Aggressive lowering cholesterol may prevent hardening of arteries in diabetics
from the National Institutes of Health
Aggressively lowering cholesterol and blood pressure levels below current targets in adults with type 2 diabetes may help to prevent – and possibly reverse – hardening of the arteries, according to research supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Hardening of the arteries, also known as atherosclerosis, is the number one cause of heart disease and can lead to heart attack, stroke and death.
The three-year study of 499 participants is the first to compare two treatment targets for LDL (“bad”) cholesterol and systolic blood pressure levels, key risk factors for heart disease, in people with diabetes. “This study provides good news for adults with type 2 diabetes,” said Elizabeth G. Nabel, M.D., NHLBI director. “These patients are two to four times more likely than people without diabetes to die from heart disease. For the first time, we have evidence that aggressively lowering LDL cholesterol and blood pressure can actually reverse damage to the arteries in middle-aged adults with diabetes.”
In the Stop Atherosclerosis in Native Diabetics Study (or SANDS), approximately one-half of the participants (247) were asked to lower to standard levels their LDL cholesterol (to 100 milligrams per deciliter) and blood pressure (systolic blood pressure of 130 mmHg or lower), while the other half (252) aimed for more aggressive lowering of LDL cholesterol to 70 mg/dL or lower and of systolic blood pressure to 115 mmHg or lower.
All participants were American Indians 40 years or older (average age of 56) who had diabetes, high blood cholesterol, and high blood pressure but no history of heart attack or other evidence of heart disease. The study was conducted at four clinical centers in southwestern Oklahoma; Phoenix, Ariz.; northeastern Arizona; and South Dakota.
All participants continued to receive their medical care, including diabetes management, dietary and exercise counseling, and smoking cessation, from their health care providers with the Indian Health Service. Like the NIH, the Indian Health Service is part of the U.S. Department of Health and Human Services.
“American Indians have a high rate of diabetes and cardiovascular disease related to diabetes, but there are few clinical trials that address these issues in this population,” said Barbara V. Howard, Ph.D., of MedStar Research Institute in Hyattsville, Md., lead author of the paper. “These study results provide needed evidence to help develop community-based programs to treat and prevent the epidemic of cardiovascular disease among American Indians. At the same time, we are increasing our understanding of the effects of intensively lowering cholesterol and blood pressure in adults with type 2 diabetes, which might also apply to other populations.”
During the study, participants were examined by study clinicians one month after enrollment, then every three months, to assess their blood cholesterol and blood pressure levels and general well being. Food and Drug Administration-approved blood pressure and cholesterol medications were added and adjusted as needed to help participants achieve their treatment goals. The same medications were available to participants in the standard and the aggressive treatment groups. Participants were also encouraged to follow lifestyle approaches to help meet their blood pressure and cholesterol treatment targets, such as following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking.
To assess the impact of the treatments on the participants’ cardiovascular health, researchers used ultrasound to measure the thickness of the carotid (neck) artery – an indication of hardening of the arteries, a leading effect of high blood pressure and cholesterol and an early sign of cardiovascular disease. In addition, ultrasound was also used to measure the size and function of the left ventricle, the heart’s main pumping chamber. Enlarged hearts are known to be predictors of increased risk of heart attack and stroke. These measurements were taken at enrollment, at 18 months, and at 36 months, when the study ended.
On average, participants in both groups reached and maintained their target goals for blood cholesterol and blood pressure levels. The numbers of heart attacks and other cardiovascular events were similar between the two groups and lower than expected.
In addition, carotid artery thickness measurements of participants in the aggressive treatment group were significantly lower than those in the standard treatment group. Researchers report that, compared to baseline, carotid artery thickness increased slightly in the standard group and regressed in the aggressive treatment group, indicating a partial reversal of atherosclerosis. Furthermore, although heart size decreased from baseline in both groups, the beneficial change was significantly greater among participants in the aggressive treatment group.
“Many patients with diabetes do not reach their blood pressure and cholesterol goal levels and thus remain at high risk for heart attacks and stroke,” noted Howard. “In our study, participants successfully managed their blood cholesterol and blood pressure to reach their goal levels. Our message to doctors, nurses, and patients is that you can reach your goal levels, and we should work together to help you do that.”
“These encouraging findings from SANDS suggest that more aggressive blood pressure and cholesterol targets than those currently recommended in patients with diabetes may reduce their future cardiovascular risk,” said Jerome L. Fleg, M.D., NHLBI project officer of the study and a coauthor of the paper. “Longer term followup of this population as well as additional studies in other populations are needed to confirm the benefit and cost-effectiveness of these lower targets.”
Program seeks to inform
abouts signs of stroke
St. Joseph Health Center’s volunteer department is sponsoring a program of information, enlightenment and fun for those 55 years and older at 2:30 p.m., Tuesday, March 23 in the hospital’s second floor classrooms. Certified Stroke Center Coordinator Mary Ann Cashier will discuss signs and symptoms of a stroke. Cost of the program is $4, which includes dinner and door prizes. To make a reservation, call 330-841-4375 or 330-841-4376 by March 1.
Falls prevention program
at St. Joe’s at the Mall
A Falls Prevention Program will be held from 11 a.m. to noon or 6 to 7 p.m., on Wednesday, March 31 at St. Joe’s at the Mall. Ben Melnykovich, St. Elizabeth Health Center injury prevention coordinator, will present information on the types of injuries due to falls, risk factors, in-home and outdoor risks, and prevention. Participants will also view a short video on making changes in the home to prevent falls, as well as receive a falls prevention assessment to determine risk for falling, and referral to appropriate assistance. The program is free but registration is required by calling 330-652-7542. St. Joe’s at the Mall is located inside the Eastwood Mall, Niles, next to Sears.
Hospice breakfast
scheduled for March 14
Volunteers from Hospice of the Valley are sponsoring a pancake breakfast from 8:30 a.m. to 1 p.m. on Sunday, March 14 at Canfield United Methodist Church, 27 S. Broad St., Canfield. Tickets are $5 for adults, $3 for children ages 4 to 12, and free to children 3 and under. Tickets may be purchased at the door. Take out orders are available. Proceeds benefit Hospice of the Valley volunteer projects. Hospice volunteers serve in a variety of ways including companions for hospice patients at home or in nursing homes as well as helping at the Hospice House inpatient facility. New volunteers are needed. For more information on the work of the Hospice of the Valley volunteers, call 330-788-1992.
Web site seeks to educate
youth on steroid dangers
Steroids.com went live last month under new ownership with the primary goal to educate youths about the dangers of steroid abuse. Backed by the legal team at Womack & Associates of Houston, Texas, steroids.com aims to become the de-facto informational Web site related to all things steroids. Steroids.com has collaborated with the Taylor Hooton Foundation (www.taylorhooton.org) to provide an educational resource network to deter teenagers and young adults from using illegal steroids.
Steroids.com launches with an encyclopedic library of factual information about steroids, including: side effects and dangers of anabolic steroids; in-depth overviews of why and how these drugs are taken and obtained; the ethical and peer pressure aspects of steroids; steroid use in schools and sports; the history of anabolic steroids; how to spot a steroid user; and how to talk to your child about steroids. For more information, visit the Web site at http://www.steroids.com or contact info@steroids.com.
Cancer Society program
aids women’s appearance
Do you know a woman who is undergoing cancer treatment? Is she concerned about her appearance? Does she avoid public places because treatment has caused hair loss or complexion changes?
The American Cancer Society’s Look Good Feel Better is a free program that shows a woman how to improve her appearance by using beauty techniques while she is undergoing treatment.
“Chemotherapy and radiation are necessary to treat the cancer, but it often causes hair loss, discolored nails, complexion changes and other noticeable side effects to the face and body,” said Al Stabilito, public relations director of the Northeast Ohio Region American Cancer Society.
Volunteer licensed cosmetologists and beauty professionals lead small groups, usually consisting of six to 10 women, through a practical, hands-on session. Women learn about makeup techniques, skin care, nail care and options related to hair loss such as wigs, turbans and scarves.
Each participant receives a complimentary kit of cosmetics valued between $250– $300 for use during and after the workshop. The skin tone of a woman determines the type of kit she receives. Kits are available in light, medium, dark and extra dark. The cosmetics provided are samples to use and learn the techniques demonstrated during the workshops. A variety of brand name, top quality cosmetics are used and donated by recognized and respectable companies.
“The name of the program sums up the way a woman feels at the conclusion of the two-hour session,” Stabilito added. “After learning a variety of different cosmetic and beauty tips, women actually look good and feel much better about themselves. Not only are we able to improve their appearance, but their attitude is more positive and upbeat too.”
Look Good Feel Better is a program provided by the American Cancer Society in cooperation with the Personal Care Products Council, formerly known as the Cosmetic, Toiletry and Fragrance Association; and the National Cosmetology Association. Hospitals and medical centers throughout Ohio also support the program by providing a room or an area for these classes.
Look Good Feel Better is one of many free programs offered by the American Cancer Society to cancer patients. Sessions are held on a regular basis. However, enrollment for each session is limited and reservations must be made. For more information, or to find out when the next session is held in the area, call the American Cancer Society toll free at 1-888-227-6446.
Compiled from local and national reports.
