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Three Strikes, But Whose Out?

Posted Mar 14 2010 12:00am

A good number of patients in our practice will tell you that we've had some reservations about recommendations to push systolic (the "top number") blood pressures aggressively under 120-130 mmHg.

Presentations being made, today, at the American College of Cardiology Meeting (and published online in the New England Journal of Medicine) suggest this, and other recent broad recommendations, have not been very helpful in preventing heart attacks among Type 2 diabetics. In fact, some of the recommendations have been suggested to have been "harmful".

The results are surprising and disappointing, heart and diabetes experts say. An estimated 21 million Americans have Type 2 diabetes, the kind once known as adult-onset, and they are at enormous risk for heart disease. The only measures proven to reduce their chances — avoiding cigarettes and taking medication to lower bad cholesterol and blood pressure — still leave diabetics with a heart attack risk equivalent to that of a nondiabetic who already had a heart attack.

So doctors began trying other strategies they hoped would help: get blood pressure to a normal range; raise levels of good cholesterol and lower levels of dangerous triglycerides; or modulate sharp upswings in blood sugar after a meal.

Although Type 2 diabetics make up about 9% of the population, they account for, at minimum, 25% of all heart attacks. The following recommendations are now being questioned as ineffective to reduce that trend-- rigorously lowering systolic blood pressure under 120 mmHg
-- adding fibrates to lower triglycerides or help raise HDL ("good cholesterol")
-- preventing rapid rises in blood sugar after eating

As we always say, you have to look at the patient as an individual. Broad, across the board, recommendations are often not needed or helpful in many cases.

The details are in the New York Times article here . Amazingly, once again, the Times did not blame former President George W. Bush for the negative results of these studies!

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