statistically significant reduction in the risk of microalbuminuria and macroalbuminuria in patients randomly assigned to intensive glycemic control (risk ratios of 0.86 and 0.74, respectively) [6,7]. The reduction in risk of end-stage renal disease did not reach statistical significance (RR 0.69, 95% CI 0.46-1.05). There was no reduction in the risk of doubling of the serum creatinine level or death from renal disease (RRs 1.06 and 0.99, respectively) [6]. Of note, the majority of the trials in the meta-analyses were not of long enough duration to show a beneficial effect of glycemic control on end-stage renal disease, which typically manifests after 10 to 20 years of diabetes duration [8]. In the trials included in the meta-analyses, the absolute rates of severe renal outcomes were low in both the intensive- and conventional-therapy groups, reducing the ability of the analysis to demonstrate a benefit, if one exists. In the one trial with longer-term follow-up (United Kingdom Prospective Diabetes Study [UKPDS] cohort followed for 22 years), there was a beneficial effect of intensive therapy on the development of more advanced clinical outcomes, including renal disease
type  2  T2D  diabetes  risk  tight  management  glucose  control  blood  benefit  morbidity  mortality  microvascular  complications  kidneys  eyes  retinopathy  nephropathy  renal  disease  cardiovascular  peer-reviewed  research  review  meta-analysis  overview  in  vivo  situ  human  clinical  trial  symptoms  comorbidities  self  treatment  care 
4 weeks ago by Michael.Massing
Long-Chain Omega-3 Fatty Acid Supplements in Depressed Heart Failure Patients: Results of the OCEAN Trial - ScienceDirect
Patients with CHF and depression had low blood omega-3 concentrations that were associated with an elevated risk of mortality.

Methods

This study was a randomized, double-blind, placebo-controlled pilot clinical trial using a 400/200 eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) fish oil at 2 g and an almost pure EPA at 2 g, compared with a matched placebo, daily for 12 weeks for patients with CHF and major depressive disorder. Statistical analyses included the intention-to-treat population and “completers” (defined as participants consuming ≥70% of the capsules and completing the final endpoint evaluation between 10 and 14 weeks).

Results

A total of 108 patients with CHF and major depressive disorder and a score ≥18 on the Hamilton Depression Scale who were randomized at 1:1:1 to the 3 interventions at 3 enrolling centers from June 12, 2014, to May 19, 2016; 80 (74.1%) qualified as completers. Intention-to-treat analyses revealed that the levels of all omega-3 variables were significantly elevated in the omega-3 groups, whereas the placebo group showed little change; there were no between-group differences with overall depression measurements. Per-protocol exploratory analyses showed that scores on the social functioning measurement of the 36-item Short Form Health Survey improved notably in the 400/200 EPA/DHA (p = 0.040) and EPA (p = 0.10) groups compared with the placebo group. Spearman correlation analysis indicated that increased omega-3 indices were associated with improved cognitive depressive symptoms.

Conclusions

Omega-3 supplementation resulted in significant increases in omega-3 levels in red blood cell counts, corresponding to a particular compound of omega-3. Changes in cognitive depressive symptoms and social function were in favor of the omega-3 supplementation. Further studies with larger sample sizes are necessary to confirm the benefits of omega-3 supplementation on modifying psychosocial factors for patients with CHF. (Omega-3 Supplementation for Co-Morbid Depression and Heart Failure Treatment [OCEAN]; NCT02057406)
depression  CHF  major  depressive  disorder  peer-reviewed  research  human  clinical  trial  in  vivo  situ  cognition  functional  improvement  treatment  cognitive  comorbidity  mortality  risk  benefit  supplements  omega-3  DHA  EPA  RCT 
6 weeks ago by Michael.Massing
Air Pollution Linked to Infant Deaths | Global Health | JAMA | JAMA Network
Poor air quality is responsible for 1 in 5 infant deaths in sub-Saharan Africa, according to a study published in Nature.

To quantify the effect of breathable air pollutants on premature deaths among infants in Africa, the investigators examined recent satellite-based estimates of air pollutant particles (ambient respirable particulate matter with an aerodynamic diameter less than 2.5 μm [PM2.5]). They combined the air quality data with results from 65 household surveys across 30 sub-Saharan African countries on the timing and location of almost 1 million infant births—and any subsequent deaths in the first year of life—between 2001 and 2015. They then matched the location and timing of each birth to satellite-based estimates of PM2.5 exposure from 9 months before birth to 12 months after.

The investigators found a strong linear association of infant mortality with increases in PM2.5 exposure. Specifically, with every 10 μg per cubic meter increase in the concentration of breathable particulate matter in the first 12 months of life, there was about a 9% increase in infant mortality. This association was consistent over the study’s 15 years and was independent of household wealth.

Concentrations of PM2.5 higher than minimum exposure levels were responsible for 22% of infant deaths in 30 countries and led to 449 000 additional infant deaths in 2015. This estimate is more than 3 times higher than earlier data, suggesting poor air quality is an even bigger problem than previously appreciated.
air  pollution  environmental  factors  environment  infant  mortality  Africa  particulate  matter  risk  peer-reviewed  research  correlation  human  in  vivo  population  situ 
7 weeks ago by Michael.Massing
Can a Sauna Session Count as a Workout?
Those who sweated it out two to three times per week were 23 percent less likely to suffer from coronary heart disease or cardiovascular disease. People who sauna-bathed four to seven times per week were 48 percent less likely to die of those heart diseases — and 40 percent less likely to die of any other causes than people who only sauna-bathed once per week. 

The longer people spent in the heat during each sauna session — which ran from two- to 90-minutes(!) long — the greater their risk of survival. Guys who spent more than 19 minutes in the sauna were 52 percent less likely to suffer sudden cardiac death that men who sauna-bathed for less than 11 minutes at a time.
sauna  bathing  risk  benefit  cardiac  cardiovascular  morbidity  mortality  correlation  human  cohort  prospective  in  vivo  situ  peer-reviewed  research  all-cause 
july 2018 by Michael.Massing
Postprandial glucose regulation: new data and new implications. - PubMed - NCBI
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management.
OBJECTIVES:
The objectives of this article are to review current data on postprandial hyperglycemia and to assess whether, and how, management of type 2 diabetes should change to reflect new clinical findings.
METHODS:
Articles were selected from MEDLINE searches (key words: postprandial glucose, postprandial hyperglycemia, and cardiovascular disease) and from our personal reference files, with emphasis on the contribution of postprandial hyperglycemia to overall glycemic load or cardiovascular (CV) risk.
RESULTS:
About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes > or =70% to the total glycemic load in patients who are fairly well controlled (HbA1c <7.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of approximately 90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbA1c below currently recommended levels than basal insulin glargine (66% vs 40%; P < 0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P < 0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18% for glyburide (P < 0.01) over 1 year, although levels of HbA1c and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over > or =1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006).
CONCLUSIONS:
All components of the glucose triad (ie, FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  morbidity  mortality  threshold  peer-reviewed  research 
september 2017 by Michael.Massing
Do multivitamin supplements increase mortality risk? | Public Health
An unescapable facet of public health is that we lumber forward with our scientific methods in an inescapable fight against powerful industries that produce the conditions in which ill-health forms and is reproduced.
vitamin  supplements  benefit  mortality  risk  peer-reviewed  research 
july 2017 by Michael.Massing
Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. - PubMed - NCBI
DATA SYNTHESIS:
9 of 11 trials testing high-dosage vitamin E (> or =400 IU/d) showed increased risk (risk difference > 0) for all-cause mortality in comparisons of vitamin E versus control. The pooled all-cause mortality risk difference in high-dosage vitamin E trials was 39 per 10,000 persons (95% CI, 3 to 74 per 10,000 persons; P = 0.035). For low-dosage vitamin E trials, the risk difference was -16 per 10,000 persons (CI, -41 to 10 per 10,000 persons; P > 0.2). A dose-response analysis showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with increased risk of dosages greater than 150 IU/d.
LIMITATIONS:
High-dosage (> or =400 IU/d) trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult.
CONCLUSION:
High-dosage (> or =400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided.
vitamin  E  mortality  risk  dosage  dose-dependent  peer-reviewed  research 
july 2017 by Michael.Massing
FDA lets Lilly cite Jardiance heart data, shares jump | Reuters
At the time of approval [of Lilly's SGLT2 inhibitor Jardiance] the FDA asked that a separate trial be conducted to show the drug did not increase the risk of cardiovascular problems.

The study instead unexpectedly showed Jardiance slashed deaths by 32 percent in patients with type 2 diabetes at risk of heart attack and stroke, when added to standard diabetes medications.

It was the first time any diabetes drug was shown to reduce risk of cardiovascular death. Moreover, patients taking Jardiance had a 35 percent lower rate of hospitalization for heart failure. That information can now be included on the drug's label.

[Other SGLT2 inhibitors] include Johnson & Johnson's $1.3 billion-a-year Invokana and AstraZeneca Plc's Farxiga.

[Per @MarkHamel, Victoza has similar data.]
drug  effects  benefit  treatment  diabetes  type  2  T2D  cardiovascular  heart  risk  morbidity  mortality  dcde 
december 2016 by Michael.Massing
Learning How to Die in the Anthropocene - The New York Times
I found my way forward through an 18th-century Samurai manual, Yamamoto Tsunetomo’s “Hagakure,” which commanded: “Meditation on inevitable death should be performed daily.” Instead of fearing my end, I owned it. Every morning, after doing maintenance on my Humvee, I’d imagine getting blown up by an I.E.D., shot by a sniper, burned to death, run over by a tank, torn apart by dogs, captured and beheaded, and succumbing to dysentery. Then, before we rolled out through the gate, I’d tell myself that I didn’t need to worry, because I was already dead. The only thing that mattered was that I did my best to make sure everyone else came back alive. “If by setting one’s heart right every morning and evening, one is able to live as though his body were already dead,” wrote Tsunetomo, “he gains freedom in the Way.”
apocalypse  civilization  mortality  death  philosophy  climate  change  global  warming  humanity  meditation  self-awareness  earnest  David.E 
september 2016 by Michael.Massing
Numbers Matter: 1-Hour Post Prandial Glucose Possible Predictor of Prediabetes Risk
A 1-h glucose value > 155 mg/dl predicts mortality even when the 2-h level is < 140 mg/dl.
An elevated 2-hour glucose level indicated increased mortality risk, independent of the 1-hour level.
Patients with a 2-hour glucose level less than 140 mg/dL but an elevated 1-hour glucose had a 28% increased mortality risk
 

One-hour post-load plasma glucose level during the OGTT predicts mortality: observations from the Israel Study of Glucose Intolerance, Obesity and Hypertension. Diabet Med. 2016 Mar 21. doi: 10.1111/dme.13116. [Epub ahead of print]
diabetes  diagnostic  standards  impaired  fasting  glucose  tolerance  blood  mortality  risk  IGT  threshold  diagnosis  screening  peer-reviewed  research  human  in  vivo 
june 2016 by Michael.Massing
Muhammad Ali’s peaceful death, surrounded by family and not doctors, shows his bravery in his final fight.
Most patients over 75 years old with one of many serious underlying medical problems have less than a 10 percent chance of surviving CPR. For octogenarians living in nursing homes or other skilled care facilities with even moderate cognitive disabilities, those suffering from a stroke, metastatic cancer, major trauma, or septic shock (which Ali developed), the survival rate is less than 2 percent. By 85 years of age, such patients have less than a 1 percent chance of survival. The few that do survive often die on respirators after prolonged stays in intensive care units. Yet sadly, patients such as these frequently receive CPR, which, if the patient has any brain function, is about as painful a procedure as one can possibly imagine. It often saddens me that the last substance to enter a patient’s bloodstream is a heart stimulant rather than medication to ease pain and suffering.
death  CPR  risk  benefit  aging  heroic  measures  intervention  mortality  dying  Muhammad  Ali  earnest  healthcare  hospitalization  institutionalization  palliative  care 
june 2016 by Michael.Massing
D-is-for-Diabetes: Medicare's Competitive Bidding Program Puts Beneficiaries' Lives at Risk
The Forum built upon the GAO's analysis by examining access to diabetes testing supplies for Medicare beneficiaries living with diabetes and requiring insulin therapy.  Working with some of the nation's leading endocrinologists,* the Forum's study found that the Competitive Bidding Program disrupted beneficiaries' ability to access diabetes testing supplies, and this disruption was associated with an increase in mortality, higher hospitalization rates and inpatient costs.

"Self-monitoring blood glucose supplies are a critical component of diabetes care among insulin-treated individuals and the value of safe, effective testing supplies cannot be underestimated," said Jaime Davidson, M.D., clinical professor of Medicine at the University of Texas Southwestern Medical Center, and an author of the study. "We are particularly concerned about the disruption we detected in our analysis given the predominant use of rapid- and short-acting insulin by Medicare beneficiaries, who are at significantly greater risk for hypoglycemia than younger individuals with insulin-treated diabetes."

"We are troubled that CMS failed to detect these 'unintended' consequences and, instead, reported that the program was a success," said Gary A. Puckrein, Ph.D., president and CEO of the National Minority Quality Forum and a study author. "Based on our findings and employing the safety monitoring protocols commonly used to protect human subjects, we believe policymakers should immediately suspend the program until CMS can demonstrate its ability to effectively monitor the effects of the program, correct the structural flaws causing this problem and ensure that the lives of America's greatest generation are no longer at risk." 

The ahead of print article "Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis" can be found online: Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis . The full article will also be published here: http://dx.doi.org/10.2337/dc15-1264.
watchdog  diabetes  insulin-dependent  SMBG  supplies  cost  benefit  mortality  hospitalization  competitive  bidding  Medicare  in  vivo  situ  human  peer-reviewed  research  health  disparities  healthcare 
may 2016 by Michael.Massing
Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis | Diabetes Care
RESEARCH DESIGN AND METHODS The study population consisted of insulin users: 43,939 beneficiaries in the nine test markets (TEST) and 485,688 beneficiaries in the nontest markets (NONTEST). TEST and NONTEST were subdivided: those with full self-monitoring of blood glucose (SMBG) supply acquisition (full SMBG) according to prescription and those with partial/no acquisition (partial/no SMBG). Propensity score–matched analysis was performed to reduce selection bias. Outcomes were impact of partial/no SMBG acquisition on mortality, inpatient admissions, and inpatient costs.

RESULTS Survival was negatively associated with partial/no SMBG acquisition in both cohorts (P < 0.0001). Coterminous with CBP (2010–2011), there was a 23.0% (P < 0.0001) increase in partial/no SMBG acquisition in TEST vs. 1.7% (P = 0.0002) in NONTEST. Propensity score–matched analysis showed beneficiary migration from full to partial/no SMBG acquisition in 2011 (1,163 TEST vs. 605 NONTEST) was associated with more deaths within the TEST cohort (102 vs. 60), with higher inpatient hospital admissions and associated costs.

CONCLUSIONS SMBG supply acquisition was disrupted in the TEST population, leading to increased migration to partial/no SMBG acquisition with associated increases in mortality, inpatient admissions, and costs. Based on our findings, more effective monitoring protocols are needed to protect beneficiary safety.

Received June 12, 2015.
Accepted January 9, 2016.
© 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Impact of CMS Competitive Bidding Program on Medicare Beneficiary Safety and Access to Diabetes Testing Supplies: A Retrospective, Longitudinal Analysis
Gary A. Puckrein, Gail Nunlee-Bland, Farhad Zangeneh, Jaime A. Davidson, Robert A. Vigersky, Liou Xu, Christopher G. Parkin, David G. Marrero
Diabetes Care 2016 Mar; http://dx.doi.org/10.2337/dc15-1264
diabetes  insulin-dependent  SMBG  supplies  cost  benefit  mortality  hospitalization  competitive  bidding  Medicare  in  vivo  situ  human  peer-reviewed  research 
may 2016 by Michael.Massing
Type 2 Diabetes Genetic Predispositions
The study included 6,501 participants (81.1% non-Hispanic white, 12.7% non-Hispanic black, and 6.2% Mexican-American). 38 type 2 diabetes-related single nucleotide polymorphisms (SNPs) were genotyped. Association between aggregate genetic risk for type 2 diabetes and all-cause mortality was investigated.

After adjusting for age, sex, BMI, smoking, alcohol, and hypertension, increased mortality risk was observed for every type 2 diabetes allele an individual had, independent of BMI (OR 1.04, 95% CI 1.00 – 1.07, P = 0.05). These findings were consistent with non-Hispanic whites and non-Hispanic blacks, but not with Mexican Americans. Mexican Americans showed a negative trend even after adjustments. The analysis was repeated with Cox regression that showed generally similar results. Association of increased risk of mortality was evaluated by ethnicity, which yielded similar results for non-Hispanic whites, and non-Hispanic blacks, but not for Mexican Americans (OR 0.95, 95% CI 0.89 – 1.01, P = 0.01).

When BMI was accounted for, the mortality risk per allele was higher among obese non-Hispanic whites as compared to normal-weight non-Hispanic whites. There was a negative trend observed in normal-weight Mexican Americans (BMI <25 kg/m2, OR 0.91, 95% CI 0.82 – 1.00)....

Individuals with diabetes carrying type 2 diabetes alleles have an increased risk of mortality.
High BMI (> 25 kg/mm3) is associated with increased risk of mortality in individuals with high genetic predisposition to type 2 diabetes.
Individuals with diabetes should maintain a normal-body weight to reduce the risk of mortality, especially the ones genetically predisposed to type 2 diabetes.
Researched and prepared by Sabair Pradhan, Doctor of Pharmacy Candidate USF College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE
mortality  risk  factor  race  ethnicity  peer-reviewed  research  genetic  etiology  genetics 
april 2016 by Michael.Massing
Socioeconomic Status and Risk of Diabetes-Related Mortality in the U.S.
Results

Having less than a high school education was associated with a twofold higher mortality from diabetes, after controlling for age, gender, race/ethnicity, marital status, and body mass index, compared with adults with a college degree or higher education level (relative hazard [RH] = 2.05, 95% confidence interval [CI] 1.78, 2.35). Having a family income below poverty level was associated with a twofold higher mortality after adjustments compared with adults with the highest family incomes (RH=2.41, 95% CI 2.05, 2.84).....

Conclusion

Findings from this nationally representative cohort demonstrate a socioeconomic gradient in diabetes-related mortality, with both education and income being important determinants of the risk of death.
diabetes  mortality  socioeconomic  status  SES  correlation  peer-reviewed  research  poverty  education  risk 
march 2016 by Michael.Massing
The Coffee Debate New Research Shows Benefits of Drinking Coffee
RT : Research shows people who drink coffee may have lower death rates; maybe it can help combat liver disease, too.
coffee  risk  benefit  liver  mortality  fatty  peer-reviewed  research  from twitter
january 2016 by Michael.Massing
Good Control Now = Lifetime Benefit - Diabetes Self-Management
Two famous studies showed that tight control of glucose did not cause a statistically significant reduction in heart attacks or early death. But roughly 20 years after the studies ended, tight control subjects are living longer and healthier than those who were in the comparison groups. What is going on?

This long-delayed benefit is called the “legacy effect.” It was found in follow-up of patients in the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS)....

Same in Type 2
The UKPDS tried to do for Type 2 diabetes what DCCT had done for Type 1: show the effects of tight glucose control. UKPDS included about 5,000 recently diagnosed people with Type 2. Half were assigned to a tight control group, defined as a fasting blood sugar (FBS) below 108 mg/dl (6.0 mmol/ml). In practice, the tight control group had a median (midpoint) A1C of about 7.0.

Just as in DCCT, people receiving “intense control” had fewer eye, kidney, and nerve problems. But heart problems and strokes were no different for the two groups at the end of the study. After ten years, “no attempts were made to maintain previously assigned therapies,” and glucose levels in the two groups became similar. However, 15 years later, the tight control group has had far fewer cardiac events and a lower death rate.
tight  control  SMBG  legacy  effect  insulin  treatment  self  mortality  benefit  diabetes  glucose  self-monitored  blood  monitoring  management 
september 2015 by Michael.Massing
Unhealthiness of Sitting Not Offset by Exercise: Meta-Analysis | Medpage Today
Because of this variation, Lynch and Owen wrote, it's not clear how much sedentary behavior puts a person at risk for chronic disease...

Franklin said he thinks that the dangers of sitting should still be part of public health messaging[:] "When we talk about healthier diets, when we talk about no smoking, when we talk about a regular exercise program, we should also be including avoiding prolonged sedentary behaviors, sitting in front of a computer for hour after hour after hour."
research  morbidity  factor  risk  activity  peer-reviewed  sitting  health  mortality  sedentary  exercise  correlation 
february 2015 by Michael.Massing
Red Meat Risk :: Diabetes Self-Management
[Red meat] (along with its even more infamous cousin, processed meat) increases the risk of death from ailments such as cancer and heart disease. Two years ago, a large meta-analysis...found that eating red meat, and processed meat in particular, was associated with a higher risk of developing Type 2 diabetes...even after controlling for the generally less healthy lifestyle of frequent red meat eaters; age, weight, physical activity, smoking status, and family history of diabetes were all taken into account....

A new study [looks] at the effects of changes in red-meat-eating habits, rather than simply comparing people who ate more red meat with others who ate less. Published online by JAMA Internal Medicine, the study followed over 149,000 adults, most of them women, for up to 20 years, with questionnaires on participants’ diets conducted every four years. [R]esearchers found that participants who increased their intake of red meat by at least half a serving each day, over a four-year period, were 48% more likely to develop Type 2 diabetes within the next four years. This was true after controlling for family history and many lifestyle factors, including how much red meat someone was consuming before the increase. Conversely, reducing red meat intake by at least half a serving daily was associated with a 14% reduction in the risk of developing Type 2 diabetes....

The type of iron found in red meat is a known contributor to insulin resistance, and the saturated fat that is common in red meat may also raise a person’s diabetes risk. This may also be true of the nitrates and high levels of sodium often seen in processed meat. In an editorial accompanying the study in JAMA Internal Medicine, a doctor who was not involved in the study writes that saturated fat is the most likely culprit for the diabetes risk associated with red meat. To test this idea, he suggests conducting a similar study to examine the connection between dairy intake and Type 2 diabetes.
meat  risk  mortality  morbidity  diabetes  type  2  T2D  correlation  peer-reviewed  research  meta-analysis  insulin  resistance  dietary  iron  saturated  fats  animal  dairy  etiology  factor  public  health 
december 2014 by Michael.Massing
How Long Have I Got Left? - NYTimes.com
Faced with mortality, scientific knowledge can provide only an ounce of certainty: Yes, you will die. But one wants a full pound of certainty, and that is not on offer.

What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.

I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I’ve not even read that well, learned long ago as an undergraduate, began to repeat in my head, and the seemingly impassable sea of uncertainty parted: “I can’t go on. I’ll go on.” I took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” And then, at some point, I was through.
cancer  survival  prognosis  Kaplan-Meier  curve  odds  statistics  medicine  mortality  dying  earnest  hatmandu 
june 2014 by Michael.Massing
Take a whole-diet approach to preventing heart disease - Mayo Clinic
Later studies began to look at increasing consumption of specific foods or food groups, rather than restricting fat and cholesterol. Foods found to be heart healthy include:

Nuts
Vegetables
Fruits
Whole grains
Legumes
Fish
Olive oil
Alcohol (in moderation)
Subsequent studies compared combinations of these foods to fat- and cholesterol-restricted diets. They found that dietary patterns that included the above foods (such as Mediterranean-style diets) were more effective in preventing heart attacks and resulting deaths than the fat- and cholesterol-restricted diets were. Although whole-diet approaches reduced the number of heart attacks, they didn't reduce total and LDL ("bad") cholesterol levels.
mortality  risk  diet  research  overview  peer-reviewed  Mediterranean  heart-healthy  benefit  comparison  legumes 
april 2014 by Michael.Massing
Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Health Survey for England data -- Oyebode et al. -- Journal of Epidemiology & Community Health
Results Fruit and vegetable consumption was associated with decreased all-cause mortality (adjusted HR for 7+ portions 0.67 (95% CI 0.58 to 0.78), reference category <1 portion). This association was more pronounced when excluding deaths within a year of baseline (0.58 (0.46 to 0.71)). Fruit and vegetable consumption was associated with reduced cancer (0.75 (0.59–0.96)) and cardiovascular mortality (0.69 (0.53 to 0.88)). Vegetables may have a stronger association with mortality than fruit (HR for 2 to 3 portions 0.81 (0.73 to 0.89) and 0.90 (0.82 to 0.98), respectively). Consumption of vegetables (0.85 (0.81 to 0.89) per portion) or salad (0.87 (0.82 to 0.92) per portion) were most protective, while frozen/canned fruit consumption was apparently associated with increased mortality (1.17 (1.07 to 1.28) per portion). [!]

Conclusions A robust inverse association exists between fruit and vegetable consumption and mortality, with benefits seen in up to 7+ portions daily. Further investigations into the effects of different types of fruit and vegetables are warranted.
diet  mortality  inverse  correlation  fruit  canned  fresh  frozen  vegetables  daily  intake  peer-reviewed  research  open  access 
april 2014 by Michael.Massing
Lessons In the Art of Dying | Health | Washingtonian
“You might lay out how debilitating and expensive an intervention is likely to be when it will have only marginal benefit,” I say. “When you’ve established a therapeutic relationship, it is surprisingly easy to have that discussion. When you can honestly explain that only 8 percent of patients who have CPR survive more than a month, then patients can tell you they’ve had enough. What typically happens, though, is that patients aren’t asked if they want more treatment. It’s forced on them by medical staff or family members who mistakenly urge them to ‘fight.’ ”
healthcare  dying  mortality  treatment  doctor  patient  medicine  empathy  training  education  medical 
march 2014 by Michael.Massing
Obesity Paradoxes | T & F Online
In this review, we examine the original obesity paradox phenomenon (i.e. in cardiovascular disease populations, obese patients survive better), as well as three other related paradoxes (pre-obesity, “fat but fit” theory, and “healthy” obesity). An obesity paradox has been reported in a range of cardiovascular and non-cardiovascular conditions. Pre-obesity (defined as a body mass index of 25.0–29.9 kg · m−2) presents another paradox. Whereas “overweight” implies increased risk, it is in fact associated with decreased mortality risk compared with normal weight. Another paradox concerns the observation than when fitness is taken into account, the mortality risk associated with obesity is offset. The final paradox under consideration is the presence of a sizeable subset of obese individuals who are otherwise healthy. Consequently, a large segment of the overweight and obese population is not at increased risk for premature death. It appears therefore that low cardiorespiratory fitness and inactivity are a greater health threat than obesity, suggesting that more emphasis should be placed on increasing leisure time physical activity and cardiorespiratory fitness as the main strategy for reducing mortality risk in the broad population of overweight and obese adults.
obesity  paradox  research  review  fatness  fitness  mortality  morbidity  risk  benefit  activity  inactivity  exercise  cardiorespiratory  peer-reviewed 
february 2014 by Michael.Massing
Mortality in British vegetarians: review and preliminary results from EPIC-Oxford
The mortality of both the vegetarians and the nonvegetarians in these studies is low compared with national rates. Within the studies, mortality for major causes of death was not significantly different between vegetarians and nonvegetarians, but the nonsignificant reduction in mortality from ischemic heart disease among vegetarians was compatible with the significant reduction previously reported in a pooled analysis of mortality in Western vegetarians.
meat  diet  vegetarian  health  relative  risk  death  mortality  correlation  earnest  peer-reviewed  research  human  EPIC-Oxford  cohort 
february 2014 by Michael.Massing
Type 2 Diabetes and Mortality Risk
There was an increased Relative Risk (RR) associated with type 2 diabetes for both Cardiovascular Disease (CVD) mortality and stroke mortality; 1.76 (95% CI 1.66-1.88) and 2.26 (95% CI 1.7-3.02), respectively. These rates were concurrent with those found in previous literature. Other factors associated with increased mortality were found to include smoking, retinopathy, Peripheral Vascular Disease (PVD), hypertension, low or high alcohol intake, poor lipid profile, age and sex, and combination of drugs such as sulfonylureas and metformin in patients on insulin. Interestingly, nephropathy was associated with an increased mortality risk as well, whereas HbA1c and diabetes duration showed inconsistent associations with mortality.

The authors concluded that type 2 diabetes increases mortality risk by about two-fold.

This study highlights the importance of prevention and management of type 2 diabetes in order to prevent micro and macrovascular complications contributing to increased mortality.

Practice Pearls:

Type 2 diabetes is associated with an increased risk of mortality regardless of age of diagnosis.
Type 2 diabetes is associated with increased risk mortality due to CVD causes regardless of gender.
Public health interventions aimed at type 2 diabetes management should focus on prevention.
Diabetes/Metabolism Research & Reviews 2014. [Nwaneri, C et al. Mortality in type 2 diabetes mellitus: magnitude of the evidence from a systematic review and meta-analysis. The British Journal of Diabetes & Vascular Disease. 2013;0(0):1-16.]
diabetes  type  2  T2D  mortality  prognostic  correlation  risk  peer-reviewed  research  comorbidities  diagnosis  retinopathy 
january 2014 by Michael.Massing
Exercise as Potent Medicine - NYTimes.com
The results consistently showed that drugs and exercise produced almost exactly the same results. People with heart disease, for instance, who exercised but did not use commonly prescribed medications, including statins, angiotensin-converting-enzyme inhibitors or antiplatelet drugs, had the same risk of dying from — or surviving — heart disease as patients taking those drugs. Similarly, people with diabetes who exercised had the same relative risk of dying from the condition as those taking the most commonly prescribed drugs. Or as the researchers wrote in statistics-speak, “When compared head to head in network meta-analyses, all interventions were not different beyond chance.”

On the other hand, people who once had suffered a stroke had significantly less risk of dying from that condition if they exercised than if they used medications — although the study authors note that stroke patients who can exercise may have been unusually healthy to start with.

Only in chronic heart failure were drugs noticeably more effective than exercise. Diuretics staved off mortality better than did exercise.
mortality  comparison  treatment  self  efficacy  exercise  peer-reviewed  research  meta-analysis  heart  disease  failure  diabetes  type  2  T2D  health  care  economics  effectiveness  activity  statins  risk  drug  effects 
january 2014 by Michael.Massing
Methicillin Resistant Staphylococcus Aureus (MRSA)
Colonies of Staphylococcus aureus are found in the nose, armpits, groin, and on the skin of about 20% to 30% of healthy adults; about 80% of all people may be colonized with the organism at various times but not consistently (Herchline). Hospitalized individuals, hospital personnel, and healthcare workers generally have higher rates of Staphylococcus aureus colonization (Herchline). Although the presence of the organism does not result in disease in the majority of individuals, it may more easily overwhelm the immune system and cause infection in those who have an existing skin injury, other significant injury, chronic illness such as diabetes, or whose immune system function is compromised (immunosuppression).
MRSA  risk  healthcare  transmission  infection  colonization  prevalence  incidence  morbidity  mortality 
august 2013 by Michael.Massing
Beware of Calcium Supplements | BMJ 2013; 346: f228 
highest rates of death from all causes and CVD, but not from stroke, were among women with the highest dietary calcium intake, above 1400 mg/day. Compared with dietary intakes of 600-1000 mg/day, calcium intake above this level was associated with 1.40, 1.49, and 2.14 times the risk for death from any cause, CVD, and ischemic heart disease, respectively.

These risk increases were seen after multivariable adjustment, and the authors note that a shift from lower to higher risk with the multivariable model was mainly the result of adjusting for use of calcium containing supplements.

A quarter of the study population in 1997 were taking calcium supplements; among these women, a high dietary calcium intake exceeding 1400 mg/day was associated with an even greater excess mortality risk.

In a separate analysis from the date of the second survey, stratified according to no use or type of calcium supplement use, women with the highest dietary calcium intake who took calcium tablets (500 mg per tablet) had a 2.57-fold increased risk for all cause mortality compared with those with a dietary intake of 600-999 mg/day, and those who took any type of calcium-containing supplement had a 1.51-fold increased risk, whereas the risk was not significant among non-users of calcium supplements.

The team wrote, "Thus among women with a high dietary intake of calcium, the addition of calcium supplements increased the risk of death in a dose dependent fashion."

Karl Michaëlsson (Uppsala University, Sweden) and team conclude that, "Our present data together with previous observations suggest that for the prevention of fractures in elderly people and simultaneous avoidance of possible serious adverse events related to a high calcium intake (such as higher risk of hip fracture, cardiovascular disease, renal stone, and, as observed in the current study, mortality) emphasis should be placed on people with a low intake of calcium rather than increasing the intake of those already consuming satisfactory amounts."
risk  dietary  supplements  calcium  supplemental  CVD  mortality  excess  all-cause  earnest  fracture  osteoporosis 
february 2013 by Michael.Massing
That Woman Is Not Adam Lanza's Mother, and She's Distracting Us From the Real Issue
Sometimes it's just random acts of violence, sometimes it's being in the wrong place at the wrong time — sometimes it's as simple as being born a certain color. For example, in 2008 and 2009, black children accounted for forty-five percent of all child gun deaths in the United States, despite being only fifteen percent of the child population. Black children suffer from lax gun laws, and they suffer greatly.

Need further proof that guns kill kids? As of 2004, every day in the United States, eight children were killed by guns. In 2007, Gary Younge picked a day and reported their stories. Heartbreaking.
blogging  parenting  privacy  libel  criticism  memoir  child  children  right  US  violence  guns  mortality  risk  race  racism  African-American 
december 2012 by Michael.Massing
Gun Deaths Outpace Motor Vehicle Deaths in 10 States | Alternet
According to the Violence Policy Center’s (VPC) new state-by-state analysis of the latest 2009 government data, gun-related deaths outpaced motor vehicle deaths in 10 states. The 10 states are: Alaska, Arizona, Colorado, Indiana, Michigan, Nevada, Oregon, Utah, Virginia, and Washington (each state’s firearm and motor vehicle mortality figures are listed below).

The decline of motor vehicle deaths results from decades of federal health-based injury prevention strategies that regulate vehicle safety standards and highway design. Firearms, on the other hand, remain the only consumer product that is not federally regulated for health and safety, reports the VPC.

VPC’s Legislative Director Kristen Rand said:

Americans are reaping the benefits of smart safety regulation of motor vehicles. The idea that gun deaths exceed motor vehicle deaths in 10 states is stunning when one considers that 90 percent of American households own a car while fewer than a third own firearms. It is also important to consider that motor vehicles--unlike guns--are essential to the functioning of the entire U.S. economy. It is time to end firearms’ status as the last unregulated consumer product.
gun  firearms  death  mortality  health  policy  US  risk  regulation  state  list  statistics  data  violence  comparison  geography  demographics  cars  motor  vehicles 
august 2012 by Michael.Massing
Diet Soft Drinks Linked to Risk of Heart Disease | The Journal of General Internal Medicine online 2012 | via NYTimes.com
Some studies have suggested that consumption of diet soft drinks may be associated with Type 2 diabetes and development of the condition known as metabolic syndrome — high blood pressure, abdominal obesity and other risk factors. Now a 10-year epidemiological study has found a link between diet soft drinks and cardiovascular disease.

[Among] 2,564 adults over 40 living in Manhattan,] diet and regular soft drink consumption were both associated with a number of risk factors for cardiovascular disease.

Even after controlling for many of those risks, including diabetes, the researchers found that daily consumption of diet soda was still independently associated with an increased risk for stroke, heart attack and death.
medical  research  peer-reviewed  risk  mortality  morbidity  diabetes  diet  cardiovascular  stroke  heart  circulation  brain  disease  epidemiology  soda  pop  soft  drinks  hatmandu  correlation  factor  etiology 
february 2012 by Michael.Massing
Predicting Kidney Disease in Diabetes Using Tumor Necrosis Factors | Godha T, et al. J Am Soc Nephrol 2012; 23: DOI: 10.1681/ASN.2011060628
Among those with type 1 diabetes, patients with the highest quartile of TNFR2 values were three times more likely to have renal decline than those in the other quartiles, and the risk associated with high TNFR1 values was slightly less than that seen in those with elevated TNFR2.
These studies found that levels of circulating tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) predict kidney disease in both type 1 and type 2 diabetes.
kidney  damage  disease  end-stage  renal  ESRD  mortality  morbidity  diabetes  prognostic  risk  biological  marker  predictive  medical  research  peer-reviewed 
february 2012 by Michael.Massing
Excess Mortality for Adults with Young-Onset Diabetes Persists | Conway B et al. Diabetes Care 2012/01/11
Participants with diabetes were stratified by insulin therapy at baseline: group A treated with insulin only; group B treated with insulin and oral hypoglycemic agent; and group C receiving no insulin treatment.
During a mean follow-up of 3.9 years, the researchers found that 4.6% of the cohort without diabetes died, compared with 15, 12.5, and 7.3% of groups A, B, and C, respectively. The hazard ratios (HRs) for all-cause mortality were 4.3, 4.2, and 2.0 for groups A, B, and C, compared with individuals without diabetes. The leading cause of death in groups A, B, and C were ESRD, ESRD and CAD, and CAD, respectively. The HRs for these conditions were at least twice as high as the HRs for all-cause mortality, extending to 17.3, 17.9, and 5.1 in groups A, B, and C, respectively, for ESRD.
"Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality," the authors write.

[Excuse me? Don't the numbers, if correctly reported, suggest that insulin-and-drug therapy increases mortality by over two-thirds, and insulin-only therapy more than doubles mortality?—DMM]
diabetes  mortality  insulin  drug  effects  risk  bad  science  peer-reviewed  end-stage  renal  disease  coronary  artery  MODY  ESRD  CAD  cardiovascular  heart  circulation  kidney  results  intervention  over-treatment  medical  research  correlation  benefit 
february 2012 by Michael.Massing
African-Americans More Likely to Develop Hypertension But Less Likely to Take Life-Saving Medication | Lewis L. Journal of Cardiovascular Nursing 2012.
Racial disparities in hypertension control account for nearly 8,000 preventable deaths annually among African-Americans, making increased blood pressure control among African-Americans a “compelling goal"...
African-Americans commonly develop hypertension at a younger age, are less likely to have their blood pressure under control, and disproportionately suffer strokes and fatality when compared with their Caucasian counterparts[:] a 30% greater rate of non-fatal stroke, an 80% greater rate of fatal stroke, and a staggering 420% greater rate of end-stage kidney disease for African-Americans...
[Only 51% of all patients with hypertension adhere to their medications;] adherence rates are even lower for African-American patients.
Dr. Lewis identified self-efficacy, depression, and patient-provider communication among the factors in medication nonadherence. She called for further study, but advised that these factors are important for healthcare providers to consider when treating hypertensive African-American patients.
“Increasing blood pressure control requires a comprehensive approach...Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. [Clinicians also] may want to screen their hypertensive patients for depression...”
racial  health  disparities  race  African-Americans  risk  treatment  self  care  hypertension  high  blood  pressure  epidemiology  demographics  stroke  morbidity  mortality  kidney  disease  what.I'm.reading  T2D  research  diabetes  correlation  peer-reviewed  genetic  genetics  management  public  literacy 
february 2012 by Michael.Massing
Depression Defies Rush to Find Evolutionary Upside - NYTimes.com
According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.
disability  morbidity  mortality  risk  depression  evolution  theory  comorbidities  brain  medical  research  hippocampus  cardiovascular  mental  health  illness  chronic  hatmandu  earnest 
february 2012 by Michael.Massing
Elevated Glucose Associated with Undetected Heart Damage | Selvin E Rubin J et al. Journal of the American College of Cardiology 2012.
[A new study] suggests that hyperglycemia (high blood sugar) injures the heart, even in patients without a history of heart disease or diabetes...[E]levated levels of glycated hemoglobin (HbA1c), a marker for chronic hyperglycemia and diabetes, were associated with minute levels of the protein troponin T (cTnT), a blood marker for heart damage. The high-sensitivity test they used detected levels of cTnT tenfold lower than those found in patients diagnosed with a heart attack....[H]yperglycemia may be related to cardiac damage independent of atherosclerosis....
Higher levels of HbA1c were associated in a graded fashion with elevated levels of high-sensitivity cTnT. This relationship was present at HbA1c levels even below the threshold used to diagnose diabetes. Using conventional tests, troponin T can be detected in 0.7% of the population and is associated with heart attacks and death. With the high-sensitivity cTnT test, low levels of troponin were found in 66% of the study population....
"[G]lucose might not only be related to increased atherosclerosis, but potentially elevated glucose levels may directly damage cardiac muscle"...
risk  morbidity  mortality  atherosclerosis  blood  vessel  damage  glucose  sugar  high  dysglycemia  hyperglycemia  prognostic  medical  research  in  vivo  human  peer-reviewed  hemoglobin  A1c  marker  heart  cardiovascular  correlation  diagnosis  clinical  trial 
february 2012 by Michael.Massing
Animas Corp [Johnson & Johnson] Receives Warning Letter from the FDA
Federal regulators have warned Johnson & Johnson that it could face fines and other sanctions for selling faulty insulin pumps and delaying disclosures of serious injuries to diabetics who were using its OneTouch Ping and 2020 pumps. The FDA ordered the Animas Corp. unit of J&J to explain why it kept selling pumps known to fail and also to submit a plan to rectify a failure to promptly report cases in which its device might have caused or contributed to death or serious injury....
In the issue with the Animas insulin pumps, some pump keypads for controlling how much insulin is injected were deteriorating prematurely, leading to failures. "We decided to go with a new keypad because it's more durable," [spokesperson Caoline] Pavis said.
But while Animas was lining up the new keypad supplier, it was still selling the older ones. The FDA demanded documents about the company's decision to do that.
corporatism  capitalism  mortality  regulation  medical  devices  insulin  Johnson&Johnson  risk  safety  diabetes  drug  effects  morbidity  injury  hospitalization  ketoacidosis  government  accountability 
february 2012 by Michael.Massing
Sleep Problems Increase Risk for Cardiovascular Disease, Diabetes and Obesity | Grandner M Gehrman P et al.
“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues"...
The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic and health risk factors, patients with sleep disturbances at least three nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.
Grandner and colleagues analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) of 138,201 patients[—]the world’s largest telephone survey, designed to monitor health-related behaviors in the general population.
“This study is one of the largest ever to link sleep problems with important cardiovascular and metabolic diseases. It joins other studies that show that sleep is an important part of health, just like diet and physical activity"...
medical  research  peer-reviewed  sleep  risk  benefit  cardiovascular  diabetes  obesity  disease  morbidity  mortality  David.E  hatmandu  earnest  T2D  type  2  human  in  vivo  correlation  clinical  trial 
february 2012 by Michael.Massing
Risks of Tight BP Control May Outweigh Benefits | Redon J et al. J Am Coll Cardiol 2012;59:74-83.
There was no evidence of any adverse effect of low systolic blood pressure on any cardiovascular outcome, except for cardiovascular mortality, which was significantly increased in patients with a baseline systolic blood pressure below 130 mm Hg who had the greatest systolic blood pressure reduction.

When in-treatment systolic blood pressure was examined by decile, there was a progressive reduction in the incidence of stroke down to 115 mm Hg systolic blood pressure, whereas there was a J-curve relationship for the other outcomes. For cardiovascular death, the nadir of the J-curve was around 135.6 mm Hg for diabetic patients and 133.1 mm Hg for nondiabetic patients.

For diastolic blood pressure, the primary outcome was most common in patients with the lowest or highest in-trial diastolic blood pressure (for both diabetic and nondiabetic patients), regardless of the systolic blood pressure.

What are the therapeutic implications of these findings? "In both diabetic and nondiabetic patients, progressively greater systolic BP reductions were accompanied by reduced risk for the primary outcome only if baseline systolic BP levels ranged from 143 to 155 mm Hg," the authors say.

They continue, "Around or below an initial systolic blood pressure of 130 mm Hg, antihypertensive treatment should be implemented with caution because of the possibility of untoward cardiac effects that could counterbalance the beneficial consequences of aggressive blood pressure reduction for stroke. This might also apply to diastolic blood pressure values of 67 mm Hg or less."

"Clearly," they add, "more evidence from prospective trials is necessary to learn whether high-risk diabetic patients with blood pressure levels between 130 and 140 mm Hg should be treated to lower blood pressure levels."
high  blood  pressure  hypertension  treatment  self  care  targets  threshold  mortality  risk  benefit  tight  control  medical  research  peer-reviewed  diabetes  correlation  overtreatment 
february 2012 by Michael.Massing
ACCORD Travesty :: David Spero :: Diabetes Self-Management
I may say some nasty and completely true things about the medical establishment.
I only started paying attention [to the ACCORD study] when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got...ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it....
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.[Encouraging participating doctors to unsystematically and aggressively prescribe multiple drugs all but guaranteed drug interactions and adverse effects.]
In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.
Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low....
What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.
You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.
A1c  risk  tight  control  David  Spero  research  criticism  health  literacy  peer-reviewed  science  diabetes  management  mortality  benefit  bad  corruption  medical  pharmaceutical  industry  news  media  journalism  reporting  drug  effects  adverse  healthcare  self  care  polypharmacy  outbasket  corporatism  capitalism  glucose  outbox  exercise  physical  activity  correlation  self-monitored  blood  monitoring  SMBG 
february 2012 by Michael.Massing
Obese Nurses More Stressed, Less Active : | Han K. et al. Journal of Nursing Administration (volume 41, issue 11
[Surveyed] nurses with long work hours were significantly more likely to be obese compared with underweight or normal weight nurses. The obese nurses also reported having jobs requiring less physical exertion and less movement.
"Long work hours and shift work adversely affect quantity and quality of sleep, which often interferes with adherence to healthy behavior and increases obesity"...
[The University of Maryland School of Nursing studies adverse effects from unfavorable nursing schedules on nurses' health,] hospitals and patient care outcomes.
[Previous research by the same team] found that, along with long work hours, the work schedule component most frequently related to patient mortality was lack of time off from the job. Another study revealed evidence to challenge the common 12-hour nursing shift, which can result in sleep deprivation, health problems, and a greater chance for patient-care errors. [Researchers have also] described barriers that keep nursing executives from moving away from the practice, and offered strategies to help mitigate the possible negative effects of 12-hour shifts.
The obesity study suggests that educational interventions about sleep hygiene and strategies for adapting work schedules should be offered by hospitals and other health care institutions; and that a favorable organizational climate that supports napping in the workplace can help prevent work-related sleep deprivation, reduce fatigue, and increase energy for healthy [behaviors].
About 55% of the nurses surveyed were obese. "Considering that more than half of nurses are overweight or obese, increasing availability of healthy food and providing sufficient time to consume it may reduce the risk of obesity and future health problems",,,.
mortality  risk  labor  nursing  obesity  shift  work  length  12-hour  sleep  patient  error  fatal  care  hospital  bureaucracy 
january 2012 by Michael.Massing
Statins Can Increase Risk of Diabetes | Culver A. Ma Y. et al. Archives of Internal Medicine. 2012-01-09
Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus.
New data from the Women's Health Initiative (WHI) [indicates risk of diabetes is higher than previous studies have suggested: 48% increased risk]....
Recently published data reported the potential risk of diabetes with statin therapy. Dr. Kausik Ray (St. George's University of London, UK) and colleagues published a meta-analysis of [five trials testing high-dose statin therapy,] and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in The Lancet in 2010 by Dr. Naveed Sattar (University of Glasgow, UK) also showed that statin therapy was associated with a 9% increased risk of diabetes.
[The present study produced an unadjusted risk model associating statin use at baseline] with a 71% (95% CI 1.61–1.83) increased risk of diabetes. After adjusting for potential confounding variables, the risk...declined to 48% (95% CI 1.38–1.59). The association was observed for all types of statins.
Dr. Kirsten Johansen,[ Editor of the Archives of Internal Medicine, noted that previous meta-analyses show no benefit of statins on all-cause mortality in the setting of primary prevention]...
[S[tatins are used with increasing frequency, including in primary prevention, and—based on the JUPITER trial—in patients with normal LDL cholesterol, but elevated C-reactive protein (more than 2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.
Just 7% of women in the WHI study were taking statins in the analysis, but today that number would be significantly higher, making the potential risk of diabetes at the population level much more widespread.
medical  research  drug  effects  risk  benefit  statins  women  peer-reviewed  meta-analysis  overview  mortality  diabetes  iatrogenic  what.I'm.reading  T2D  correlation  adverse 
january 2012 by Michael.Massing
IOM Recommends FDA Set New Standards for Salt in Foods
Asked to address the concerns of naysayers, who argue that there is little proof that reducing salt in the diet will have an effect on health outcomes and who say that the administration should not get involved in "nanny-state" activities like regulating the amount of sodium people consume, Bakris said that government-backed salt-reduction campaigns "have been very effective in the UK, in Finland (with a dramatic improvement in mortality) and in Japan, and there is absolutely no reason we should not do this.

"The reality is that there needs to be some guidance to the general public about this—most people do not read labels, most people don't pay attention, and they don't know how much salt is too much... Clearly, the FDA does have a role as a regulatory body to adjust sodium standards in foods so that they are in keeping with the current guidelines."

"It's certainly true that people who are in their 20's and teens don't need salt restriction for blood-pressure control, [but it is an acquired taste. If] you don't learn from a young age, it's going to catch up with you in your 40's, 50's, and 60's, when you actually will need some salt restriction..."

In response to what Bakris calls the "outcomes mafia, who say that unless we have an outcomes study it's impossible to make any conclusions," he remarked, "[C]ommon sense has to prevail. The FDA as a regulatory body has accepted the notion that lowering of blood pressure is a validated surrogate for a reduction in cardiovascular mortality and morbidity... To do an [outcomes] clinical trial...you would need well over 100 000 people, so it's not feasible. Let's be reasonable."

"If you are telling me that reducing BP by 5 to 7 mm Hg, which is what most of these salt restrictions will do, is not going to translate into a benefit, then I think we have to throw out all the clinical trials we have to date...[No meta-analysis of any clinical trials] fails to show that a reasonable reduction in blood pressure has not [sic] been associated with a benefit, certainly on stroke and to a lesser degree on coronary events...[T]he data are very consistent."

"I think the conflict of interest here needs to be established,...With all due respect, many of the people who are saying this are also consultants to the Salt Institute, they are lobbyists in their own right. They spin the data to make it suit what their needs are."
health  policy  guidelines  regulation  salt  sodium  diet  intake  risk  benefit  medical  research  outcomes  evidence  surrogate  indicator  marker  stroke  cardiovascular  blood  circulation  mortality  morbidity  corruption  spin  distortion  food  industry  lobby  earnest 
january 2012 by Michael.Massing
Relation between blood glucose and coronary mo... [Diabetes Care. 2006] - PubMed - NCBI
All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.
CONCLUSIONS:
A threshold model with linear slope [rising from 83mg/dL] best described the dose-response relationship between postload blood glucose and CHD mortality risk.
glucose  risk  dysglycemia  threshold  mortality  morbidity  cardiovascular  normal  respiratory  all-cause  medical  research  peer-reviewed  diabetes  prediabetes  standards  self  care  management  diagnosis 
january 2012 by Michael.Massing
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