35% of U.S. Adults Over 20 Have Pre-Diabetes

Nearly 26 million Americans have diabetes, according to new estimates from the Centers for Disease Control and Prevention (CDC). In addition, an estimated 79 million U.S. adults have prediabetes, a condition in which blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. Prediabetes raises a person’s risk of type 2 diabetes, heart disease and stroke.

Diabetes affects 8.3 percent of Americans of all ages, and 11.3 percent of adults aged 20 and older, according to the National Diabetes Fact Sheet for 2011. About 27 percent of those with diabetes—7 million Americans—do not know they have the disease. Prediabetes affects 35 percent of adults aged 20 and older. [Read more…]

Heart Disease Hospitalization Rates in the U.S.

Heart disease hospitalization rates among Americans aged 65 years and older vary substantially depending on where they live, according to a report released today by the Centers for Disease Control and Prevention.

The “Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries” shows that the highest hospitalization rates occur among blacks compared to other racial and ethnic groups.  Hospitalization rates were also highest in counties located primarily in Appalachia, the Mississippi Delta, Texas and Oklahoma. A significant number of Medicare beneficiaries live in counties without hospitals capable of providing specialized heart disease treatment.

The atlas provides for the first time statistics about heart disease hospitalizations at the county level.  Data came from the Medicare records of more than 28 million people each year between 2000 and 2006 in the 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. The report documented an average of 2.1 million hospitalizations for heart disease each year.

“These data bring into sharp focus the differences in heart disease hospitalization rates that exist across this country,” said Michele Casper, Ph.D., epidemiologist in CDC’s Division for Heart Disease and Stroke Prevention.  “Importantly, with county–level information, health professionals at the local, state and national levels will be able to tailor heart disease prevention programs and polices to the needs of people living in communities with high rates of heart disease.”

Heart disease is the nation’s leading cause of death. In 2010, it is estimated to cost the United States $316.4 billion in health care services, medications and lost productivity.

In states with the highest heart disease hospitalization rate, the burden is generally two times higher than states with the lowest rates.  For instance, in Louisiana there were 95.2 hospitalizations for every 1,000 Medicare beneficiaries, compared with 44.8 in Hawaii over the same six–year period.

The atlas also brings to light significant racial and ethnic disparities. The heart disease hospitalization rate is much higher among blacks (85.3 hospitalizations per 1,000 beneficiaries) than for whites (74.4 per 1,000) or Hispanics (73.6 per 1,000).  While these rates declined slowly between 2000 and 2006 for Hispanic and white Americans aged 65 years and older, they remained steady among older black Americans.

The atlas also points out geographical differences in access to hospitals with the capability to treat heart disease patients. In 2005, 21 percent of all counties in the United States had no hospital, and 31 percent lacked a hospital with an emergency room.  Specialized cardiac services are even more limited, with 63 percent of U.S. counties lacking a cardiologist outside the Veterans Affairs system.

“Heart disease is largely preventable, and reducing the toll of this disease on society is a national priority,” said Darwin Labarthe, M.D., Ph.D., director of CDC’s Division for Heart Disease and Stroke Prevention. “With targeted public health efforts, such as prevention and early identification of risk factors, and increased access to appropriate medical care, the burden of heart disease can be reduced.”

Source: CDC (March 1, 2010)

Combination Hormone Therapy (CHT) Poses Heart Disease Risk for Postmenopausal Women

New analyses from the Women’s Health Initiative (WHI) confirm that combination hormone therapy increases the risk of heart disease in healthy postmenopausal women. Researchers report a trend toward an increased risk of heart disease during the first two years of hormone therapy among women who began therapy within 10 years of menopause, and a more marked elevation of risk among women who began hormone therapy more than 10 years after menopause. Analyses indicate that overall a woman’s risk of heart disease more than doubles within the first two years of taking combination HT.

The difference in the initial level of risk does not appear related to age, based on findings that the increased risk of heart disease was similar between women in their 50s on combination hormone therapy and women in their 60s.

“Today, most women who take hormone therapy for menopausal symptoms begin therapy shortly after menopause. Based on today’s report, even these women appear to be at increased risk of heart disease for several years after starting combination hormone therapy,” noted Susan B. Shurin, M.D., NHLBI acting director. “It is clearer than ever that women who are considering postmenopausal hormone therapy for menopausal symptoms should discuss their risk of heart disease and other risks – such as breast cancer, stroke, and dangerous blood clots – with their doctors before starting therapy.”

Jacques E. Rossouw, M.D., chief of the NHLBI Women’s Health Initiative Branch and a coauthor of the paper, added, “Although the number of recently menopausal women who would be expected to suffer a heart attack during the first years of combination hormone therapy is small, the risk is likely to be real. Our findings continue to support FDA recommendations that postmenopausal hormone therapy should not be used for the prevention of heart disease.”

Combination hormone therapy includes progestin in combination with estrogen. Adding progestin is known to prevent endometrial cancer in women with a uterus. Today’s findings do not apply to women who have had a hysterectomy and take estrogen-only hormone therapy. Similar analyses on the results of the clinical trial of estrogen only therapy are planned.

Researchers from the Harvard School of Public Health and the NHLBI reanalyzed data from the landmark WHI clinical trial of the effects of combination hormone therapy in 16,608 postmenopausal women with an intact uterus, ages 50 to 79 years (average age of 63) at enrollment.

In the new analyses, the researchers compared the effects of hormone therapy on heart disease risk among women who began hormone therapy within 10 years of menopause and women who began therapy more than 10 years after menopause. The researchers used models that adjusted for adherence, or the actual amount of medication that participants took during the study. They also studied the effects of hormone therapy on heart disease over time (up to eight years). In addition, they compared the findings with similar analyses of 34,575 women in the Nurses Health Study, an observational study with an average follow-up of 9.3 years. The researchers report similar effects of hormone therapy from both studies.

In the WHI clinical trial of estrogen-plus-progestin, 8,506 participants were randomly assigned to receive a combination of estrogen (0.625 milligrams of conjugated equine estrogens per day) plus progestin (2.5 mg of medroxyprogesterone acetate), and 8,102 women were given placebo (inactive pill). The study was stopped in 2002 after an average of 5.6 years of treatment due to an increase in breast cancer in the women on hormone therapy. Compared to women on placebo, women on combination hormone therapy were also at increased risk of stroke, dangerous blood clots, and heart disease, while their risk of colorectal cancer and hip fractures was lower.

Overall, among the 8,506 women assigned to combination hormone therapy during the study, there were 188 cases of coronary heart disease (80 in the first two years), compared to 147 heart disease cases (51 in the first two years) among the 8,102 women on placebo. When adjusted for adherence, the analysis shows that women on combination hormone therapy were about 2.4 times more likely to develop heart disease in the first two years. At eight years, the women on combination hormone therapy were 69 percent more likely to develop heart disease.

The new analyses also showed:

Women who were within 10 years of menopause had a trend toward an increased risk of heart disease, with a 29 percent higher risk at two years from the start of hormone therapy. Although the increased risk of heart disease was not statistically significant, this finding is consistent with a similar analysis of data from the larger Nurses Health Study.

Women who started combination hormone therapy less than 10 years after menopause remained at increased risk of heart disease on average for about six years, after which those in the treatment group appeared to have a lower risk of heart disease compared to similar women who were not on combination hormone therapy. In the nurses study, the initially increased risk on combination hormone therapy changed toward lower risk of heart disease after about three years.

In contrast, women who started hormone therapy 10 years or more after menopause were nearly 3 times more likely to develop heart disease within the first two years of treatment compared to women on placebo. These women continued to be at increased risk of heart disease throughout the 8 years of follow-up.

It is not clear why the heart disease risk appears to be higher in women who start combination hormone therapy a decade after menopause than in women who begin combination hormone therapy within 10 years after menopause. According to Sengwee Toh, Sc.D., lead author of the paper and now an instructor in the Department of Population Medicine, Harvard Medical School, “This study suggests that the risk of heart disease may depend on when women start their combination hormone therapy and how long they are on this treatment. Future investigations should consider both of these aspects.”

The WHI is a major 15-year research program designed to address the most frequent causes of death, disability, and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis. The principal findings from the two WHI hormone therapy trials, which studied 27,347 postmenopausal women on estrogen plus progestin, estrogen-alone, or placebo, found that the overall risks of long-term use of hormone therapy outweigh the benefits. Both of these trials were stopped early because of increased health risks and failure to prevent heart disease, a key question of the studies.

The NHLBI collaborates on the WHI with the National Cancer Institute, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, and the Office of Research on Women’s Health, all parts of the NIH. Wyeth-Ayerst Research provided the medication and placebo for the hormone study.

Source: em>Annals of Internal Medicine (2/16/2010); National Institutes of Health (2/15/2010)

Twenty Percent of American Teens Have Abnormal Lipid Levels

Twenty percent of young people aged 12-19 years in the United States have at least one abnormal lipid level, according to a study from the Centers for Disease Control and Prevention.  Abnormal lipid levels are major risk factors for heart disease, the leading cause of death among adults in the United States.

The report, “Prevalence of Abnormal Lipid Levels among Youths —United States, 1999–2006,” was published today in CDC’s Morbidity and Mortality Weekly Report (MMWR).

The report examined data for 1999–2006 from the National Health and Nutrition Examination Survey (NHANES), an ongoing study that explores the health and nutritional status of about 6,000 participants every year.  Researchers analyzed measurements of low-density lipoprotein, or “bad,” cholesterol (LDL-C); high-density lipoprotein, or “good,” cholesterol (HDL-C); and triglycerides.

The researchers found that young people who were overweight or obese were more likely to have one or more abnormal lipid levels compared to normal weight youth.  Fourteen percent of normal weight, 22 percent of overweight, and 43 percent of obese youth had one or more abnormal lipid levels.

The study also found that 32 percent of these young people would be candidates for lipid screening based on American Academy of Pediatrics (AAP) guidelines.  The AAP recommends lipid screening for young people with a family history of high blood cholesterol or premature cardiovascular disease, or the presence of at least one major risk factor for heart disease, such as smoking, high blood pressure, diabetes, or overweight/obesity.

Reviewing health indicators for 3,125 youths, researchers found that differences in lipid levels were associated with sex, age, and race/ethnicity. Specifically:

  • More boys (24 percent) than girls (16 percent) had at least one abnormal lipid level.
  • Fourteen- and 15-year-olds (9 percent) and 18- and 19-year-olds (10 percent) were more likely to have low HDL cholesterol levels than 12- and 13-year-olds (5 percent).
  • Non-Hispanic white youths were more likely to have low levels of HDL cholesterol (8 percent) and high triglycerides (12 percent), compared to non-Hispanic black youths (5 percent and 4 percent, respectively).

Typically, heart disease develops in adulthood. But its risk factors, such as abnormal lipid levels and overweight/obesity often emerge during childhood and adolescence.

“Overweight and obese young people are at far greater risk of having abnormal lipid levels than are youths with normal weights,” said Ashleigh May, Ph.D.,  Epidemic Intelligence Service Officer in CDC’s Division for Heart Disease and Stroke Prevention, and lead author of the report.  “The current epidemic of childhood obesity makes this a matter of significant and urgent concern.”

In the past three decades, obesity among American youths has increased from 5 percent to more than 17 percent.  In light of this, the study’s authors suggested that clinicians should be aware of guidelines for lipid screening and treatment among youths.

Source: Centers for Disease Control (Jan. 21, 2010)

Genetic Link Between Heart Disease and Gum Disease

BBC News reports that a genetic link between gum disease and heart attacks has been found by researchers in Germany.
Periodontitis (gum disease) is known to be associated with heart disease but how exactly they are linked is unknown.

Now the University of Kiel team has found a common gene mutation in people with periodontitis and heart attack patients, a conference heard.

Source: BBC, May 25, 2009
news.bbc.co.uk/1/hi/health/8063512.stm

Nicotine Content In Womens’ Toenails Can Predict Heart Disease

The level of nicotine in womens’ toenails can predict the risk of coronary heart disease, say researchers from the University of California, San Diego.

By analyzing the nicotine levels in the toenails of more than 60,000 women, the researchers found that those who had suffered heart disease had on average twice the levels of nicotine in their toenails than women without heart disease.

“Using toenail nicotine is a novel way to objectively measure exposure to tobacco smoke, and ultimately, to increase our understanding of tobacco-related illnesses,” explained Wael Al-Delaimy, Ph.D., Department of Family and Preventive Medicine, UC San Diego School of Medicine. “It has advantages over using other biomarkers and could become a useful test to identify high-risk individuals in the future. This would be especially helpful in situations where smoking history is not available or is biased.”

Researchers found no difference in age, body mass index, aspirin use, or history of high cholesterol corresponding to the toenail nicotine levels. Women with the highest toenail nicotine levels were physically less active, had a lower body mass index, drank a higher amount of alcohol, and were more likely to have histories of high blood pressure, diabetes, and family history of heart attack than women with lower levels.

Why toenails? The toenails have an advantage over other existing biomarkers of smoking because they grow more slowly. The levels detected in the nails represent nicotine taken up from blood by nails during growth. The slow growth rates of toenails provide a more stable estimate of average exposure, which is most relevant for illnesses related to tobacco smoke, such as heart disease. Using toenail samples in epidemiological studies is also an attractive concept because they’re easy to collect and store for relatively low cost.

The study was conducted by researchers at University of California, San Diego, School of Medicine, in collaboration with colleagues from Harvard University, and published in the April, 2008 issue of the American Journal of Epidemiology.

A Soft-Drink a Day Increases Heart Disease Risk Factors

Adults who drink at least one soft drink per day are 30% more likely to develop new-onset diabetes or have low levels of good cholesterol.

A recent study in Circulation: Journal of the American Heart Association reports that drinking at least one soft drink a day of a diet or regular soft drink are at greater risk for heart disease than those who don’t. The study was conducted on 3,500 middle aged men and women. The study found that soft-drink consumers are more likely to develop matabolic syndrome, a combination of
a combination of factors like high blood pressure and elevated triglycerides — are more likely to suffer diabetes and heart disease.

Adults who consume at least one soft drink a day are more likely to develop risk factors for heart disease than those who don’t, even if the beverage is diet, according to a study published today in Circulation: Journal of the American Heart Association.

Researchers studying about 3,500 middle-aged men and women as part of a larger, long-term heart study found an association between daily soft drink consumption and an increased risk of developing metabolic syndrome.

The American Heart Association defines metabolic syndrome as:

  • Abdominal obesity (excessive fat tissue in and around the abdomen)
  • Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls)
  • Elevated blood pressure
  • Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar)
  • Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood)
  • Proinflammatory state (e.g., elevated C-reactive protein in the blood)
  • Metabolic syndrome is a growing problem in America, where an estimated 50 million people exhibit symptoms and have greater risk of coronary heart disease and other diseases related to plaque buildups in artery walls.