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For Heart Health, Focus on Risk Factors

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For Heart Health, Focus on Risk Factors

Treating multiple factors that contribute to heart attack risk is better than simply focusing on lowering a patient’s cholesterol level, according to U.S. researchers.

“We’ve been worrying too much about people’s cholesterol level and not enough about their overall risk of heart disease,” Dr. Rodney A. Hayward, director of the Veterans Affairs Center for Health Services Research and Development, and a professor of internal medicine at the University of Michigan Medical School, said in a news release.

Levels of harmful LDL cholesterol should be less than 130 for most people and less than 70 for high-risk patients, according to the National Cholesterol Education Program.

In their study, Hayward and his colleagues analyzed data from Americans, aged 30 to 75, with no history of heart attack, who took part in clinical trials of cholesterol-lowering statin drugs. The researchers evaluated the benefit of five years of treatment tailored to a patient’s overall heart attack risk based on factors such as age, family history, diabetes, high blood pressure, smoking status and C-reactive protein level.

The results showed that the tailored treatment was more efficient (more benefit per person treated) and prevented substantially more heart attacks, strokes and cardiovascular deaths than simply reducing cholesterol to a certain target. The tailored treatment saved 500,000 more quality-adjusted life years than cholesterol-focused therapy, the researchers said.

“The bottom line message — knowing your overall heart attack risk is more important than knowing your cholesterol level. If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is, and if your risk is very high, [you] should probably be on a high dose of statin,” Hayward said in the news release.

“However, if your LDL cholesterol is high, but your overall cardiac risk is low, taking a statin does not make sense for you. If your cholesterol is your only risk factor and you’re younger, you should work on diet and exercise,” he added.

The study was published online Jan. 18 in the Annals of Internal Medicine.
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Less sleep for kids may mean higher blood sugar

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Less sleep for kids may mean higher blood sugar

Young children may be more apt to have high blood sugar, a precursor to diabetes, if they average 8 hours or less of sleep a night, report Chinese and American researchers.

This risk may be even greater among obese youngsters, Dr. Zhijie Yu, at the Chinese Academy of Sciences in Shanghai and colleagues note in Archives of Pediatric and Adolescent Medicine.

Moreover, Yu said in an email to Reuters Health, shorter sleep seemed to influence blood sugar “independently of a large variety of risk factors,” such as age, gender, birth-related influences, early life feeding or later diet, recent illness, physical activity, body mass, and waist girth.

Yu’s team investigated sleep duration and blood sugar levels in 619 obese and 617 non-obese children who were 3 to 6 years old and free of diabetes or blood sugar problems.

Parental reports showed a greater percentage of the obese (47 percent) than the non-obese (37 percent) kids averaged 8 or fewer hours of sleep nightly. These reports also showed nightly averages of 9 or 10, or 11-plus, hours of sleep less common in obese (37 and 16 percent) versus non-obese (43 and 20 percent) kids, respectively.

High blood sugar levels, defined as 100 milligrams of glucose per deciliter of blood after not eating for 8 hours, appeared about 1.35-fold and 2.15-fold more likely in the shorter-sleeping non-obese and obese kids, respectively. (For comparison, 110 milligrams per deciliter is considered “pre-diabetes,” while diabetes is diagnosed at 126 milligrams.)

High blood sugar levels were evident in 23 of the 217 non-obese and in 49 of the 291 obese kids sleeping less than 8 hours. By contrast, 21 each of the 175 non-obese and 229 obese kids getting 9 or 10 hours of sleep nightly had high blood sugar.

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Combo pill an option for diabetes-related nerve pain

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Combo pill an option for diabetes-related nerve pain

A single pill containing the pain relievers tramadol and acetaminophen is as effective as the drug gabapentin for treating diabetes-related nerve pain, according to study findings presented Tuesday at the 20th World Diabetes Congress in Montreal.

Gabapentin is an anti-seizure drug frequently prescribed for epilepsy. The drug is also used to treat persistent neurological pain.

In general, gabapentin is regarded as a first-line therapy for “diabetic neuropathy” — a painful condition that causes a range of symptoms from a tingling sensation or numbness in the toes and fingers to paralysis, lead researcher Dr. Bong Yun Cha, from the Catholic University of Korea, Seoul, told Reuters Health.

In the current study, Cha and colleagues compared gabapentin with the tramadol/acetaminophen (TA) combination pill in adults with painful diabetic neuropathy in the lower extremities. Sixty-six study subjects received TA and 73 received gabapentin.

The study was sponsored by JANSSEN KOREA, which markets the combination pill as Ultracet in the US.

Cha and colleagues report that the two groups experienced similar improvements in pain and related parameters over the 6-week study period.

Moreover, the rate of treatment-associated side events in the TA group was not significantly different from that in the gabapentin group: 50.6 percent vs. 36.9 percent.

The current findings, said Cha, support TA as a suitable alternative to gabapentin as a first-line therapy for painful diabetic neuropathy.

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