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Do all diabetics need to be on statins? Maybe not.

August 1, 2011

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Doctors often tell those with type 2 diabetes that they have about a 20 percent risk of suffering a heart attack or other serious cardiac event in the next 10 years and that they should take a cholesterol-lowering statin to reduce this risk. But a study published last week in the Archives of Internal Medicine confirms that the risk is much lower in some with the disease and that a routine blood test to measure glucose levels in the blood might be helpful in calculating an individual’s risk.

The researchers found that the blood test, called hemoglobin A1C, can help predict with better certainty which diabetics are at greater risk of having a heart attack in the next 10 years - especially in younger women with diabetes, who tend to have lower heart disease risks because of their age and gender.

“We found that every percentage point increase in A1C raised a woman’s 10-year heart disease risk by 17 percent and a man’s risk by about 10 percent,’’ said study author Nina Paynter, an epidemiologist at Brigham and Women’s Hospital. She couldn’t explain why the test was more predictive in women but said researchers have known for some time that soaring blood sugar levels are a stronger predictor of heart problems in women than in men.

Using a new risk calculation tool that incorporated A1C levels into other measurements such as blood pressure and cholesterol levels, the researchers found that nearly one-fifth of the 685 diabetic women who participated in the study actually had a risk of heart disease that was very low: less than 5 percent over the next 10 years.

This raises the question: Should women in this low-risk category be prescribed statins?

Experts say that’s tough to answer. “Individuals with diabetes have substantially higher longer-term/lifetime cardiovascular disease risk,’’ wrote Dr. Mark Pletcher, a professor of general medicine at the University of California, San Francisco, in an editorial that accompanied the study. And statins have been shown to lower the rate of heart attacks and deaths in those with a 10-year heart attack risk of 20 percent or greater.

But there’s a lack of evidence to determine one way or the other whether treating diabetics - who have low heart disease risks because of, for example, their young age - earlier with cholesterol-lowering medications will help prevent heart attacks or heart disease deaths down the road.

The cost of the drugs must be considered along with side effects like muscle aches, sleep difficulties, headaches, and gastrointestinal upset. Although statins are considered to be very safe drugs, in very rare cases, they can lead to muscle and kidney damage.

“I don’t think we should lump all diabetics into the same high-risk category,’’ said Dr. Om Ganda, head of the Joslin Diabetes Center Lipid Clinic. “Clinicians really need to use their judgment and consider other factors like age, family history of heart disease, blood pressure and cholesterol levels, and smoking habits.’’

DEBORAH KOTZ

lgmoney wrote: Agree with Dr. Ganda comment here, tough to lump all people together on that one. Listen to your PCP, if in your family history, as well as being overweight and such, one must be getting blood sugar readings every checkup, which as you get older should be more frequent. Best defense would be an excellent offense of living healthy.

jorgechi wrote: Show me one study that concludes the use of statin drugs prevent an event for anyone that has not had a previous event. Yes statin drugs will lower your cholesterol and risk factors, however they do not prevent events in those that have not had events.

Deborah Kotz responds: There actually have been plenty of studies that have found statins beneficial for preventing heart attacks and deaths in those at high risk who haven’t who haven’t had previous cardiac events. A Cochrane review study of 14 clinical trials published this year concluded that drugs do work to lower heart risks - though there’s wide variation on the size of the benefit.

A doll that breast-feeds?

When I was 7, I desperately wanted Baby Alive, a doll that ate, drank, and soiled its diaper, but my Dad refused, saying that food would get trapped and attract bugs. Now parents have another doll to fume about: one that sucks at pretend nipples worn by a child - as if breast-feeding.

The child wears a halter top affixed with two appliques that trigger the doll to make sucking sounds and movements when its mouth is placed near one. Although fake milk doesn’t spout forth from the “nipples,’’ the baby cries anyway until it’s burped.

Currently selling for $118 on Amazon and other online sites, the Breast Milk Baby - or Bebe Gloton as it was named by its Spanish manufacturer, Berjuan - is expected to hit US stores later this year, retailing for $69.99. The manufacturer’s website says the toy is designed “to teach little girls how to breast-feed’’ and for them to learn about the bond between mother and child. But some psychologists contend that it’s not an appropriate form of play and is forcing kids to grow up too soon. - D.K.

SophmoreCamelCharlestown wrote: Why not? Children breast-feed when they are born. Why not educate their children to a natural body function, especially one that they may see in public?

poppy609 wrote: It’s a little weird and I don’t see how it’s necessary. Little kids already have nipples and can just hold a baby up to their own body if they want to emulate breast-feeding.

ActonMom wrote: My then 3-year-old got a Bitty Baby doll a few months after her little brother (whom I breast-fed in front of her) was born. One day she pulled up her shirt and positioned her doll as if feeding her.

Stressing out over psoriasis

When a celebrity like Kim Kardashian develops a blotchy skin condition, it can have career-ending consequences. At least that’s what Kardashian (inset), who announced her diagnosis of psoriasis on TV recently, would have us believe.

“Psoriasis! I cannot have psoriasis,’’ she told the dermatologist who diagnosed her. “People don’t understand the pressure on me to look perfect.’’ But her doctor said all that stress and pressure may be what’s fueling the autoimmune disorder.

Dr. Emmy Graber, assistant professor of dermatology at BU School of Medicine, examined Kardashian’s blotchy legs and torso and said it looks like she has the less common psoriasis variety called guttate, which spreads rapidly over the body - often after a bout of strep throat or excessive stress.

“In many cases,’’ she said, “it won’t recur after treatment.’’ That differs from the plaque form, which usually causes large scaly lesions on the knees and elbows and tends to flare again and again. Treatment for either variety includes steroid creams to quell the immune reaction or light therapy in the doctor’s office.

Lifestyle changes are also key to reducing flare-ups. Kardashian and others with psoriasis would benefit from getting a proper amount of sleep, eating a balanced diet, avoiding excess alcohol, and, yes, minimizing stress. - D.K.

LoveBoston wrote: I don’t blame Kim for freaking about the psoriasis. Anyone who has suffered any kind of skin condition can relate. Her career is based on her looks so I can totally understand her concern.

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