Nondiabetics Should Watch Blood Sugar, Too
From: Roman Bystrianyk (rbystrianyk_at_gmail.com)
Date: 09/28/04
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Date: 28 Sep 2004 08:47:54 -0700
Steven Reinberg, "Nondiabetics Should Watch Blood Sugar, Too", Forbes,
September 20, 2004,
Link: http://www.forbes.com/lifestyle/health/feeds/hscout/2004/09/20/hscout521255.html
High blood sugar levels aren't a heart disease concern for diabetics
only.
While it has been long known that diabetics have higher odds of heart
disease and stroke when their blood sugar is not controlled, a new
study suggests a high glucose mark is a risk factor in nondiabetics as
well.
"Diabetes is well-recognized to be associated with increased risk of
cardiovascular disease," said lead author Dr. Kay-Tee Khaw, a
professor at the School of Clinical Medicine at the University of
Cambridge in England.
However, even in people who do not have diabetes, levels of glycated
hemoglobin, which is an indicator of long-term blood glucose level,
predicted cardiovascular disease incidence and total mortality in
10,232 men and women aged 45 to 79 living in the general community in
Britain, who were followed up over six years, she said.
The relationship of cardiovascular disease and mortality was
continuous and increased with increasing blood glucose levels, even
across the normal, nondiabetic range, in a linear relationship, Khaw
said.
According to the report, an increase of glycated hemoglobin of 1
percent was associated with about a 25 percent higher risk of death.
"Fifteen percent of the deaths occur in the 4 percent of the
population with diabetes or glycated hemoglobin levels of 7 percent or
more, but 72 percent occurred in those with glycated hemoglobin levels
above the optimal level of less than 5 percent," she said.
The increased risk was independent of classical cardiovascular disease
risk factors including age, blood pressure, blood lipids, cigarette
smoking and body mass index, Khaw said.
The report appears in the Sept. 21 issue of the Annals of Internal
Medicine.
"Even in persons without diabetes, higher levels of glycated
hemoglobin may indicate persons at higher risk of cardiovascular
disease," Khaw said. "This may be helpful in identifying those who may
benefit most from preventive interventions, such as
cholesterol-lowering or blood pressure- lowering medication."
Khaw said there is no evidence from intervention studies that lowering
blood glucose levels in people who do not have diabetes may reduce
heart disease.
"However, we already know from trials that behavioral interventions,
such as physical activity and reduction of obesity, can reduce blood
glucose levels and prevent diabetes in high-risk individuals. This may
strengthen existing advice for lifestyle modification to prevent
cardiovascular disease in the general population," she said.
In another report in the same journal, Elizabeth Selvin, a graduate
student in the Department of Epidemiology at the Johns Hopkins
Bloomberg School of Public Health and her colleagues add to the
evidence of the connection between high blood sugar and heart disease
among diabetics.
Selvin's team reviewed 13 previously published studies on the
relationship between glycosylated hemoglobin and heart disease risk.
They found that people with type 2 diabetes had an 18 percent
increased risk for cardiovascular disease for each 1 percent increase
in glycosylated hemoglobin level. In addition, people with type 1
diabetes had a 15 percent increase risk for cardiovascular disease
risk for each 1 percent increase in glycosylated hemoglobin level.
"In persons with diabetes, it is clear that known risk factors for
cardiovascular disease such as high blood pressure, high cholesterol
and smoking should be treated aggressively," Selvin said. "But our
study suggests that patients and physicians should also be paying
attention to blood sugar levels to prevent heart disease in persons
with diabetes. Our results suggest that lowering glucose levels in
persons with diabetes may further reduce their risk of heart disease."
"It is clear from the two articles that an abnormal glucose level is
now well-established as a risk factor for future heart attacks and
strokes and deaths from cardiovascular disease," said Hertzel
Gerstein, a professor of medicine at McMaster University in Canada.
Gerstein, the author of an accompanying editorial, said glucose levels
should be considered in the same way as cholesterol levels or blood
pressure. "It's a marker for cardiovascular risk in everybody, not
just in people with diabetes," he added.
To combat high glucose, Gerstein recommends moderate physical activity
and eating less. "We know that if everybody were able to make these
minor changes, they would reduce their risk of diabetes and rises in
glucose levels," he said.
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