Tuesday, Apr. 8, 2008; 4:00 AM
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MONDAY, April 7 (HealthDay News) — Use of the antipsychotic medication olanzapine may put a person at an increased risk for heart disease and type 2 diabetes, new findings show.

A team of French researchers studying the drug’s effect on male rats found that, after consuming olanzapine over several weeks, the rodents’ blood sugar levels rose significantly compared to rats not on the drug. This was especially noticeable after the rats ate meals with glucose in them. The rats consuming olanzapine did not gain weight or increase their food intake; however, the proportion of fat stored in their abdominal cavity was notably higher.

These changes are increased risk factors of metabolic syndrome, which puts an individual at greater risk of heart disease and type 2 diabetes.

“Based on these findings, we concluded that male rats treated with olanzapine experienced an early disruption of energy metabolism. This was a result of the fat tissue we observed and the impairment in blood sugar regulation which are both associated with metabolic syndrome and subsequent risk of diabetes,” senior study author Dominique Hermier, of the Department of Human Nutrition, INRA, in Paris, said in a prepared statement.

The study was to be presented Monday at the Experimental Biology annual meeting, in San Diego.

Olanzapine is a part of the second generation of antipsychotics known as atypical antipsychotics being used to treat schizophrenia. These newer medicines have proven as effective as their predecessors in treating the delusions and hallucinations that accompany psychotic mental illness and even more effective in combating other symptoms, such as apathy. Side effects, though, include weight gain and a greater chance for developing metabolic syndrome. Physicians fear these side effects may cause their patients to stop taking their medicine.

“Atypical medications like olanzapine are of tremendous value in treating individuals with certain kinds of mental illness. Our hope is that through discoveries such as this one, such life-enhancing medicines can be further optimized,” Hermier said.

MONDAY, March 31 (HealthDay News) — Diabetics are more than twice as likely to suffer a heart attack, stroke and death from cardiovascular disease, putting them at the same risk level as non-diabetics who had previously suffered a heart attack, Danish researchers report.

The findings, appearing in April 1 issue of Circulation, led one study author to suggest all diabetics talk to their doctors about possibly starting treatments to control cholesterol levels and blood-pressure levels.

“We’ve talked about ‘the lower, the better’ for cholesterol and blood pressure to reduce the risk of heart attack,” lead author Dr. Tina Ken Schramm, a research fellow at the Gentofte Hospital in Hellerup, Denmark, said in a prepared statement. “Now I think we should be saying the sooner, the better for primary prevention of cardiovascular diseases in diabetics.”

The study analyzes patient and national registries for people aged 30 and older living in Denmark in 1997. Researchers found 71,801 people with diabetes and 79,575 who had a previous heart attack, then identified deaths and causes of death over five years.

“The increased risk was observed in people at all ages with either type 1 or type 2 diabetes who were receiving insulin or other drugs to reduce levels of sugar in the blood,” Schramm said. “When people with diabetes do have heart attacks, they are twice as likely to die as non-diabetics.”

The relative risk, or hazard ratio, of dying from cardiovascular disease was found to be 2.45 times greater for female diabetics compared with 2.62 times greater for women with a prior heart attack. The relative risk of dying from cardiovascular causes was 2.42 times higher in male diabetics; for men who had a prior heart attack the hazard ratio was 2.44.

When looking at heart attack, stroke or death from cardiovascular disease combined, men with diabetes faced a 2.32 higher risk while the risk rate was 2.48 for men who had at least one heart attack. For female diabetics, the combined relative risk was 2.48 while those with a history of myocardial infarction had a hazard ratio of 2.71.

The study did not look at patients on diet-only treatment for diabetes. The researchers also couldn’t differentiate between type 1 and type 2 diabetes patients or adjust for common risk factors, including high blood pressure, high cholesterol, obesity, smoking, physical activity and blood glucose levels.

Type 2 diabetes, the most common form of diabetes, develops when the body doesn’t make enough insulin and fails to efficiently use what insulin it does produce. In type 1 diabetes, the pancreas makes little or no insulin, requiring the patient to need daily doses of insulin.

TUESDAY, Feb. 26 (HealthDay News) — A national effort is needed to deal with the effects of high blood sugar in heart patients, says an American Heart Association scientific statement released Monday.

The statement highlights a number of unanswered questions about the condition, also known as hyperglycemia, in people hospitalized with acute coronary syndrome (ACS), which includes heart attack and a variety of other cardiovascular conditions.

“Although studies indicate that one-fourth to one-half of ACS patients have hyperglycemia when they arrive at hospital, elevated blood sugar is frequently ignored despite being strongly associated with increased mortality,” writing committee chair Dr. Prakash Deedwania, chief of cardiology at the VA Medical Center and the University of California, San Francisco, in Fresno, said in a prepared statement.

A number of studies have shown that hospitalized ACS patients with high blood sugar have increased rates of in-hospital complications and death. But much more needs to be learned about the link between hyperglycemia and poor outcomes in these patients. For example, it’s unclear whether elevated blood sugar levels in ACS patients are a marker for heart muscle damage or actually cause the damage, Deedwania noted.

Since evidence about how best to approach glucose management in ACS patients is still being gathered, the AHA statement provides “a general reference” for medical teams treating these patients.

The statement recommends that all ACS patients with elevated blood sugar be screened for diabetes or prediabetes as part of their in-hospital evaluation. Blood sugar should be kept in the range of 90 to 140 mg/dL for ACS patients who have significant hyperglycemia on admission and are placed in the intensive care unit. Blood sugar levels should be kept below 189 mg/dL for ACS patients who aren’t in the ICU.

The statement is published in the Feb. 26 issue of Circulation.

“This is a call to action for organizations such as the National Institutes of Health [NIH] to design appropriate large, randomized clinical trials where several of these critical and clinically important questions can be answered. Only then will we be able to find and implement treatments that may reduce deaths,” Deedwania said.

Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks. Aspirin can benefit people at high risk of a heart attack, such as those with diabetes and other risk factors such as high blood pressure. It can also help people with diabetes who have had a heart attack or a stroke, or who have heart disease. However, aspirin’s effects have not been studied in people under age 30.

How does aspirin lower my risk for a heart attack?

Exactly why aspirin works is not completely understood, but it may be because it helps keep red blood cells from clumping together. These cells seem to clump together more readily in people with diabetes. When blood cells clump, a blood clot can form and narrow or block a blood vessel. This can lead to a heart attack or stroke.

Is aspirin safe for everyone?

Taking a daily low-dose aspirin is not safe for everyone — it’s best to ask your health care provider whether you should take aspirin. In some people, aspirin can irritate the lining of the stomach, resulting in pain, nausea, vomiting, or bleeding. You should avoid taking aspirin if:

• you’re allergic to it
• you have a tendency to bleed
• you’ve recently had bleeding from your digestive tract
• you have liver disease that’s currently active
• you’re under 21 years of age

Check with your health care provider to see if aspirin therapy is right for you.

How much aspirin should I take every day?

Your health care provider can suggest the lowest possible dosage for you. Most people take a pill containing a dosage between 75 and 162 milligrams. The low-dose version may be labeled “baby aspirin.”

What form of aspirin is recommended?

Some health care providers recommend the enteric-coated form of aspirin. This form of aspirin is coated with a substance that allows it to pass through the stomach without dissolving. Instead, the aspirin is absorbed in the intestine, decreasing the risk of side effects.

The good news is that you can take steps to prevent heart disease or reduce your chances of having another heart attack. Lifestyle changes, such as choosing foods wisely and being physically active, as well as taking medication can help.

What is coronary artery disease?

Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart. It’s the most common form of heart disease. Your blood carries oxygen and other needed materials to your heart. Blood vessels to your heart can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to your heart is reduced or cut off.

What steps can I take to prevent coronary artery disease?

You can lower your risk by keeping your ABCs of diabetes on target with wise food choices, physical activity, and medication. Losing weight can also help you manage your ABCs and prevent heart disease. Every step you take will help. The closer your numbers are to your targets, the better your chances of preventing heart disease or cutting your risk for another heart attack. If you smoke, get help to quit.

A is for A-1-C

An A-1-C is the blood glucose (sugar) check “with a memory.” It tells you your average blood glucose for the past 2 to 3 months. The American Diabetes Association (ADA) recommends that people aim for an A-1-C below 7.

B is for blood pressure

Your blood pressure numbers tell you the force of blood inside your blood vessels. When your blood pressure is high, your heart has to work harder than it should. The ADA recommends that you keep your blood pressure below 130/80 (said as “130 over 80”) mmHg.

C is for cholesterol

Your cholesterol numbers tell you the amount of fat in your blood. Some kinds, like HDL cholesterol, help protect your heart. Other kinds, like LDL cholesterol, can clog your blood vessels and lead to heart disease. Triglycerides are another kind of blood fat that raises your risk for heart disease.

What can I do to reach my ABC targets?

Making wise food choices, being physically active, and taking medications can help you reach your targets.

Make wise food choices

Many people find that changing what they eat can make a big difference in their blood glucose, blood pressure, and cholesterol levels. Below are several strategies for making wise food choices. Determine which ones you would be willing to try. For more information about how to make these changes, talk with your health care team.

· I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

· I’ll choose lean meats and meat substitutes.

· I’ll switch to low-fat or fat-free dairy products.

· I’ll eat at least 5 servings of fruits and vegetables each day.

· I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products).

· I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil. Nuts also have a healthy type of fat.

· I’ll eat fish two or three times a week, choosing kinds that are high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

· I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

· I’ll eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables).

· I’ll eat less salt and sodium.

Lose weight or take steps to prevent weight gain

· I’ll cut down on calories and fat.

· I’ll try to be more physically active than I am now.

Be physically active

Before you start a new routine, check with your health care team to find out which activities will be safe for you. Then think about how you can add more activity to your routine. If you’re just starting out, begin with 5 minutes a day and gradually add more time. Then work up to doing a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.

Take medications

Medications are available to help you reach your ABC targets and lower your risk of another heart attack. You may need several medications to stay on track.

Some types of blood pressure and cholesterol-lowering medications can protect your heart. Your health care provider can provide information about which medications are best for you.

Aspirin can also help lower your risk of heart disease. Ask your provider whether taking a low-dose aspirin every day would be wise.

What can help me quit smoking?

If you’re ready to quit, talk with your health care team. They can help you find ways to quit. Joining a support group or smoking-cessation program can also help.