Wednesday, July 27, 2011
Risk of incident diabetes with intensive-dose compared with moderate-
dose statin therapy: a meta-analysis.
A recent meta-analysis demonstrated that statin therapy is associated
with excess risk of developing diabetes mellitus.
To investigate whether intensive-dose statin therapy is associated
with increased risk of new-onset diabetes compared with moderate-dose
We identified relevant trials in a literature search of MEDLINE,
EMBASE, and the Cochrane Central Register of Controlled Trials
(January 1, 1996, through March 31, 2011). Unpublished data were
obtained from investigators.
We included randomized controlled end-point trials that compared
intensive-dose statin therapy with moderate-dose statin therapy and
included more than 1000 participants who were followed up for more
than 1 year.
Tabular data provided for each trial described baseline
characteristics and numbers of participants developing diabetes and
experiencing major cardiovascular events (cardiovascular death,
nonfatal myocardial infarction or stroke, coronary revascularization).
We calculated trial-specific odds ratios (ORs) for new-onset diabetes
and major cardiovascular events and combined these using random-
effects model meta-analysis. Between-study heterogeneity was assessed
using the I(2) statistic.
In 5 statin trials with 32,752 participants without diabetes at
baseline, 2749 developed diabetes (1449 assigned intensive-dose
therapy, 1300 assigned moderate-dose therapy, representing 2.0
additional cases in the intensive-dose group per 1000 patient-years)
and 6684 experienced cardiovascular events (3134 and 3550,
respectively, representing 6.5 fewer cases in the intensive-dose group
per 1000 patient-years) over a weighted mean (SD) follow-up of 4.9
(1.9) years. Odds ratios were 1.12 (95% confidence interval [CI],
1.04-1.22; I(2) = 0%) for new-onset diabetes and 0.84 (95% CI,
0.75-0.94; I(2) = 74%) for cardiovascular events for participants
receiving intensive therapy compared with moderate-dose therapy. As
compared with moderate-dose statin therapy, the number needed to harm
per year for intensive-dose statin therapy was 498 for new-onset
diabetes while the number needed to treat per year for intensive-dose
statin therapy was 155 for cardiovascular events.
In a pooled analysis of data from 5 statin trials, intensive-dose
statin therapy was associated with an increased risk of new-onset
diabetes compared with moderate-dose statin therapy.
PMID: 21693744 [PubMed - indexed for MEDLINE]
Wednesday, June 29, 2011
CHICAGO | Tue Jun 21, 2011 4:06pm EDT
CHICAGO (Reuters) - Taking a high-dose statin to lower cholesterol may increase risk of developing diabetes by as much as 12 percent, but the heart benefits of statins still outweigh the risks, new research shows.
Statins such as Pfizer's Lipitor are the world's best-selling drugs. They work by lowering levels of low-density lipoprotein, or LDL, the so-called "bad" cholesterol.
Doctors say the new research made public on Tuesday should not prompt any patients to stop taking statins, but patients on high doses of statins should get screened regularly for diabetes.
The findings on two of the biggest-selling statins may lead doctors to choose Lipitor when high doses are needed versus the less expensive, generic version of Merck & Co's Zocor.
While both drugs raise the risk of diabetes, high-dose Lipitor worked far better than generic Zocor at cutting heart risks, the team said.
Study after study has shown that taking statins can lower the risk of heart attacks and strokes, but some studies have suggested that the drugs may raise the risk of diabetes.
To see if dose is a factor, researchers from St George's, University of London and the University of Glasgow analyzed data from five different studies involving 32,752 patients who were treated with high and moderate doses of statins.
Over a five-year period, 2,749 participants, or 8.4 percent, developed diabetes, and 6,684 participants, or 20 percent, had a major heart problem.
"Overall, we found that high doses were associated with a 12 percent increased risk of diabetes compared with standard doses," Professor Kausik Ray of St George's said in an e-mail.
He said for every 498 patients treated there was one extra case of diabetes. But use of high-dose statins reduced risk of heart attacks, strokes, and the need for artery-clearing angioplasty by 16 percent.
For every 155 people treated, one of these heart problems was prevented, the team reported in the Journal of the American Medical Association on Tuesday.
"Nobody should stop taking their prescribed statins because of the evidence shown in this research," Professor Peter Weissberg of the British Heart Foundation, who was not involved with the study, said in a statement.
"Statins play a vital role in protecting the hearts of many, many people and the benefits still far outweigh any risks associated with diabetes," he said.
LIPITOR BETTER THAN GENERIC ZOCOR?
"Patients who need high doses of statins are at very high risk of heart attacks and strokes. They should not come off these drugs, but simply be monitored more closely." Ray said.
The team also compared rates of heart problems in people who took high doses of Zocor, available widely as the generic simvastatin and less costly than brand-name Lipitor.
Lipitor, or atorvastatin, had global sales last year of nearly $11 billion and is expected to lose U.S. patent protection at the end of November.
The risk of developing diabetes proved to be the same with both drugs. But high-dose Lipitor cut the risk of heart attacks and strokes by 22 percent, compared with a 5 percent reduction in heart risk among those who took simvastatin, Ray said.
He said the study shows high-dose simvastatin is not the best option.
"The net benefit of simvastatin is clearly very low and patients on simvastatin 80 mg should be moved to atorvastatin 80 mg instead," Ray said. "I don't think we can wait for loss of (Lipitor's) patent to stop using simvastatin 80 mg," Ray said in an email.
Currently, the National Institute for Health and Clinical Excellence, Britain's health cost watchdog, recommends an 80 mg dose of simvastatin because it is the least costly option for patients with heart disease.
U.S. health regulators earlier this month recommended limiting the 80 mg dose of simvastatin because it increases the risk of muscle damage.
An estimated 2.1 million patients in the United States were prescribed a product containing 80 mg of simvastatin in 2010, according to the U.S. Food and Drug Administration.
Monday, June 27, 2011
The number of adults with diabetes has doubled world-wide over the last three decades to nearly 350 million and increased nearly threefold in the U.S., a sign that the epidemic will impose an ever-greater cost burden on health systems.
The latest calculation, based on a study published in the British journal Lancet, found that the number of adult diabetics jumped to 347 million from 153 million in 1980.
Many public-health experts consider the rise in diabetes to be more worrying than the rise in high blood pressure rates and cholesterol levels. While rates for those conditions have dropped in some parts of the world, type-2 diabetes is becoming more common almost everywhere, and is increasingly showing up in children.
In the U.S., the total cost of diagnosed diabetes was estimated at $174 billion in 2007, according to the American Diabetes Association.
What's worse is that patients are looking to drugs to help manage their condition however, the underlying causes which are primarily lifestyle related, are not being addressed. Diabetes is one of the most avoidable diseases and with a little education, we can avoid this disease.
To learn more about what we can do to help you with this problem, please call us at (360) 433-9580.
Thursday, June 23, 2011
Resveratrol retards progression of diabetic nephropathy through modulations of oxidative stress, proinflammatory cytokines, and AMP-activated protein kinase
Chih-Chun Chang, Chieh-Yu Chang, Yang-Tzu Wu, Jiung-Pang Huang, Tzung-Hai Yen and Li-Man Hung
Journal of Biomedical Science 2011, 18:47 doi:10.1186/1423-0127-18-47
Published: 23 June 2011
Diabetic nephropathy (DN) has been recognized as the leading cause of end-stage renal disease. Resveratrol (RSV), a polyphenolic compound, has been indicated to possess an insulin-like property in diabetes. In the present study, we aimed to investigate the renoprotective effects of RSV and delineate its underlying mechanism in early-stage DN.
The protective effects of RSV on DN were evaluated in streptozotocin (STZ)-induced diabetic rats.
The plasma glucose, creatinine, and blood urea nitrogen were significantly elevated in STZ-induced diabetic rats. RSV treatment markedly ameliorated hyperglycemia and renal dysfunction in STZ-induced diabetic rats. The diabetes-induced superoxide anion and protein carbonyl levels were also significantly attenuated in RSV-treated diabetic kidney. The AMPK protein phosphorylation and expression levels were remarkably reduced in diabetic renal tissues. In contrast, RSV treatment significantly rescued the AMPK protein expression and phosphorylation compared to non-treated diabetic group. Additionally, hyperglycemia markedly enhanced renal production of proinflammatory cytokine IL-1beta. RSV reduced IL-1beta but increased TNF-alpha and IL-6 levels in the diabetic kidneys.
Our findings suggest that RSV protects against oxidative stress, exhibits concurrent proinflammation and anti-inflammation, and up-regulates AMPK expression and activation, which may contribute to its beneficial effects on the early stage of DN.
Tuesday, June 21, 2011
In early 2009, Dr. Marksfeld returned back to the Southwest Washington area to help those suffering with severe neurological conditions utilizing a revolutionary non-invassive treatment protocol that offers immediate results for disc pain sufferers, spinal stenosis and peripheral neuropathies.
Dr. Marksfeld is committed to being at the leading edge in the field of Healthcare and regularly attends workshops, seminars and courses that enable him to provide the best possible care for his patients. Dr. Marksfeld has established highly effective treatment parameters for difficult cases, including peripheral neuropathies, herniated or bulging discs, spinal stenosis, numbness as well as challenging conditions like Fibromyalgia, Chronic Pain Syndrome's, Parkinson's, Multiple Sclerosis, Reflex Sympathetic Dystrophy, Symptoms related to brain injuries and strokes.When not providing care to patients, Dr. Marksfeld spends time with his family and enjoys traveling, skiing, golfing and mountain biking.