OBESITY, DIABETES EPIDEMICS COULD MEAN MORE HEART DISEASE

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BY JOEL B. FINKELSTEIN

HEALTH BEHAVIOR NEWS SERVICE

It’s already the leading killer in America, but heart disease may become even more prevalent due to a growing epidemic of obesity and diabetes, experts predicted at a July 2002 meeting at the National Institutes of Health.

“The current diabetes epidemic is a harbinger of an epidemic of cardiovascular disease,” said Hertzel Gerstein, M.D., of McMaster University.

Someone with diabetes and no prior heart disease has just as much risk of having a heart attack as a person with heart disease, but not diabetes. People with both prior heart disease and diabetes have a much greater risk of having and dying from a heart attack.

Even early signs of diabetes, such as high blood sugar levels, are a risk for future heart disease, Gerstein said.

Patients on the verge of diabetes have twice the risk of developing cardiovascular disease or angina, said Steve Haffner, M.D., of the University of Texas Health Sciences Center.

At the pre-diabetic stage, aggressive treatment combined with lifestyle changes — such as adoption of a low-fat, high-fiber diet and regular exercise — and, to a lesser extent, drug therapies can reduce the risk of developing diabetes by more than 50 percent.

“One way to prevent heart disease is to prevent diabetes,” Haffner said. Once a patient develops diabetes, aggressive treatment and control of blood sugar, cholesterol and blood pressure can help reduce the risk of heart disease.

Despite the clear and proven benefits of aggressive treatment to prevent diabetes and heart disease, few patients receive enough treatment to achieve established clinical targets, said Frank Vinicor, M.D., of the Centers for Disease Control and Prevention.

The medical community’s approach to improving the “house of health” has been to raise the roof — improving treatments, for example — when it should be widening the foundation to include more people getting the treatments that are already available, he said.

While research is still needed to improve treatment for diabetes, a lot of knowledge is available to doctors and patients, but too many barriers keep them from using it, according to Vinicor.

Time is the most prominent barrier. Vinicor said that while patients spend 100 percent of their time with diabetes, they spend only about 0.0002 percent of their time with a doctor.

Communication and education, community involvement and changes to the way the health care system operates are all necessary in order to use what is already known to maximize benefits to patients, the experts said.

They added that transportation, urban planning and nutrition also play a role in the development and prevention of diabetes and need to be taken into consideration when designing an approach to combating the epidemic.

“We know so darn much now about diabetes,” Vinicor said, “and people still aren’t getting it.”

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