Relationship Between Diabetes And Heart Disease

In 2008, a discovery rocked the medical community, forcing the researchers to rapidly stop a clinical trial aimed at investigating the relationship between type 2 diabetes and heart disease. A method of treatment that experts think will help diabetic patients at high risk for heart problems can lower their blood sugar levels quickly ended with the fall of some of their victims.

Recent findings from this trial, ACCORD study, published in the New England Journal of Medicine. They showed that patients who received intensive therapy, typically involves several drugs, still have a high risk of death a few years later. These findings are also many many scientists confused.

The relationship between diabetes and heart disease

Research that includes more than 10,000 people should be able to help clarify whether aggressive treatment of diabetes can help heart health.


Why? People with diabetes are two to four times the risk of heart disease. Several large studies also found patients with high blood sugar tend to have a heart attack and other cardiovascular problems. Scientists think that from time to time, high glucose levels damage blood vessel walls. They are then more vulnerable to the buildup of artery-blocking plaque, the most common cause of heart disease, explains Om Ganda, MD, of Joslin Diabetes Center and Harvard Medical School in Boston.

"What then causes the simple assumption that if blood glucose high and it is bad for the heart, then lowered it must be good for the heart," said David Kendall, MD, scientific officer and medical chief at the American Diabetes Association and one of the researchers original ACCORD's clinical.

Which turned out to be a fatal assumption.

Treating diabetes = more deaths?

This research was given to some subjects with standard diabetes therapy type. This means that changes in lifestyle, diet, exercise and medication. This group is intended to measure the levels of hemoglobin A1C, a blood sugar control over the previous 2 to 3 months-7 to 7.9 percent. (Most people with diabetes should keep their levels below 7 percent, according to the guidelines.)

The second group received more intense intervention. They also received dietary and exercise advice, but taking a drug that is needed to get their blood sugar levels as low as that of people without diabetes, a HbA 1c less than 6 percent. For both groups, doctors can determine the action the FDA approved treatment that is needed to reach targets, such as metformin, Actos, Avandia, and insulin. About half of those in the second group ended up taking three or more drugs plus insulin, compared with 16 percent of those in the standard group.

Original findings, published in 2008, did show that patients in the second group had 21 percent fewer heart attacks are not fatal. However, 22 percent more of them died from various causes including stroke, heart attack and other cardiovascular. "This shows that there is something about intensive care, while it may have protected some heart from a heart attack, may have caused some of the more serious events that cause death," said Dr Kendall. So the researchers took them from the strict regimen and continue to follow them.

The kicker: "I can tell you that on this date, there has been no clear explanation for the finding that," said study author Hertzel C. Gerstein, MD, of McMaster University and Hamilton Health Sciences in Canada.

Trying to find the cause

Scientists have ruled out at least one possibility, that low blood sugar is the cause of death. They now suspect that the number of patients gained weight in the average number of drugs that nearly 8 pounds compared to less than one pound in the standard group-may play a role. Weight loss is known side effect of several types of popular diabetes drug, including Avandia controversy, which has been linked with heart risks.

Or, something about the type or combination of drugs needed to achieve a low target may have proved deadly, speculates Dr Ganda.

To complicate matters, two other trials published in recent years also found no aggressive approach helped to the heart. But they are not showing the same uptick in death, either.

Another thing to remember: For the people in this study, heart damage may be done by the time they began intensive therapy, Dr. Ganda said. The patients in this study were a select group of high risk for heart problems. (Find out your risk level with our Heart Quiz.) They are type 2 diabetes for 10 years, and many who had suffered a heart attack. "It's like putting out fires after the fire has been burning for a long time," says Dr Double. "This is not the same thing with someone who started with newly diagnosed diabetes."

The role of diet and exercise

It could be that simple is better when it comes to lower heart risk for patients with type 2 diabetes. "The best way is the way of good old-maintaining a healthy weight and active. Even if you can not lose weight, regular exercise will make you more sensitive to insulin, so you will not end up requiring insulin or drugs a few in the first place, "says Dr Double. (Need help Belly Recipes Learn how Lean can help you lose weight and prevent diabetes.?)

However, the people in this study can not control their diabetes through lifestyle measures-that is why many of them turn to drugs, even those in the control group of non-aggressive. "Choosing the proper treatment when diet and exercise do not work are still very important, especially before complications set in," explained Dr Ganda.

Perhaps the biggest takeaway from this research is the message that science is always evolving. Even as type 2 diabetes mengancam more from us-an estimated one out of three Americans have prediabetes, doctors are still learning how best to control it. Dr Gerstein said: "The most important message that comes out of this trial is that we really need a test like this, to examine the things that doctors believe may or may not be true."

What should you do?

If you have diabetes, talk to your doctor about measures proven heart-healthy: lifestyle changes and medication, if needed. And considering the newer diabetes drugs such as Byetta, which reduces blood sugar without weight loss, says Dr Double.

Of course, prevention is best. Eat right, exercise, and are in a healthy weight to prevent diabetes and heart problems.