Updated guidelines advise focusing on women's lifetime heart risk

http://www.americanheart.org/presenter.jhtml?identifier=3045524

Highlights of the changes include:

• Recommended lifestyle changes to help manage blood pressure include weight control, increased physical activity, alcohol moderation, sodium restriction, and an emphasis on eating fresh fruits, vegetables and low-fat dairy products.
• Besides advising women to quit smoking, the 2007 guidelines recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
• Physical activity recommendations for women who need to lose weight or sustain weight loss have been added – minimum of 60–-90 minutes of moderate-intensity activity (e.g., brisk walking) on most, and preferably all, days of the week.
• The guidelines now encourage all women to reduce saturated fats intake to less than 7 percent of calories if possible.
• Specific guidance on omega-3 fatty acid intake and supplementation recommends eating oily fish at least twice a week, and consider taking a capsule supplement of 850–1000 mg of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) in women with heart disease, two to four grams for women with high triglycerides.
• Hormone replacement therapy and selective estrogen receptor modulators (SERMs) are not recommended to prevent heart disease in women.
• Antioxidant supplements (such as vitamin E, C and beta-carotene) should not be used for primary or secondary prevention of CVD.
• Folic acid should not be used to prevent CVD – a change from the 2004 guidelines that did recommend it be considered for use in certain high-risk women.
• Routine low dose aspirin therapy may be considered in women age 65 or older regardless of CVD risk status, if benefits are likely to outweigh other risks.   (Previous guidelines did not recommend aspirin in lower risk or healthy women.)
• The upper dosage of aspirin for high-risk women increases to 325 mg per day rather than 162 mg.   This brings the women’s guidelines up to date with other recently published guidelines.

Consider reducing LDL cholesterol to less than 70 mg/dL in very high-risk women with heart disease (which may require a combination of cholesterol-lowering drugs).

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Potential to create a genetic test to predict diabetes

This is A breakthrough gene  (see report below) .

 

According to this short report, ' ...explain up to 70% of the genetic background of type 2 diabetes...' and '...SLC30A8, which is involved in regulating insulin secretion....', do these mean that insulin resistance is less important than insulin secretion among persons with type 2 DM?

 

This is A big leap for a gene study team, A baby step for predicting type 2 DM by using genes only. Hope I am wrong.

 

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Subject: Potential to create a genetic test to predict diabetes

Breakthrough gene find may halt spread of adult diabetes

STEWART PATERSON

February 12 2007

An international team of scientists has made a breakthrough which could help halt the growth of diabetes.

Researchers from Britain and Canada have identified the gene that causes diabetes, which means potential sufferers could be tested to assess their risk of developing the disease.

It is hoped the discovery will also help develop new treatments for adult onset, or type 2 diabetes, which is one of the most common illnesses among middle aged and older people in the UK.

In Scotland, around 150,000 people suffer type 2 diabetes while another 60,000 are estimated to have the disease but are unaware. The number of people with the illness is expected to increase by half over the next decade.

The research, published online in the science magazine, Nature, is the first time the genetic make-up of any disease has been mapped in such detail.

If adult diabetes is not properly managed, patients can suffer severe complications, such as blindness, amputations and kidney disease, and are at far higher risk of developing heart disease or suffering a stroke.

The researchers at McGill University, Montreal, and Imperial College London, believe their findings explain up to 70% of the genetic background of type 2 diabetes.

Our research shows that this technology can generate big leaps forward Professor David Balding, Imperial College

In addition, one of the genetic mutations they detected may further explain the causes behind the disease, potentially leading to a new therapy.

Lead researcher Dr Constantin Polychronakos, of McGill University, said: "The rapidly increasing prevalence of type 2 diabetes is believed to be due to environmental factors, such as increased availability of food and decreased opportunity and motivation for physical activity, acting on genetically susceptible individuals."

The study revealed people with the disease have a mutation in a particular zinc transporter known as SLC30A8, which is involved in regulating insulin secretion.

Type 2 diabetes is caused by a deficiency in insulin and the researchers believe it may be possible to treat it by fixing this transporter.

Professor Philippe Froguel, of Imperial College London, said: "The two major reasons why people develop type 2 diabetes are obesity and a family link. Our new findings mean we can create a good genetic test to predict people's risk of developing this type of diabetes.

"If we can tell someone their genetics mean they are pre-disposed towards type 2 diabetes, they will be much more motivated to change things such as their diet to reduce their chances of developing the disorder."

The scientists reached their conclusions after comparing the genetic makeup of 700 people with type 2 diabetes and a family history of the condition, with 700 controls. They looked at mutations in the building blocks, called nucleotides, which make up DNA.

There are mutations in about one in every 600 nucleotides and the scientists examined more than 392,000 of these to find the ones specific to type 2 diabetes.

Professor David Balding, epidemiologist at Imperial College, said: "Our research shows this technology can generate big leaps forward. The task now is to study the genes identified in our work more intensively, to understand more fully the disease processes involved, devise therapies for those affected and to try to prevent future cases."

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Obesity worse than inactivity

There are overwhelming evidences that both obesity and physical inactivity related to higher risk of diabetes. However, comparison between two is not fair to physical activity. Physical inactivity is in behavior domain, and obesity is in sort of bio-marker domain. Obesity is a mediator and an offspring of behavior including physical inactivity , over-eating, genetic factors , etc.. 

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Obesity poses larger diabetes risk than inactivity NEW YORK (Reuters) -- Although obesity and lack of physical activity both raise the risk of type 2 diabetes in women, obesity appears to be the more important factor, researchers report in the journal Diabetes Care. Dr. Frank Hu of the Harvard School of Public Health, Boston, Massachusetts, and colleagues note that the relative contribution of obesity and inactivity to the risk of developing type 2 diabetes remains controversial. To investigate further, the researchers monitored 68,907 women taking part in the Nurses' Health Study, a large ongoing study that is evaluating women's health over time. The women in the current trial had no history of diabetes, cardiovascular disease or cancer at study entry. During 16 years of follow-up, there were 4,030 incident cases of type 2 diabetes. After allowing for age, smoking, and other diabetes-associated factors, the risk of type 2 diabetes increased progressively with increasing body mass index (BMI - the ratio of height to weight often used to determine whether someone is overweight or too thin). The risk also increased with waist circumference, and decreased with physical activity levels. Using women who had a healthy weight (BMI of less than 25) and were physically active as the reference group, the relative risks of type 2 diabetes were 16.75 in women with a BMI of 30 or more and were inactive. The corresponding risk in obese women who were active was 10.74. In women who were lean but inactive, the relative risk was 2.08. Although both variables were significant predictors of type 2 diabetes, the researchers found that the association for waist circumference was substantially stronger than that for physical inactivity. They researchers conclude that "the magnitude of risk contributed by obesity is much greater than that imparted by lack of physical activity," and therefore "weight loss and maintenance of healthy weight should be emphasized as an eventual goal to prevent the onset of type 2 diabetes." Copyright 2007 Reuters. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.