Oct
02
2003

Heart Scan Saves Lives In Diabetics

A simple new nuclear perfusion study of the heart when applied to healthy appearing diabetics (adult onset or “type 2 diabetics”) showed silent hardening of the coronary arteries in 21.6%. This large study of an American medical team was recently presented at the 18th Congress of the International Diabetes Federation in Paris/France. Dr. F. Wackers, professor of medicine from Yale University school of medicine and one of the lead investigators, explained that 1,124 patients with diabetes in the age range of 55 to 75 years who were all thought to not have any heart blood vessel disease, either had nuclear perfusion studies performed and a control group did not.

As indicated above to the surprise of the investigators 113 patients of 522 (=21.6%) had positive heart scans showing perfusion difficulties of the heart muscle. Further testing with other methods revealed that 73% indeed had perfusion defects and 27% had other heart disease, electrocardiogram abnormalities and other heart dysfunctions. Conventional assessment tools such as a smoking history, determination of degree of obesity, blood pressure,kidney disease , high blood lipid levels, high C-reactive protein levels, the diabetes test hemoglobin A1C or homocysteine levels in the blood were also assessed. However, these conventional tests did not help in predicting that these patients would have developed perfusion defects in their heart muscle. This was due to hidden narrowing of the heart blood vessels (=coronary arteries) and this affected the supply of nutrients and oxygen to the heart even though these patients were completely symptom free at the beginning of the trial.

Heart Scan Saves Lives In Diabetics

Heart vessels and nuclear scan

Dr. Vivian Fonsega, a professor of medicine and pharmacology at Tulane University in New Orleans and co-researcher of the team, added that after a follow-up of 1 year those who had normal initial nuclear perfusion studies of the heart only 1% developed serious heart disease. These control patients who have now been followed for 3 years overall remained very healthy. In other words a normal (called “negative”) nuclear perfusion test in diabetics predicts a better longterm outcome than a positive perfusion test.

With this heart scan the cardiologist can identfy the high risk group among diabetics and can subsequently concetrate on doing something actively about the identified diseased heart blood vessel(=”coronary artery”) disease. Identified narrowing in the coronary arteries (“stenotic arterial lesions”) can be overcome by prying them open and placing heart stents across the affected section utilizing catheters (angiography). In other cases heart bypass surgery can be done by the heart surgeon to improve the perfusion of the heart muscle. The researchers stressed that those diabetics at risk can be identified with this test and the life expectancy of this high risk group of patients can be significantly prolonged. The study will continue for several more years so that the longterm results of any intervention can be measured when compared to controls.

Based on The Medical Post (Sept. 23, 2003 ): p. 55.

Here is a link to a chapter on diabetes and here is a link to heart attacks.

Last edited December 9, 2012

Jan
01
2003

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

In the January 18, 2003 issue of the Lancet (Lancet 2003; 361:195-200) Dr. Dr. Naveed Younis and his collegues published a study from the Royal Liverpool University Hospital, U.K. where diabetic patients underwent thorough eye examinations in regular intervals for 5 years. The question of this study was whether it mattered at what interval patients would be examined with regard to their eye-sight, so that perhaps blindness could be postponed or avoided through early interventions.

At the baseline of the study a special eye-photography method (three-field mydriatic photography) was used to document the blood vessel changes in the back of the eye. This helps the physician to assess whether or not there is a degree of retinopathy (blood vessel damage from diabetes) of the eyes or not. The investigators defined three groups:

For group one (no eye damage in the beginning of the study) there was a retinopathy rate of 0.3% at the end of the first year. Group two (moderate retinopathy in the beginning) showed a worsening of the retinopathy at the end of the first year of 5% (threatening blindness). Group three (significant retinopathy in the beginning) showed a rate of 15% of worsening retinopathy (threatening blindness) at the end of one year.

The Liverpool Eye Study...How Often The Eye Sight Of Patients With Diabetes Should Be Examined

The Liverpool Eye Study…How Often The Eye Sight Of Patients With Diabetes Should Be Examined

This shows that not every person with diabetes is equal with respect of having the threat of blindness. The medical investigators found that about 70% of patients fell into the group that did not have serious diabetic retinopathy. However, the other 30% would not do well with simply yearly eye examinations as it is recommended now. Instead the authors of the Liverpool study were able to make practical recommendations as follows:

After a baseline eye examination those who belong into group one would get an eye examination every 3 years. Those with prior moderate retinopathy (group2) on the initial baseline examination would get examinations at yearly intervals (until the degree of retinopathy worsens). Group 3 with significant retinopathy at the beginning would, however, be examined every 4 months (new recommendation) so that blindness hopefully could be avoided or significantly postponed through interventional therapies.

The following link is telling you about hardening of the artieries (arteriosclerosis) and how diabetes accelerates this process:

The following site is about the metabolic effects of diabetes on the body and in particular also about the danger of diabetic retinopathy:

Diabetes: http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Last edited December 10, 2012

Oct
18
2002

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

In mid October 2002 the British Medical Journal(BMJ 2002;325:p.857-860) published a paper by Dr. Mika Kivimäki from the University of Helsinki where 812 healthy factory workers were followed for about 25 years. The issue was whether stress from work would have negative consequences, which could be measured in terms of cardiovascular disease. Various risk groups were defined from low stress to high stress.

Low stress jobs were classified as people who often had more training, more responsibilities, better salaries, physically less strenuous jobs with more job security. High stress jobs involved the opposite(high demand/low job control/low salary/no job security). Depending on which subgroups of high versus low risks were compared, the investigators found a 2.2 to 2.4-fold increase of strokes and heart attacks due to cardiovascular disease.The team measured other cardiovascular risk factors. They found a significant increase of cholesterol in the high stress job group after 5 years. After 10 years there was a marked weight gain in the stressed group with obesity becoming much more frequent. The authors noted that this likely led to a change of metabolism in the sense of hyperinsulinism, which is known to cause high cholesterol levels and leads to hardening of the arteries with heart attacks and strokes.

Work Stress Is A Killer...More Than 2-Fold Over A Period Of 25 Years

Work Stress Is A Killer…More Than 2-Fold Over A Period Of 25 Years

Visit these useful related links to chapters of my free Internet based Nethealthbook:
Hyperinsulinism or syndrome of insulin resistance:
http://www.nethealthbook.com/articles/hormonalproblems_diabetesmellitus.php

Heart disease:
http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Stroke:
http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/hemorrhagic-stroke/

Last edited October 25, 2014