The U.S. Department of Education has identified 16 "key components" in state bullying legislation, including a statement of scope, listing of enumerated groups, process of district policy review, definitions and reporting guidelines. Minnesota ranks last in the country with its state bullying law only covering two of the 16 components, according to an Education Department analysis of state bullying laws released in December. Nebraska ranks second-to-last by covering four of the 16 components.

Statement of scope, one of the most common components of state bullying laws, establishes where legislation applies and what conditions must exist for schools to have authority over student conduct.

According to the Education Department report, Minnesota is one of just three states -- alongside Wisconsin and Arizona -- that prohibits bullying but doesn't define that behavior. The state also doesn't provide for its districts a model bullying policy, and at a mere 37 words, its anti-bullying law is the shortest one in the country:

Each school board shall adopt a written policy prohibiting intimidation and bullying of any student. The policy shall address intimidation and bullying in all forms, including, but not limited to, electronic forms and forms involving Internet use.

Experts who were not involved in the multi-center trial agreed larger trials were needed, and said the impact of the drug on blood glucose levels[—.5% reduction in A1c over three months at the highest tested dose of 4g daily—]was moderate. But they said the findings were exciting because they suggested Type 2 diabetes could be treated by targeting the underlying inflammation....
Since atherosclerosis is also considered an inflammatory state, this approach may also potentially reduce the risk of cardiovascular complications associated with diabetes...
Salsalate sells for less than a quarter a pill, and does not present the opportunity for profit that would attract large pharmaceutical companies to do the research...
The patients continued with their regular Type 2 diabetes treatment regimen throughout the study.

"Then we realized that there were other salicylates, chemically similar to aspirin, that don’t carry the same risk of bleeding.” The drug they’re studying now, salsalate, was widely used not too long ago to treat arthritis, but it got “back-shelved” when other drugs were developed for the treatment of pain and arthritis.
The researchers’ first salsalate studies showed that blood glucose control and glucose metabolism improved in people with diabetes; salsalate also lowered inflammation markers and improved levels of cholesterol and triglycerides in the blood. The second round of studies, investigating whether the drugs could have a beneficial impact on overweight people who do not have diabetes but are at risk for developing it, found that blood glucose levels improved, as did inflammatory markers and other risk factors for disease.

Each percentage point decrease in A1C lowers the risk of long-term diabetes complications by 37%.
Diabetes is more common and often more severe in African Americans. To determine if people in this population could lower their A1C levels by talking regularly with others who had successfully controlled their blood glucose levels, researchers recruited 118 African Americans at the Philadelphia Veterans Affairs Medical Center who hadn’t been successful at lowering their A1C[:]
Those in the usual care group were provided with specific goals for A1C.
Participants in the financial incentive group were given $100 for lowering their A1C by one point (for example, from 7.9% to 6.9%) and $200 for lowering their A1C by two points or for hitting an A1C level of 6.5% or lower.
Those in the peer-mentoring group were connected with someone with diabetes who had once had poor blood glucose control but who had brought it to target levels (an average of 6.7%). The mentors were paid $20 and told to meet with their “mentees” at least once per week for the duration of the six-month study.
Mentors and mentees spoke an average of four times during the first month of the study and twice a month thereafter. The researchers were not sure whether this decrease in contact was due to reduced motivation or to a perceived lack of need for more frequent communication.
[Peer-mentoring participants] achieved the greatest reduction in A1C levels: Among those in the usual care group, A1C was reduced, on average, from 9.9% to 9.8%; among those in the financial incentive group, A1C was reduced from 9.5% to 9.1%; and among those in the peer-mentoring group, A1C was reduced from 9.8% to 8.7%.
“Perhaps the most obvious attraction of this type of peer mentoring is that it is virtually free, almost certainly enhancing its cost-effectiveness relative to more expensive interventions, such as nurse care management, telemedicine, and group medical appointments"...
The researchers note that all participants in the study were veterans, so the sense of camaraderie among them may not translate to other groups of people with diabetes, and they call for future studies that look into whether the blood glucose effects seen in this trial are sustainable....
{T]o find a diabetes mentor, check out the article “Peer Support, Education, and Mentoring,” [link] by certified diabetes educator Martha Mitchell Funnell.

[A study published in the November 23/30, 2011, issue of The Journal of the American Medical Association] detailed the results of a blinded crossover trial in which 75 subjects ate either canned soup or homemade soup for five days. Half ate canned soup, followed by a two-day washout period and then homemade soup. The other half ate homemade soup first, followed by a washout period, then canned soup. Aside from the soup, they could eat whatever they liked.
When subjects ate the nationally distributed canned soup, their urinary levels of BPA were 20 times higher than when they ate a similar homemade soup, averaging 1.1 mcg/L when they ate homemade soup for five days and soaring to 20.8 mcg/L when they ate the canned soup for the same amount of time. This wasn’t all soup all the time, people: It was one serving of soup per day at lunch. Just think of all the food and drink we consume out of cans. All day long. (Not to mention the water we drink that comes to us through plastic water pipes.)

People sleeping less than six hours a night were twice as likely to have a stroke or heart attack and 1.6 times as likely to have congestive heart failure. And those sleeping more than eight hours each night were two times as likely to have angina and 1.1 times more likely to have coronary artery disease.

Walnut consumption in a Mediterranean diet was associated with better memory scores and cognitive function. In a recent study, results suggested that antioxidants present in walnuts and other Mediterranean dietary patterns may help counteract age-related cognitive decline and reduce the incidence of neurodegenerative diseases, including Alzheimer's. The investigators believe that the high polyphenol (antioxidant) content found in walnuts may be one of the key elements. Coffee, virgin olive oil and wine were also associated with better cognitive scores. "Findings from previous studies and the current study suggest that a diet with walnuts may reduce the risk of dementia in the elderly population. This may be attributed to a unique combination of anti-amyloidogenic, antioxidant and anti-inflammatory properties of walnuts.

A recent post on the New York Times blog Well looked at what both human and animal studies have found out about the connection between statins and muscle damage. The most recent study, published last year in the Journal of Applied Physiology, found that rats who were given a very high dose of atorvastatin for two weeks had 60% more oxidative stress (an indicator of possible cell damage) than those not given any of the drug. Some of the rats from each group were also made to run on treadmills for as long as possible. Not only did the rats on atorvastatin run a shorter distance than their non-drugged counterparts, but their post-workout oxidative stress was also 226% higher.

Human studies have yielded similar, if less dramatic, results. One study cited in the Well post — published in 2005 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology — found that among healthy people who took atorvastatin for four weeks, 56 genes were expressed differently in leg muscle cells eight hours after vigorous exercise, compared with participants who took a placebo (inactive pill). In particular, genes known to affect muscle building and repair had a lower level of expression in the atorvastatin group. There is also plenty of evidence from patient and doctor reports that statins can lead to muscle fatigue and damage. According to Well, at least 10% of people who take statins will experience some fatigue or weakness, and this number rises to 25% among those who exercise regularly.

[Researchers analysed the results of four studies on white rice consumption and diabetes risk: two in China and Japan and two in the USA and Australia]. All participants were diabetes free at study baseline.
White rice is the predominant type of rice eaten worldwide and has [a high glycemic index]. High GI diets are associated with an increased risk of developing type 2 diabetes. [Chinese eat an average of four portions a day while Westerners eat fewer] than five portions a week.
A significant trend was found in both Asian and Western countries with a stronger association found amongst women than men. [The] authors estimate that the risk of type 2 diabetes is increased by 10% with each increased serving of white rice (assuming 158g per serving).
White rice has a lower content of nutrients than brown rice including fibre, magnesium and vitamins, some of which are associated with a lower risk of type 2 diabetes. [Low intake of these nutrients may increase risk in addition to the high glycemic index and glycemic load.]

A healthy lifestyle maintained throughout young adulthood and middle age [correlates] with low cardiovascular disease risk in middle age. [Investigators claim this is the first study to have shown this.]
The majority of people who maintained five healthy lifestyle factors from young adulthood (including a lean body mass index (BMI), no excess alcohol intake, no smoking, a healthy diet and regular physical activity) were able to remain in this low-risk category in their middle-aged years.
In the first year of the study, when the participants’ average age was 24 years old, nearly 44% had a low cardiovascular disease risk profile. Twenty years later, overall, only 24.5% fell into the category of a low cardiovascular disease risk profile.
Sixty percent of those who maintained all five healthy lifestyles reached middle age with the low cardiovascular risk profile, compared with fewer than 5% who followed none of the healthy lifestyles.
Researchers used data collected over 20 years from the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. It began in 1985 and 1986 with several thousand 18 to 30 year-olds and has since followed the same group of participants.
For this study, the researchers analyzed data such as blood pressure, cholesterol, blood sugar, BMI, alcohol intake, tobacco use, diet and exercise from more than 3,000 of the CARDIA participants to define a low cardiovascular disease risk profile and healthy lifestyle factors.
“Many studies suggest that people who have low cardiovascular risk in middle age will have a better quality of life, will live longer and will have lower Medicare costs in their older age"...

[Women who are sedentary for most of the day [appear to be at greater risk of] exhibiting the early metabolic defects that act as a precursor to developing type 2 diabetes....
[Women in a study] who spent the longest time sitting had higher levels of insulin, as well as higher amounts of C-reactive protein and chemicals released by fatty tissue in the abdomen, leptin, and interleukin6, and which indicate problematic inflammation...
[T]he link between sitting time and diabetes risk was much stronger in women than men....
"[W]omen who meet the national recommendations of 30 minutes of exercise a day may still be compromising their health if they are seated for the rest of the day.

ICU core measures

Some studies have suggested that consumption of diet soft drinks may be associated with Type 2 diabetes and development of the condition known as metabolic syndrome — high blood pressure, abdominal obesity and other risk factors. Now a 10-year epidemiological study has found a link between diet soft drinks and cardiovascular disease.

[Among] 2,564 adults over 40 living in Manhattan,] diet and regular soft drink consumption were both associated with a number of risk factors for cardiovascular disease.

Even after controlling for many of those risks, including diabetes, the researchers found that daily consumption of diet soda was still independently associated with an increased risk for stroke, heart attack and death.

Among those with type 1 diabetes, patients with the highest quartile of TNFR2 values were three times more likely to have renal decline than those in the other quartiles, and the risk associated with high TNFR1 values was slightly less than that seen in those with elevated TNFR2.
These studies found that levels of circulating tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) predict kidney disease in both type 1 and type 2 diabetes.

Still allowing plastic in your kitchen? In your food? In your children's toys?

Even minuscule amounts of BPA (used in everything from pesticides to water bottles) can scramble hormone signals, and trick fat cells into taking in more fat or mislead the pancreas into secreting excess insulin. Among the most ubiquitous and scrutinized of these...endocrine disruptors is bisphenol, better known as BPA. The chemical is a common ingredient in plastics and food-can linings.
Angel Nadal, a BPA expert at the Miguel Hernandez University in Spain stated that, "When you eat something with BPA, it's like telling your organs that you are eating more than you are really eating"[—]the chemical triggers the release of almost double the insulin actually needed to break down food. High insulin levels can desensitize the body to the hormone over time, which in some people may then lead to weight gain and Type 2 diabetes....
BPA fools a receptor into thinking it is the natural hormone estrogen, an insulin regulator. [Even the tiniest amounts of BPA—a quarter of a billionth of a gram—do] the trick. The effect disappeared when the researchers stripped the specific receptors from the study mice, evidence that they had in fact pinpointed BPA's chemical mechanism, which had previously eluded scientists. In laboratory tests of human cells, the response was even more pronounced....
An estimated 90% of people in developed countries have BPA circulating in their blood at levels often [sic] higher than the threshold for causing hormone disruption used in Nadal's study. This high incidence is due not only to exposures from leaching food packages but also BPA-infused cash register receipts, dental sealants and toilet paper.
Frederick vom Saal, another expert in endocrine disruptors at the University of Missouri-Columbia stated that, "People are seeing effects of BPA down to 1000-fold below [Nadal's threshold]." "It takes so little of this chemical to cause harm."

Participants with diabetes were stratified by insulin therapy at baseline: group A treated with insulin only; group B treated with insulin and oral hypoglycemic agent; and group C receiving no insulin treatment.
During a mean follow-up of 3.9 years, the researchers found that 4.6% of the cohort without diabetes died, compared with 15, 12.5, and 7.3% of groups A, B, and C, respectively. The hazard ratios (HRs) for all-cause mortality were 4.3, 4.2, and 2.0 for groups A, B, and C, compared with individuals without diabetes. The leading cause of death in groups A, B, and C were ESRD, ESRD and CAD, and CAD, respectively. The HRs for these conditions were at least twice as high as the HRs for all-cause mortality, extending to 17.3, 17.9, and 5.1 in groups A, B, and C, respectively, for ESRD.
"Excess mortality persists among people with young-onset diabetes of long duration, with ESRD and CAD as the leading contributors to mortality," the authors write.

[Excuse me? Don't the numbers, if correctly reported, suggest that insulin-and-drug therapy increases mortality by over two-thirds, and insulin-only therapy more than doubles mortality?—DMM]

Children and adolescents participating in moderate to vigorous physical activity have a lower cardiometabolic risk profile. [Physical activity correlated with better waist circumference, blood pressure, triglycerides, HDL cholesterol, and insulin in study subjects] regardless of the amount of time they spend sedentary.
[Based on the findings,] children should be encouraged to increase their participation in physical activity] rather than decrease the amount of time they spend sedentary, "as this appears more important in relation to cardiometabolic health."
[In pooled data from 14 studies (1998-2009) connected to the International Children's Accelerometry Database.] the time spent in moderate to vigorous physical activity has a weak to moderate association with the amount of time children spend sedentary, and this had suggested that both variables might be independently associated with cardiometabolic risk.
[A]ctivities ingrained early in life set the stage for what individuals do in their later and older years. "We're living in an age right now where it's so easy to do no physical activity at all...kids can basically go through an entirely normal childhood existence where, unless they're forced or choose to play sports, they don't have to do anything. This study shows that the more activity that you do, even if it's outside the context of typical exercise, really does make a difference."
In the ICAD analysis, 20,871 children and adolescents from Australia, Brazil, Europe, and the US had [physical-activity levels] monitored for an average of 5.2 days using the accelerometer, and the mean daily time spent engaged in moderate to vigorous physical activity was 30 minutes. The mean daily time spent sedentary was 354 minutes.
Kids in the [most active] tertile spent more than 35 minutes per day engaged in moderate to vigorous physical activity, whereas those in the bottom tertile were moderately or vigorously active just 18 minutes per day. The mean difference in waist circumference between the most active and least active kids with the most sedentary time was 5.6 cm [and 3.6 cm] in those with less sedentary time. Similarly, the difference in systolic blood pressure between the most active and least active kids with the most sedentary time was 0.7 mm Hg[, while there was a 2.6-mm-Hg difference] between the most active and least active kids who reported less sedentary time. The variations in HDL cholesterol, insulin, and triglyceride levels were similar when analyzed by physical-activity levels and sedentary time.
Overall, the results showed that higher levels of physical activity were associated with better cardiometabolic risk factors across the tertiles of sedentary time. In contrast, sedentary time was not associated with any of metabolic outcomes independent of the time engaged in moderate and vigorous activities. The researchers note that they did not qualify what specific activities the children were engaged in while being sedentary. For this reason, reducing television viewing time is still considered an important goal of parents and public-health policy because TV watching is also associated with other unhealthy behaviors, such as snacking and drinking soda.

[Some Type 1 diabetics show differences in] HLA genes that normally help the immune system to work. In addition, there are probably at least 16 other areas of DNA where differences can increase your risk of getting Type 1 diabetes....
In most cases, you need more than one DNA difference to get Type 2 diabetes. [At least 12 genes are implicated] in Type 2 diabetes, and there are probably more that scientists know nothing about yet.
In most cases, having DNA differences isn't enough to make you diabetic—it can only increase your chance. To actually get diabetes, something else has to happen....
Early diet may be important.
Type 1 diabetes may be less common in people who were breastfed. Additionally, certain infections or even cold weather might be able to trigger Type 1 diabetes in some people.
You can decrease your chances for Type 2 diabetes by exercising and eating right.
Type 2 diabetes is more common in overweight people or people who don't get enough exercise....
A classic example of all of this is the Pima Indians of Arizona. A Pima Indian with diabetes was virtually unheard of for 2000 years or so.
Recently, many of them have adopted a more typical American lifestyle—little exercise and unhealthy food. Almost overnight, around half of the Pima Indians in Arizona ended up with Type 2 diabetes.
Obviously their DNA didn't change so quickly. The DNA differences for increased Type 2 diabetes risk were always there.
But, with their old life style, it didn't matter. In other words, the DNA wasn't enough to cause the diabetes. Their environment had to change before they developed the disease....
Identical twins share the exact same DNA. So if some trait is completely due to DNA, then both identical twins would always share that trait....
If your identical twin has Type 1 diabetes, you have less than a 50% chance of getting it too. And if your identical twin has Type 2 diabetes, you have about a 75% chance of getting it. So DNA alone doesn't make you diabetic—environment is also important....
DNA, weight, physical activity, diet, and age all affect a person's risk of diabetes. No one thing alone can predict whether or not a person will get diabetes.

Awareness Day Social Media February 2012

In general, the risk of diabetes for a sibling of a patient with type 2 diabetes is about the same as that in the general population. However, there are some exceptions to this general statement. If the patient developed diabetes despite being lean, then the sibling’s risk is about twice the general population risk. Or, if the patient has a parent with type 2 diabetes, the sibling’s risk is almost three times the general population risk. If both parents have type 2 diabetes, the sibling has a fourfold risk, or nearly a 50% chance of developing diabetes.
The genetics of type 2 diabetes is complex. While type 2 diabetes may have a strong genetic basis in some patients (something less than a third of them), the development of diabetes in most patients is dependent upon the effects of environmental and behavioral factors (obesity and sedentary lifestyle) on an underlying susceptibility that is poorly understood....
Joslin researchers and others have identified about six genes that produce MODY[—maturity-onset diabetes of the young, a rarer form of type 2—but they only account for the diabetes in about one-third of affected] families....Similar patterns can be found in studies of families with the more common form of type 2 diabetes, only the age of onset differs.
The susceptibility to certain diabetes complications also seems to be linked in some ways with genetics. For patients with susceptibility genes for complications, good blood glucose control is still an important mitigating factor.

Racial disparities in hypertension control account for nearly 8,000 preventable deaths annually among African-Americans, making increased blood pressure control among African-Americans a “compelling goal"...
African-Americans commonly develop hypertension at a younger age, are less likely to have their blood pressure under control, and disproportionately suffer strokes and fatality when compared with their Caucasian counterparts[:] a 30% greater rate of non-fatal stroke, an 80% greater rate of fatal stroke, and a staggering 420% greater rate of end-stage kidney disease for African-Americans...
[Only 51% of all patients with hypertension adhere to their medications;] adherence rates are even lower for African-American patients.
Dr. Lewis identified self-efficacy, depression, and patient-provider communication among the factors in medication nonadherence. She called for further study, but advised that these factors are important for healthcare providers to consider when treating hypertensive African-American patients.
“Increasing blood pressure control requires a comprehensive approach...Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. [Clinicians also] may want to screen their hypertensive patients for depression...”

Raspberry ketones are on the FDA’s GRAS (generally recognized as safe) list. But in terms of their fat-burning ability, the only research to support this claim dates back years…and that study was done with mice. Not humans. So we really don’t know if this supplement works. And it’s not without some possible serious side effects: increased heart rate and blood pressure, difficulty sleeping, agitation, and maybe hypothyroidism (underactive thyroid). Avoid taking this supplement if you have high blood pressure or thyroid issues. We don’t know enough about it how it affects diabetes control, either....
[Glucocil] is targeted to people with Type 2 diabetes, and its claim to fame is that it can reputedly stabilize postmeal blood glucose levels, decrease carbohydrate absorption, decrease appetite, and promote weight management. Pretty hefty claims for a supplement whose key active ingredient is mulberry leaf extract....
[This supplement also] contains alpha lipoic acid, banaba leaf extract, chromium picolinate, cinnamon bark powder, gymnema sylvestre extract, fish oil, and a few other things thrown in for good measure. Glucocil’s Web site clearly lists the research — but only for each separate ingredient. Nowhere on the site could I find research citing the effectiveness of the actual supplement....As far as mulberry leaf extract goes, a few small studies (mostly done with rats) show some reduction in glucose after ingesting it, but not enough to boast about....
We don’t know if the blend of these ingredients actually live up to Glucocil’s claims of glucose and weight control, nor do we know if the amount of ingredients in this supplement are in the right proportions to be effective. The Web site states that people under the age of 18, pregnant women, and people with liver and kidney problems should not take Glucocil. Also, they state that if you take insulin and don’t have cardiovascular, liver, or kidney problems, you can “consider” taking Glucocil. Side effects include “minor GI discomfort,” such as gas and loose stools.

NAFLD affects one in three Americans...and is marked by fatty build-up in the liver, with or without inflammation. In its advanced form, known as non-alcoholic steatohepatitis, the disease causes cell death, irreversible scarring and liver failure.
Physicians do not know why some patients develop the more severe forms of the disease fairly quickly while others remain relatively healthy, but nutrition, body weight, genes and environment are all believed to play a role in disease progression. Recent research shows that more children and adults are developing fatty livers, likely due to growing obesity rates...
In the current study, [none of the patients met the daily recommended choline] intake, but only those eating less than half the recommended doses were deemed choline-deficient.
Controlling for other risk factors, like body weight and alcohol consumption, menopausal women who consumed less than half the recommended daily choline had greater degrees of liver scarring, the researchers found. Advanced liver scarring was found in nearly half of the 63 postmenopausal women in the group with choline-deficient diets, compared with 30% of the 131 post-menopausal women with non-deficient diets. Differences were far less pronounced among men, children and women of child-bearing age. Advanced liver scarring was found in 18% of choline-deficient women of childbearing age and in 10% of those with non-deficient diets.
Eighteen percent of choline-deficient males 14 years of age and older had advanced liver scarring compared with 16% among their non-deficient counterparts. Advanced liver fibrosis was seen in 10% of choline deficient children ages 9 through 13, while 17% of non-deficient ones had the same degree of liver scarring.
[Why is there no comment or emphasis on the (correctly?) reported counterintuitive results in children and teens, or on the possibility that intake recommendations may be inflated across the board, and dangerously so for kids?—DMM]

According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.

Individuals who maintained or improved their fitness levels had a 26% and 28% lower risk of developing hypertension, a 42% and 52% lower risk of developing metabolic syndrome, and a 26% and 30% lower risk of developing elevated levels of LDL cholesterol, respectively....
[Subjects who got fatter in follow-up, as measured by percentage of body fat,] had a 26%, 71%, and 48% higher risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively...compared with individuals who lost weight. Similar results were observed when BMI was used as the criterion for fatness levels.
Every 1-MET improvement in fitness was associated with a 7%, 22%, and 12% lower risk of developing hypertension, metabolic syndrome, and hypercholesterolemia, respectively, while every unit increase in percentage of body fat was associated with a 4%, 10%, and 5% increased risk of developing the cardiovascular risk factors...
"In the real world, people change their fitness levels or fatness over time...Fitness and fatness, not the baseline levels, but the changes over time, are both independently important to reduce cardiovascular disease risk factors."
[Patients who had stable or increasing amounts of fatness in combination with loss of fitness had significantly higher rates of cardiovascular risk factors when compared with] individuals who gained fitness over time and lost fat. They did observe that losing fitness regardless of fat changes and getting fatter irrespective of the change in fitness levels were associated with a higher risk of developing metabolic syndrome. The adverse effects of getting fatter were attenuated slightly if fitness was maintained or improved, while declines in fitness could be offset by reductions in body-fat percentage.
"Maintaining or improving fitness levels and preventing fat gain are both important, independent of the changes of each other...[T]he ideal combination is to improve fitness and prevent fat gain, but as long as individuals maintain fitness and fatness, they are not likely to be at higher risk of cardiovascular disease risk factors. Losing weight and gaining fitness is very challenging to the general population, but maintaining fitness and fatness are less so and more doable."

Individuals who are genetically predisposed to have low levels of high-density lipoprotein (HDL[, "good"]) cholesterol or high levels of triglycerides have an increased risk of developing type 2 diabetes....
[Using data from 2,447 patients with type 2 diabetes from the Nurses' Health Study and 3,052 control subjects free of diabetes from the Health Professionals Follow-up Study, researchers analyzed genotype scores for low-density lipoprotein (LDL) cholesterol, HDL cholesterol, and triglycerides. Only] HDL cholesterol and triglycerides scores were linearly associated with an increased risk of type 2 diabetes. For each point of the HDL cholesterol genotype score, there was a 3 percent increase in the risk of developing type 2 diabetes, and for each point on the triglyceride genotype score, the increase was 2 percent. Comparing the highest and lowest quartiles of genotype scores, the odds ratios for type 2 diabetes were 1.39 for HDL cholesterol and 1.19 for triglycerides.
"In conclusion, genetic predisposition to low HDL cholesterol or high triglycerides is related to elevated type 2 diabetes risk."

[A new study] suggests that hyperglycemia (high blood sugar) injures the heart, even in patients without a history of heart disease or diabetes...[E]levated levels of glycated hemoglobin (HbA1c), a marker for chronic hyperglycemia and diabetes, were associated with minute levels of the protein troponin T (cTnT), a blood marker for heart damage. The high-sensitivity test they used detected levels of cTnT tenfold lower than those found in patients diagnosed with a heart attack....[H]yperglycemia may be related to cardiac damage independent of atherosclerosis....
Higher levels of HbA1c were associated in a graded fashion with elevated levels of high-sensitivity cTnT. This relationship was present at HbA1c levels even below the threshold used to diagnose diabetes. Using conventional tests, troponin T can be detected in 0.7% of the population and is associated with heart attacks and death. With the high-sensitivity cTnT test, low levels of troponin were found in 66% of the study population....
"[G]lucose might not only be related to increased atherosclerosis, but potentially elevated glucose levels may directly damage cardiac muscle"...

RT @JPBarlow: Study shows marijuana doesn't threaten lung health. Not that this will matter...

There are 300 recipes for macaroni and cheese on the Food Network’s Web site. I’m using mac-n-cheese here as a symbol for all of those starch- and fat-laden comfort foods we love and like to occasionally indulge in.
Mac and cheese with two cheeses. Three cheeses. Four cheeses. SEVEN cheeses! Mac and cheese with ham…with bacon…with corned beef. With heavy cream (four cups in at least one recipe). With Tater Tots.
The recipes were from such celebrity chefs as Ina Garten (the Barefoot Contessa), Alton Brown, Giada De Laurentiis, Guy Fieri, and Emeril Lagasse (who once had an episode called “Pork Fat Rules.” BAM!). And, oh yeah, Paula Deen. Who, admittedly, deep-fries mac-n-cheese.
But people are only complaining about Paula Deen cooking starch- and fat-laden foods. Why? Unless you live in a cave, you probably heard last week that Deen was diagnosed with Type 2 diabetes. Three years ago. Therefore, she should have stopped cooking those decadent foods. Immediately! Fessed up. Admitted her sins.
And her critics are crawling out of the woodwork: “5 Paula Deen recipes that could give you diabetes” proclaims one headline. (Psst! Food does NOT give you diabetes!)

Federal regulators have warned Johnson & Johnson that it could face fines and other sanctions for selling faulty insulin pumps and delaying disclosures of serious injuries to diabetics who were using its OneTouch Ping and 2020 pumps. The FDA ordered the Animas Corp. unit of J&J to explain why it kept selling pumps known to fail and also to submit a plan to rectify a failure to promptly report cases in which its device might have caused or contributed to death or serious injury....
In the issue with the Animas insulin pumps, some pump keypads for controlling how much insulin is injected were deteriorating prematurely, leading to failures. "We decided to go with a new keypad because it's more durable," [spokesperson Caoline] Pavis said.
But while Animas was lining up the new keypad supplier, it was still selling the older ones. The FDA demanded documents about the company's decision to do that.

People with diabetes are three to four times as likely to have major depression as people without diabetes, and depression appears to increase the risk of Type 2 diabetes in certain populations. Depression is also known to increase the risk of complications in people with Type 2 diabetes. Now, new research indicates that treating people for both depression and diabetes simultaneously can significantly improve both conditions.
Depression may affect a person’s ability to carry out diabetes self-management tasks, such as taking medicines and monitoring blood glucose. And the stress of managing diabetes can contribute to an increased risk of depression. (There may be other biological factors, such as inflammation, contributing to the association as well)....
[Intervention subjects] and their doctors worked along with integrated care providers to identify and deal with issues that might interfere with [taking] medicines as advised, such as the price of the medicine or a lack of social support. The managers then crafted tailored programs to help these individuals stick to their diabetes medicine and antidepressant regimens....
At the end of the 12 weeks, 60.9% of those receiving the integrated treatment approach had improved their blood glucose levels, compared to only 35.7% of people receiving standard therapy. Moreover, 58.7% of participants in the integrated treatment group showed signs of remission in their depression, compared to only 30.7% of those in the usual treatment group.

• High blood glucose makes your blood “sludgy,” slowing circulation so cells can’t get the oxygen and nutrients they need. Margaret commented, “I can tell if my sugars are high in the morning, because ‘groggy’ doesn’t begin to describe it. ‘Drugged’ is how it feels.”
• Low sugars levels also cause fatigue, because when blood sugar is low, there is not enough fuel for the cells...
• [With vascular inflammation caused by igh blood glucose,] immune cells called monocytes come into the brain, causing fatigue....
• [P]eople with diabetes are more likely than others to have thyroid problems. If your thyroid level is low, you are likely to feel tired, sleepy, and depressed.
• Low testosterone levels, especially in men. Men with diabetes are much more likely to have low testosterone.
• Infections: People with diabetes often have infections they don’t know about. Infections take energy to fight, which can cause fatigue and raise blood sugar levels. A common source is urinary tract or “bladder” infections. They often hurt, but sometimes have no symptoms, except for the fatigue. Silent dental infections and vaginal infections are also common and fatiguing.
• Undiagnosed heart disease : If you get tired after tasks that you used to sail through, it could be time to for a heart check-up....
• Many drugs for diabetes, blood pressure, depression, pain, and other issues can cause fatigue. Read labels, ask your doctor or pharmacist....
• Some people are too wound up or too busy to sleep. Or they’re up to use the bathroom all night, or they have obstructive sleep apnea (OSA), which can wake them up many times an hour....
• [Rotating shifts or working nights] can cause fatigue directly by messing with your body clock or indirectly by disrupting sleep.
• Depression is very common with diabetes. Most depressed people feel fatigued, even if they don’t feel sad. Even at low levels, depression can sap your motivation....
• Doing too much: If you’re ripping and running all day, not taking breaks or even stopping to breathe much, you are courting fatigue....
• Stress: In small doses, psychological or physical stress can give you energy, but if it goes on too long, it will wear you out...
• Too much carbohydrate — especially refined carbs — can make anyone tired, especially with diabetes. Kat wrote, “now that I am eating a higher protein/fat, lower-carbohydrate diet, I have shaken off that really sleepy/extreme fatigue that I used to have every day.”
• According to WebMD, too much caffeine can cause fatigue through a rebound effect. They also say that dehydration, or not drinking enough liquid, is a major cause of fatigue.
• Being out of shape or having weak muscles: Not moving our bodies contributes to fatigue. Of course, it’s hard to exercise when you’re fatigued.

“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues"...
The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic and health risk factors, patients with sleep disturbances at least three nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.
Grandner and colleagues analyzed data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) of 138,201 patients[—]the world’s largest telephone survey, designed to monitor health-related behaviors in the general population.
“This study is one of the largest ever to link sleep problems with important cardiovascular and metabolic diseases. It joins other studies that show that sleep is an important part of health, just like diet and physical activity"...

There was no evidence of any adverse effect of low systolic blood pressure on any cardiovascular outcome, except for cardiovascular mortality, which was significantly increased in patients with a baseline systolic blood pressure below 130 mm Hg who had the greatest systolic blood pressure reduction.

When in-treatment systolic blood pressure was examined by decile, there was a progressive reduction in the incidence of stroke down to 115 mm Hg systolic blood pressure, whereas there was a J-curve relationship for the other outcomes. For cardiovascular death, the nadir of the J-curve was around 135.6 mm Hg for diabetic patients and 133.1 mm Hg for nondiabetic patients.

For diastolic blood pressure, the primary outcome was most common in patients with the lowest or highest in-trial diastolic blood pressure (for both diabetic and nondiabetic patients), regardless of the systolic blood pressure.

What are the therapeutic implications of these findings? "In both diabetic and nondiabetic patients, progressively greater systolic BP reductions were accompanied by reduced risk for the primary outcome only if baseline systolic BP levels ranged from 143 to 155 mm Hg," the authors say.

They continue, "Around or below an initial systolic blood pressure of 130 mm Hg, antihypertensive treatment should be implemented with caution because of the possibility of untoward cardiac effects that could counterbalance the beneficial consequences of aggressive blood pressure reduction for stroke. This might also apply to diastolic blood pressure values of 67 mm Hg or less."

"Clearly," they add, "more evidence from prospective trials is necessary to learn whether high-risk diabetic patients with blood pressure levels between 130 and 140 mm Hg should be treated to lower blood pressure levels."

[Investigators, to their surprise, found that education and an active mind] offered no protection...Instead, they found hints that Alzheimer's disease could have already begun in some women by the time they entered the convent.
The nuns whose sentences were grammatically complex and packed with ideas when they were in their 20's remained sharp of mind when they were in their 80's. In contrast, almost all those whose sentences were simple and comparatively devoid of complex grammatical constructions were demented six decades later. [Without knowing the fate of the writer of each sample, researchers could] predict with 90% accuracy which ones would develop Alzheimer's disease when they were old...
[The nuns] lived together in the same environment for 60 years, so vagaries of diet or other environmental influences did not affect their risk]....
The most telling linguistic feature was idea density, a measurement imported from the field of psycholinguistics that looks at how many ideas are in a given piece of writing. [Researchers measured idea density] to categorize texts according to how difficult they are to read and understand....
"To me, it was the most bizarre finding on earth," [author James] Mortimer said. But he added that he was now convinced that Alzheimer's disease might well be "a lifelong disease," one that progresses very slowly and manifests itself as dementia only when a certain threshold in brain damage is reached....
Other researchers said they had also struggled with disbelief when they learned of the study results but found the research design elegant and the evidence compelling. Many said the study might mark a turning point in the way researchers think about Alzheimer's disease....
Dr. Neil Buckholtz [of the National Institute on Aging] cautioned that the results might not mean that Alzheimer's disease starts when people are in their 20's. Another hypothesis [is] "a difference in the brains of these two groups [that interacts with an Alzheimer's process that may occur later...Whatever] the process of Alzheimer's disease is, it occurs earlier than the symptoms...[We really don't know] how far back it goes."
[The study's conclusions fit with research by Tomas G. Ohm et al. who examined 887 brains of people 20 to 104 years old and reported] that neurofibrillary tangles, the pathological changes characteristic of Alzheimer's disease, could be present even when people were 20 years old.
In a recent paper published in Neuroscience, the German group concluded that "the deep roots of Alzheimer's disease-related neurofibrillary changes can be traced about 50 years back and may even extend into adolescence."
[Dr. David A. Snowden] and his colleagues had begun their research expecting that nuns who had spent their lives teaching would be less likely to develop Alzheimer's disease than those with a high school education or less who had handled household chores at the convent.
But the researchers found no such effect. When the investigators restricted their analysis of the writing samples to the 85 nuns with college degrees, "the results were just as striking," Dr. Snowden said.
[Psycholinguist and study author Susan J.] Kemper said it was not yet known whether idea density was related to intelligence or to measures like verbal scores on college entrance exams or an ability to do well on analogies tests...
The investigators also looked at the nuns' writings when they were older to see if the idea density in their writings remained constant. It did. Those with the prose rated most dense in ideas when they were 20 had the most idea-dense prose when they were 80, and vice versa....
The investigators are also working with Dr. Allen D. Roses of Duke University to see if one genetic risk factor, the inheritance of apo E4 genes, was more prevalent among the nuns whose writings had low idea densities.
One thing the study shows, Dr. Roses said, is that "we ought to be less seriously wed to our beloved hypotheses."

Scientists have proven that cannabis does have medical usefulness, and the more we learn the more intriguing these discoveries become. Since the early 1980s, medical researchers have published about how cannabis relieves pressure in the eye, thus easing the symptoms of glaucoma, a disease that causes blindness. THC is also "neuroprotective," meaning in essence that it prevents brain damage. Some studies have suggested that cannabis could mitigate the effects of Alzheimer's for this reason.
At the same time, we know that THC interferes with memory, and it's still uncertain what kinds of long-term effects the drug could have on memory functioning. No one has been able to prove definitively that it does or does not erode memory strength over time.
[Article strength: quite specific about potentially adverse effects on brain and body before the cautious statement above about neuroprotective effects.
Weaknesses: Ignores action of other cannabinoids and cannabinols. Sets up a false opposition insofar as the short-term memory effects seem to be about memory formation, not memory retention or loss. No citations.—DMM]

In a study of more than 4,000 black women in Los Angeles, those...living in neighborhoods with high levels of nitrogen oxides, pollutants found in traffic exhaust, were 25% more likely to develop diabetes and 14% more likely to develop hypertension than those living in sections with cleaner air.
According to the Centers for Disease Control and Prevention, forty-four percent of all black women in the U.S. have high blood pressure and about 11% have diabetes, compared with 28% and roughly 7%, respectively, of white women. Black Americans are also exposed to higher levels of air pollution than white Americans...
The findings on their relative risks for those conditions take into account several other potential influences, including how heavy the women were, whether they smoked and other stressors, including noise levels at participants' homes.
The researchers measured average pollution levels near participants' homes for only one year and the patterns remained relatively constant over the entire study period. While Dr. Coogan and her colleagues estimated nitrogen oxide concentrations near participants' homes, they did not account for commuting habits or exposure to air pollution at work...Americans, on average, spend about 70% of their time at home.
In addition to measuring nitrogen oxides, a proxy for traffic pollution, the researchers evaluated levels of fine particulate matter. Women who lived in areas with higher fine particulate exposures also faced an increased risk of diabetes and high blood pressure, although statistically the link was weak and could have been due to chance.
Previous reports have suggested that air pollution particles small enough to make their way into the bloodstream may contribute to a narrowing of blood vessels, which can lead to high blood pressure and reduce sensitivity to insulin.

Many rural American Indians live on reservations where it is difficult to obtain healthful foods, a likely scenario for many residents of rural America at large. Without access to markets with adequate food choices, many people rely on food from local convenience stores, including canned meat....
[More than 68% of study subjects] ate more than two servings of processed meat a week. Less than 1% reported never consuming any processed meat during the past year. Participants who ate processed meats at least twice a week had a 63% higher risk of diabetes compared to participants who ate processed meat less than twice a month.
Participants who reported eating canned meat at least twice a week had double the risk of diabetes, compared to those who reported never consuming canned meat....
Processed meats are rich in additives and preservatives, such as sodium nitrate. Processed meats also contain high amounts of advanced glycation end products, substances formed during the heating and processing of meats that influence inflammation and oxidative stress, both of which are risk factors for diabetes.
The researchers also note that disadvantaged participants who rely on canned meats may have other, unmeasured lifestyle factors, such as inability to comply with medical advice, that may contribute to the development of diabetes.

I may say some nasty and completely true things about the medical establishment.
I only started paying attention [to the ACCORD study] when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got...ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it....
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.[Encouraging participating doctors to unsystematically and aggressively prescribe multiple drugs all but guaranteed drug interactions and adverse effects.]
In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.
Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low....
What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.
You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.

Anderson and colleagues suggest that this association between early childhood experiences and teen obesity has origins in the brain. The limbic system in the brain controls responses to stress as well as the sleep/wake cycle, hunger and thirst, and a variety of metabolic processes, mostly through the regulation of hormones.
“Sensitive parenting increases the likelihood that a child will have a secure pattern of attachment and develop a healthy response to stress,” Anderson said. “A well-regulated stress response could in turn influence how well children sleep and whether they eat in response to emotional distress – just two factors that affect the likelihood for obesity.”
Obesity may be one manifestation of dysregulation in the functioning of the stress response system. Parents help children develop a healthy response to stress by protecting children from extreme levels of stress, responding supportively and consistently to normal levels of stress, and modeling behavioral responses to stress.
“The evidence here is supportive of the association between a poor-quality maternal-child relationship and an increased chance for adolescent obesity,” Anderson said. “Interventions are effective in increasing maternal sensitivity and enhancing young children’s ability to regulate their emotions, but the effect of these interventions on children’s obesity risk is not known, and we think it would be worth investigating.”

Kale chips: Wash and dry the kale, then remove the ribs and tear the leaves into potato chip-sized pieces. Place them on a baking sheet and toss lightly with a bit of olive oil and a pinch of sea salt. Bake at 275ºF, turning them over halfway through, for about 20 minutes.

[David Agus, MD:] "Reimbursement for preventive medicine's always difficult in our country...[T]he problem is most people change health plans all the time. So if you're that health plan, why should you spend money on something that's not going to affect a person until a decade from now? And so one of things we really have to change is we have to push prevention... a heart attack costs hundreds of thousands of dollars. A couple hundred dollar tests along with a drug can prevent it. Obviously it's cost effective as a return on investment"....
[Bill Weir:] Since my HDL (good cholesterol) levels are in fine shape, he explained that I don't need a low-fat diet, but a "good-fat diet,"—olive oil, canola oil, [heart-smart] eggs and cold-water fish—eaten on a consistent schedule. When you have lunch at noon one day and 3 p.m. the next, you're releasing stress hormones that can hurt in the long run, Agus said.
Instead of hitting the gym hard in the morning and then sitting all day (which can be as bad for you as smoking), the doctor encourages more movement throughout the day....
And he ordered me to skip the fish oil capsules and multivitamin in favor of the freshest real food I can find.
"You're not vitamin deficient...You look at all the large studies with vitamins and most of them have caused problems rather than benefits. And you don't need to be on them. So real food, regular schedule, live healthy."

[Surveyed] nurses with long work hours were significantly more likely to be obese compared with underweight or normal weight nurses. The obese nurses also reported having jobs requiring less physical exertion and less movement.
"Long work hours and shift work adversely affect quantity and quality of sleep, which often interferes with adherence to healthy behavior and increases obesity"...
[The University of Maryland School of Nursing studies adverse effects from unfavorable nursing schedules on nurses' health,] hospitals and patient care outcomes.
[Previous research by the same team] found that, along with long work hours, the work schedule component most frequently related to patient mortality was lack of time off from the job. Another study revealed evidence to challenge the common 12-hour nursing shift, which can result in sleep deprivation, health problems, and a greater chance for patient-care errors. [Researchers have also] described barriers that keep nursing executives from moving away from the practice, and offered strategies to help mitigate the possible negative effects of 12-hour shifts.
The obesity study suggests that educational interventions about sleep hygiene and strategies for adapting work schedules should be offered by hospitals and other health care institutions; and that a favorable organizational climate that supports napping in the workplace can help prevent work-related sleep deprivation, reduce fatigue, and increase energy for healthy [behaviors].
About 55% of the nurses surveyed were obese. "Considering that more than half of nurses are overweight or obese, increasing availability of healthy food and providing sufficient time to consume it may reduce the risk of obesity and future health problems",,,.

"Bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) leads to complete remission in only about one third of patients with type 2 diabetes, and should be viewed as a means for improving glycemic control, not as a cure."
Using the recently updated American Diabetes Association (ADA) standard, which defined diabetes remission as hemoglobin (Hb) A1c levels below 6% and fasting glucose levels less than 100mg/dL.(5.6 mmol/L ) at least 1 year after bariatric surgery without hypoglycemic medication, the researchers found remission to be substantially lower than had been reported with earlier criteria[:] 40.6% after gastric bypass (65/160 patients), 26% after sleeve gastrectomy (5/19 patients), and 7% after gastric banding (2/30 patients). "The remission rate for gastric bypass was significantly lower with the new definition than with the previously used definition (40.6 versus 57.5%...)." Remission rates for the other 2 procedures were not significantly different according to the new vs the old criteria...
[O]n average, patients remained obese after surgery (preoperative body mass index [BMI], 48 kg/m2 vs postoperative BMI, 35 kg/m2). After surgery, oral hypoglycemic medications were still used by 29.4% of gastric bypass patients, 63% of sleeve gastrectomy patients, and 83% of gastric banding patients.
HbA1c levels were significantly lower after surgery in all 3 surgical groups, with mean levels of 6.2% (compared with 8.1% before gastric bypass), 6.8% (7.5% before sleeve gastrectomy), and 6.3% (7.7% before gastric banding...
The authors [recommend] "establishing realistic expectations among patients, clinicians, and policy-makers" regarding bariatric surgery in the management of type 2 diabetes. They suggest that emphasis should shift to bariatric surgery as an aid in achieving glycemic control, rather than as a tool for achieving remission...
"The principal benefit of surgery, however, would not be to improve glycemic control per se but rather to reduce microvascular and macrovascular complications associated with diabetes. [We] emphasize the need for intensive follow-up of patients with type II diabetes following bariatric surgery, in order to review pharmacological treatment, monitor for complications of diabetes, and ensure that adequate glycemic control is achieved."

Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus.
New data from the Women's Health Initiative (WHI) [indicates risk of diabetes is higher than previous studies have suggested: 48% increased risk]....
Recently published data reported the potential risk of diabetes with statin therapy. Dr. Kausik Ray (St. George's University of London, UK) and colleagues published a meta-analysis of [five trials testing high-dose statin therapy,] and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in The Lancet in 2010 by Dr. Naveed Sattar (University of Glasgow, UK) also showed that statin therapy was associated with a 9% increased risk of diabetes.
[The present study produced an unadjusted risk model associating statin use at baseline] with a 71% (95% CI 1.61–1.83) increased risk of diabetes. After adjusting for potential confounding variables, the risk...declined to 48% (95% CI 1.38–1.59). The association was observed for all types of statins.
Dr. Kirsten Johansen,[ Editor of the Archives of Internal Medicine, noted that previous meta-analyses show no benefit of statins on all-cause mortality in the setting of primary prevention]...
[S[tatins are used with increasing frequency, including in primary prevention, and—based on the JUPITER trial—in patients with normal LDL cholesterol, but elevated C-reactive protein (more than 2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.
Just 7% of women in the WHI study were taking statins in the analysis, but today that number would be significantly higher, making the potential risk of diabetes at the population level much more widespread.

Low levels of vitamin D may confer a cardiovascular benefit, but too much vitamin D may have the opposite effect. The critical threshold appears to be a serum 25-hydroxyvitamin D concentration of 21 ng/mL—more than that level increases C-reactive protein (CRP), a biomarker for cardiovascular disease, but lower serum concentrations of 25-hydroxyvitamin D lower CRP levels.
A multivariate analysis that tracked 25-hydroxyvitamin D concentrations as well as CRP in more than 15,000 healthy adults revealed that above the threshold for benefit, CRP increased with each 10-ng/mL increase in 25-hydroxyvitamin D.
In a univariate analysis, CRP levels decreased as levels of 25-hydroxyvitamin D increased up to the median of 2 ng/mL.... [?]
The mean age of participants was 46, and the median serum 25-hydroxyvitamin D and CRP levels were 21 ng/mL and 0.21 mg/dL, respectively. [No significant difference in levels of 25-hydroxyvitamin D was found between near-equal numbers of men and women.] Whites had significantly higher baseline levels of 25-hydroxyvitamin D than nonwhites.
Significantly more people with a body mass index greater than 30 kg/m2 had lower 25-hydroxyvitamin D levels at baseline (41% versus 25%, P<0.0001); the same was true for smokers (22% versus 18%, P=0.004)....
"From our results, it appears that vitamin D supplementation among asymptomatic subjects with baseline vitamin D values of greater than 21 ng/mL might have no additional effects on systemic inflammation, as measured by changes in the serum CRP levels"...
[The] study found a significant inverse relationship between CRP and 25-hydroxyvitamin D levels less than 21 ng/mL.
[P]rior studies assessing the relationship between vitamin D status and markers of inflammation have yielded inconsistent results.

Amer M, Qayyum, R "Relation between serum 25-hydroxyvitamin D and C-reactive protein in asymptomatic adults (from the Continuous National Health and Nutrition Examination Survey 2001 to 2006" Am J Cardiol 2012; 109: 226–230

"Higher numbers for hypertension and diabetes definitely explain some of the excess risk for stroke in blacks compared to whites, but not this much risk," says study co-lead investigator and preventive cardiologist Erin Michos [of Johns Hopkins University]. "Something else is surely behind this problem. However, don't blame vitamin D deficits for the higher number of strokes in blacks."

[In 8,000 initially healthy men and women of both races, researchers compared the risk of death from stroke between those with the lowest to highest blood levels of vitamin D]. Among them, 6.6% of whites and 32.3% of blacks had severely low blood levels of vitamin D[:] less than 15 nanograms per milliliter.

"It may be that blacks have adapted over the generations to vitamin D deficiency, so we are not going to see any compounding effects with stroke," says Michos, who notes that African Americans have adapted elsewhere to low levels of the bone-strengthening vitamin, with fewer incidents of bone fracture and greater overall bone density than seen in Caucasians.
[Michos] emphasizes that clinical trials are needed to verify that supplements actually do prevent heart attacks and stroke. In her practice...she monitors her patients' levels of the key nutrient as part of routine blood work while also testing for other known risk factors for heart disease and stroke, including blood pressure, glucose and lipid levels.

Michos cautions that the number of fatal strokes recorded in blacks may not have been statistically sufficient to find a relationship with vitamin D deficits. And she points out that the study only assessed information on deaths from stroke, not the more common "brain incidents" of stroke, which are usually non-fatal, or even mini-strokes, whose symptoms typically dissipate in a day or so. She says the team's next steps will be to evaluate cognitive brain function as well as non-fatal and transient strokes and any possible tie-ins to nutrient deficiency.

Besides helping to keep bones healthy, vitamin D plays an essential role in preventing abnormal cell growth, and in bolstering the body's immune system. The hormone-like nutrient also controls blood levels of calcium and phosphorus, essential chemicals in the body. Shortages of vitamin D have also been tied to increased rates of breast cancer and depression in the elderly.

Michos recommends that people maintain good vitamin D levels by eating diets rich in such fish as salmon and tuna, consuming vitamin-D fortified dairy products, and taking vitamin D supplements. She also promotes brief exposure daily to the sun's vitamin D-producing ultraviolet light. And to those concerned about the cancer risks linked to too much time spent in the sun, she says as little as 10 to 15 minutes of daily exposure is enough during the summer months.

If vitamin supplements are used, Michos says that daily doses between 1,000 and 2,000 international units are generally safe and beneficial for most people, but that people with the severe vitamin D deficits may need higher doses under close supervision by their physician to avoid possible risk of toxicity.

The U.S. Institute of Medicine (IOM) previously suggested that an adequate daily intake of vitamin D is between 200 and 600 international units. However, Michos argues that this may be woefully inadequate for most people to raise their vitamin D blood levels to a healthy 30 nanograms per milliliter. The IOM has set up an expert panel to review its vitamin D guidelines, with new recommendations expected by the end of the year.

Previous results from the same nationwide survey showed that 41% of men and 53% of women have unhealthy amounts of vitamin D, with nutrient levels below 28 nanograms per milliliter.

Asked to address the concerns of naysayers, who argue that there is little proof that reducing salt in the diet will have an effect on health outcomes and who say that the administration should not get involved in "nanny-state" activities like regulating the amount of sodium people consume, Bakris said that government-backed salt-reduction campaigns "have been very effective in the UK, in Finland (with a dramatic improvement in mortality) and in Japan, and there is absolutely no reason we should not do this.

"The reality is that there needs to be some guidance to the general public about this—most people do not read labels, most people don't pay attention, and they don't know how much salt is too much... Clearly, the FDA does have a role as a regulatory body to adjust sodium standards in foods so that they are in keeping with the current guidelines."

"It's certainly true that people who are in their 20's and teens don't need salt restriction for blood-pressure control, [but it is an acquired taste. If] you don't learn from a young age, it's going to catch up with you in your 40's, 50's, and 60's, when you actually will need some salt restriction..."

In response to what Bakris calls the "outcomes mafia, who say that unless we have an outcomes study it's impossible to make any conclusions," he remarked, "[C]ommon sense has to prevail. The FDA as a regulatory body has accepted the notion that lowering of blood pressure is a validated surrogate for a reduction in cardiovascular mortality and morbidity... To do an [outcomes] clinical trial...you would need well over 100 000 people, so it's not feasible. Let's be reasonable."

"If you are telling me that reducing BP by 5 to 7 mm Hg, which is what most of these salt restrictions will do, is not going to translate into a benefit, then I think we have to throw out all the clinical trials we have to date...[No meta-analysis of any clinical trials] fails to show that a reasonable reduction in blood pressure has not [sic] been associated with a benefit, certainly on stroke and to a lesser degree on coronary events...[T]he data are very consistent."

"I think the conflict of interest here needs to be established,...With all due respect, many of the people who are saying this are also consultants to the Salt Institute, they are lobbyists in their own right. They spin the data to make it suit what their needs are."

People who live in the states of North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana are more likely to die from stroke than people living in other parts of the U.S., the researchers note.

Omega-3 fatty acids in fish, especially oily fish, favorably alter platelet aggregation, blood pressure, lipid profile, and endothelial function and may reduce the risk for ischemic stroke. However, when fish is fried, it loses natural omega-3 fatty acids. Moreover, in the U.S., most fish served fried tends to be from lean species that pack lower amounts of omega-3 fatty acids.

Millions of women over age 50 on statin drugs are at a significantly increased risk of developing diabetes, according to a new study from UMass Medical School published online Monday, Jan. 9, in the Archives of Internal Medicine. Senior author Yunsheng Ma, MD, PhD, associate professor of medicine and an epidemiologist at UMMS, said the study found that postmenopausal women on statin drugs showed a 48 percent increased rate of diabetes compared to those not on the cholesterol-lowering medications....
According to surveys by the National Center for Health Statistics, the rate of Americans over age 45 taking statins has increased tenfold over the last 20 years: from 2 percent in the period from 1988 to 1994, compared to 25 percent from 2005 to 2008, the most recent years for which figures are available. The federal data also shows that figure jumps to 50 percent of men ages 65 to 74 taking statins, while 39 percent of women age 75 and older are doing so.

The research [mapped] variation in DNA methylation - a naturally occurring mechanism for regulating genes and protect[ing DNA - instead of] conventionally mapping variation in DNA sequence. [A proof-of-concept study among 1,169 type 2 diabetes patients and a healthy control group revealed] a clear-cut, disease-predisposing DNA methylation "signature." This is a first report in the scientific literature of epigenetic risk factor for this kind of diabetes.
DNA methylation is one of the regulatory processes spoken of as epigenetic, in which an alteration in gene expression occurs without a change in the sequence of nucleotides (molecules that make up DNA)....
This analysis revealed, for the first time not only a clear-cut epigenetic signature in diabetes, but telltale methylation signature marks on the DNA of young people who later developed impaired glucose metabolism, even before signs of clinical diabetes showed up.
The HU findings seem likely to lead to the understanding of similar mechanisms in a long list of common human diseases, including many metabolic, autoimmune and psychiatric disorders.
[Epigenetic marks are sensitive to a wide range of environmental influences including diets, chemical exposures and intrauterine environments, as well as to therapeutic drugs;] these findings may open the way for the development of new prevention and/or intervention epigenetic therapies...
Human Molecular Genetics, Dec. 2011

Testosterone replacement to normal levels in middle-aged and elderly hypogonadal men significantly improved all components of the metabolic syndrome at 24 months....Positive effects were maintained for at least 60 months....

A total of 147 hypogonadal men from 38 to 83 years of age participated in the study, all of whom had presented at a urology clinic with testosterone levels between 0.14 and 3.51 ng/mL.

The men were treated with 1000 mg parenteral testosterone undecanoate (Nebido, Bayer Schering Pharma) injected once every 3 months for at least 48 months. (The product is not approved in the United States, but is licensed to Endo Pharmaceuticals. It has been approved since 2004 in Europe, Latin America, and parts of Asia and the Middle East.)

At the end of the 48-month study period, the average reduction in waist circumference was "quite substantial," at 8.0 cm, and showed "consistent and progressive decline" as far out as 60 months in some cases, he said.

In addition, body weight was reduced by 12.9 kg, from an average of 106.6 to 93.7 kg. [S]ubjects lost around 5% of their initial weight after about 15 months, and about 10% after 3.5 to 4.0 years of treatment, he added.

"[Short-term studies of testosterone replacement suggest] a shift of fat mass to lean mass. People who are on treatment for 1 year may gain 4.5 to 5.0 kg of lean mass and lose 5.0 to 6.0 kg of fat mass -- but the overall effect on weight is moderate. These 4-year data were a surprise when we saw people lost 12.9 kg, and the 60-month data suggest this continues -- we have not yet reached the plateau, the weight is still declining," he said.

Both systolic and diastolic blood pressure were also significantly reduced (by 15.2 and 13.3 mm Hg, respectively), dropping from 155/94 to 140/80.8 mm Hg at 48 months.

There was a significant improvement in lipid profiles, with total serum cholesterol dropping from 297.7 to 194.5 mg/dL, triglycerides dropping from 290.4 to 194.2 mg/dL, and low-density-lipoprotein cholesterol dropping from 160.4 to 118.3 mg/dL....

There was also an initial significant decrease in levels of liver enzymes, with aspartate aminotransferase dropping from 43.9 to 22.0 U/L and alanine aminotransferase dropping from 46.6 to 22.8 U/L over the first 24 months, and then leveling off. These decreases likely indicate an improvement of nonalcoholic fatty liver disease, said Dr. Saad.

Additionally, there was a "marked reduction" in C-reactive protein levels over the 4-year period, from 7.1 to 1.6 mg/L, which was not surprising because "testosterone has recently been shown in a number of studies to be an anti-inflammatory agent," he said.

Finally, mean plasma glucose levels declined from 105.8 to 97.0 mg/dL over the 4-year period. "Without separating those with elevated glucose from those with normal glucose at baseline, we saw a mean reduction in the first 1.5 years, and then the levels stabilized," he said.

Dr. Saad said that epidemiologic studies consistently suggest that testosterone deficiency is found in about 50% of men with type 2 diabetes. In this context, he said, screening of diabetic men "may be justified, but in the world of diabetes treatment, testosterone deficiency is still not well known."

In terms of perceived risks associated with testosterone replacement, the study found no rise in prostate-specific antigen; although there was a slight increase in prostate volume, it was considered to be a result of aging, he said. In addition, there was a decline in the International Prostate Symptom Score, a measure of urinary function, indicating an improvement.

* Higher chocolate intake is related to a decreased risk for cardiometabolic disorders overall in 5 of 7 studies.
* Higher chocolate intake is related to a reduced risk for cardiovascular disease by 37%, diabetes by 31%, and stroke by 29%. There is no link between chocolate intake and heart failure.

Buitrago-Lopez A, Sanderson J, Johnson L, et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; DOI:10.1136/bmj.d4488

A 15-minute walk can cut snacking on chocolate at work by half, according to research by the University of Exeter. The study showed that, even in stressful situations, workers eat only half as much chocolate as they normally would after this short burst of physical activity....
In the study, 78 regular chocolate-eaters were invited to enter a simulated work environment, after two days abstinence from chocolate snacking. Two groups were asked to take a brisk 15-minute walk on a treadmill and were then given work to complete at a desk. One group was given an easy, low-stress task, while the other was asked to complete a more demanding job. The other two groups were asked to have a rest before completing the same tasks as the first two groups. Again, half were given an easier task and the remainder a more challenging one. Chocolate was available in a bowl on the desk for all participants as they carried out their work.
Those who had exercised before working consumed on average half the amount of chocolate as the others: around 15 grammes, compared with 28 grammes. 15 grammes is equivalent to a small ‘treat size’ or ‘fun size’ chocolate bar.
The difficulty of the task made no difference to the amount of chocolate they ate, which suggests that stress did not contribute to their cravings for sweet snacks.

Five of the seven studies showed a significant inverse association between chocolate consumption and cardiovascular disease. Compared with the lowest levels of chocolate consumption, the highest levels of consumption were associated with a 37% reduction in the risk cardiovascular disease and a 29% reduction in the risk of stroke. There was no association between chocolate consumption and heart failure risk and no association in women between chocolate consumption and the incidence of diabetes.

Lead study author Adriana Buitrago-Lopez, RN, and colleagues noted that “Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease.”

In affected patients, postprandial glucose may be an early indicator of glucose intolerance or a prediabetes condition, which may be a better predictor of cardiovascular risk than impaired fasting glucose level. Treating patients who have early signs of hyperglycemia, including elevated postprandial glucose level, with intensive glucose control that does not lead to weight gain, and ideally may be associated with weight reduction, may be vital to preventing or reducing later cardiovascular morbidity and mortality. Because hypoglycemia is an important complication of current DM treatments and may cause acute secondary adverse cardiovascular outcomes, not causing hypoglycemia is mandatory. Given that weight loss can significantly lower cardiovascular risk and improve other cardiovascular risk factors in patients with type 2 DM and that medications are available that can result in weight reduction without leading to hypoglycemia, the successful treatment of patients with type 2 DM should be individualized and should address the complete pathophysiologic process. This review is a hypothesis article that presents arguments against general approaches to the treatment of type 2 DM. An algorithm is presented in which the goal for managing patients with type 2 DM is to lower the blood glucose level as much as possible for as long as possible without causing hypoglycemia. In addition, body weight should ideally be improved, reducing cardiovascular risk factors and avoiding therapeutic inertia.

Beta cell function can improve after just 12 weeks of weight loss in patients with type 2 diabetes...[F]or the first time, these changes have been shown to correlate with a decrease in pancreatic polypeptide....
The study involved 74 subjects with type 2 diabetes who were treated with oral hypoglycemic agents. Mean age was 56.6 years, mean body mass index was 35.8 kg/m², and mean glycated hemoglobin level was 7.7%. Subjects were prescribed 12 weeks of a weight-loss diet alone (a reduction of 500 kcal/day) followed by 12 weeks of the same diet but with aerobic exercise added.

At baseline, 12 weeks, and 24 weeks, insulin sensitivity was measured using a hyperinsulinemic isoglycemic clamp, plasma concentration of gastrointestinal peptides was measured during a fasting state and during clamp-induced hyperinsulinemia, beta cell function was assessed during standard meal tests, and the insulin secretory rate was calculated by C-peptide deconvolution.

In the cohort, mean weight loss was 5.0 kg (P = .001) after 12 weeks of dietary intervention; weight did not change significantly after the addition of exercise.

Both fasting and stimulated plasma glucose and insulin concentrations decreased in response to the diet. In the case of glucose, there was no change after the addition of exercise, but plasma insulin decreased further with exercise. Similarly, plasma concentrations of C-peptide decreased in response to the diet and further in response to exercise.

In addition, peripheral insulin sensitivity and insulin secretion increased, and glucose sensitivity of beta cells increased by 26% in response to the diet without a significant change after the addition of exercise.

They also observed a marked decrease in both fasting and hyperinsulinemic concentrations of pancreatic polypeptide in response to dietary intervention and there was no significant change in other gastrointestinal peptides.

Pancreatic polypeptide is a novel marker, and the authors are showing for the first time in the context of caloric restriction that a reduction in pancreatic polypeptide correlated with an improvement in beta cell function. The main point is that it showed an improvement in beta cell function following a guidelines-based diet.

International Diabetes Federation (IDF) World Diabetes Congress 2011, Abstract O-0473, presented December 5, 2011

All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.
CONCLUSIONS:
A threshold model with linear slope [rising from 83mg/dL] best described the dose-response relationship between postload blood glucose and CHD mortality risk.

Cardiovascular risk is already increased in people with impaired glucose tolerance. Moreover, higher-than-optimum blood glucose is a major cause of cardiovascular mortality in most world regions of the world. Whether dysglycemia is a marker for a more complex metabolic condition or may directly contribute to excess cardiovascular risk is still a matter of debate. However, experimental work has shown how increased glucose level can trigger multiple mechanisms of susceptibility to atherosclerosis, and diabetes prevention trials have indicated that along with reduction of the rate of conversion toward diabetes, significant improvement in cardiovascular risk factors occurs. Moreover, in the STOP-NIDDM trial, targeting postprandial glucose was associated with reduction in new cases of hypertension, myocardial infarction, and any cardiovascular events. In conclusion, dysglycemia should be included in the list of established cardiovascular risk factors and early treatment introduced in the attempt to improve cardiovascular morbidity and mortality.

After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality.

[We excluded subjects] with diabetes or cardiovascular disease (CVD) at the baseline examination (1971–1974)....
CONCLUSIONS—Long-term hyperglycemia and subdiabetic glycemia increase risk for microalbuminuria. Microalbuminuria, type 2 diabetes, and CVD seem to arise together over the course of decades, consistent with the hypothesis that they share a common antecedent.

There is evidence that retinopathy begins to develop at least 7 years before the clinical diagnosis of type 2 diabetes....
At present, the most effective medical treatment to slow the progression of diabetic retinopathy is glycemic control. The relationship between hyperglycemia and retinopathy has been reported in well-conducted observational studies (70). The Diabetes Control and Complications Trial (DCCT) and the U.K. Prospective Diabetes Study (UKPDS) are two randomized clinical trials that conclusively showed the efficacy of glycemic control in preventing diabetic retinopathy (71–73).

In 2008, when the UK Prospective Diabetes Study (UKPDS) group presented their 30-year findings concerning the possible sustained effects of improved glycemic control after 10 years of extended follow-up in type 2 diabetic patients, a so-called “legacy effect” was reported to address the long-term emergent and/or sustained benefits of early improved glycemic control. Opposite results were obtained by the Hypertension in Diabetes Study (HDS) carried out in the frame of UKPDS, with no evidence of any legacy effect on cardiovascular (CV) outcomes for an initial 4-year period of tight blood pressure (BP) control. Thus, it was concluded that BP control has to be continued over time, since, although it had a short time-to-effect relationship in preventing stroke, BP control was associated with a short persistence of its clinical benefits once the intervention was discontinued. These findings are unique because, whereas most interventional trials in hypertension that included diabetic patients have shown a reduction in CV outcomes shortly after starting treatment, only the UKPDS-HDS specifically explored the possible persistence of clinical benefits after discontinuing intensive BP-lowering intervention. This article aims to provide a critical interpretation of the UKPDS findings of lack of BP legacy, in the context of the currently available evidence on the benefits of antihypertensive treatment. The importance of effective BP control in type 2 diabetic patients to prevent CV outcomes and other diabetes-related complications is underlined, with emphasis on early, tight, and continuous BP control to optimize patients’ protection.

Background: admission hyperglycaemia (HG) is associated with worse prognosis and higher mortality within 3 months after stroke. Reports on long-term mortality are inconsistent.

Objective: to evaluate the influence of admission HG [blood glucose (BG) levels >8 mmol/L] on long-term mortality after ischaemic stroke (IS) and transient ischaemic attack (TIA).

Methods: consecutive patients with IS or TIA, admitted from January 1997 until December 2002, were retrospectively screened. BG was measured within 3 days from onset of symptoms. Information on the date of death was obtained within 10 years after onset.

Results: a total of 509 patients (78% IS; 22% TIA) were included. Admission HG was present in 28% and 18% of the IS and TIA patients, respectively (P = 0.05). Mean admission BG was 7.6 ± 3.2 mmol/L in the IS and 6.7 ± 2.3 mmol/L in TIA (P = 0.002). During a mean observation of 66 ± 35 months, the overall 1- and 10-year mortality rate was 12% and 51% in IS compared to 4% and 38% in TIA patients (P = 0.004). Normoglycaemic IS patients had a longer median survival than those with HG (113 vs 84 months, P = 0.04). Admission HG did not affect the mortality rates in TIA patients.

Conclusion: admission HG is associated with greater mortality rates up to 5 years after stroke but does not influence the survival of TIA patients.

Background
Diabetes mellitus (DM) is a well-recognised, independent predictor of ischaemic stroke (IS) incidence [1]. Hyperglycaemia (HG) is present in up to 49% of IS patients without a pre-existing diagnosis of diabetes, and is associated with a higher mortality within 1 month post-stroke [2]. Reports on long-term mortality combine data for diabetic and non-diabetic patients and the follow-up period has been limited to the first year post-stroke [3]. It has previously been reported that more than half of patients with transient ischaemic attacks (TIAs) or minor IS without a previously established diagnosis of DM, have impaired glucose tolerance (IGT) or diabetic glucose tolerance [4]. IGT in TIA patients has further been associated with an increased risk for stroke compared to patients with normal baseline glucose values [5]. The Group of Pharmacoepidemiology in the Elderly (GIFA) study reported blood glucose (BG) level at admission to be directly associated with in-hospital mortality after TIA or minor stroke [6].

Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence has long implicated hypoglycaemia as a potential cause of myocardial ischaemia or a cardiac arrhythmia. Hypoglycaemia provokes sympatho-adrenal activation and counterregulatory hormone secretion, which exert pronounced cardiovascular effects. Although well tolerated in healthy people, the superimposition of these profound physiological effects on a diseased coronary vasculature and a dysfunctional cardiac conductive system may induce serious or even fatal cardiovascular events. These risks should influence therapeutic targets and the approach to diabetes management in people with diabetes with established vascular disease in whom exposure to severe hypoglycaemia could be dangerous.

Among hypertensive subjects with [normal glucose regulation] there was an increase in [estimated arterial stiffness] from low normal to high normal values of glucose (p<0.01). [Arterial stiffness] was independently related to all glucose metabolic parameters (p<0.001 for all). In the present study, we demonstrated an association between arterial stiffness and glucose tolerance in hypertensive subjects. Given the prognostic significance of arterial stiffness, aims should be towards closer monitoring and intensive care of hypertensive patients with abnormal glucose metabolism.

In the Whitehall Study of 18,403 male civil servants aged 40--64 years, 7 1/2 year coronary-heart-disease (CHD) mortality has been examined in relation to blood-sugar concentration 2 h after a 50 g oral glucose load. CHD mortality was approximately doubled for subjects with inpaired glucose tolerance (IGT), defined as a blood-sugar above the 95th centile (greater than or equal to 96 mg/dl). There was no trend of CHD mortality with blood-sugar below the 95th centile. Within the IGT group, age, systolic blood-pressure, and ECG abnormality (Whitehall criteria) were significantly predictive of subsequent CHD mortality. These findings are relevant to discussions on the criteria for diabetes which include the definition of an IGT category with increased risk of large-vessel disease, but without the high risk of small-vessel disease as occurs in diabetes mellitus.

130 student/teacher edition or 180 digital download

A fact sheet of statistics on suicide with information on treatments and suicide prevention.

* Introduction
* What are the risk factors for suicide?
* Are women or men at higher risk?
* Is suicide common among children and young people?
* Are older adults at risk?
* Are Some Ethnic Groups or Races at Higher Risk?
* What are some risk factors for nonfatal suicide attempts?
* What can be done to prevent suicide?
* What should I do if I think someone is suicidal?
* For More Information About Suicide
* References


Suicide is a major, preventable public health problem. In 2007, it was the tenth leading cause of death in the U.S., accounting for 34,598 deaths.1 The overall rate was 11.3 suicide deaths per 100,000 people.1 An estimated 11 attempted suicides occur per every suicide death.1

Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.