Monday, October 10, 2011

little changes in BP and A1c can have big a impact on our lives

Yesterday we discussed cardiovascular risk factor reduction associated small decreases in our weight. Today I would like to review a study done by Dr. Heintjes and presented at the European Society for the Study of Diabetes and reviewed in ,Internal Medicine news by Michele G. Sullivan

LISBON – Even small changes in hemoglobin A1c and blood pressure could significantly reduce the risk of heart attack, stroke, and other cardiovascular complications in people with type 2 diabetes, according to the findings of a population-based observational study.

A 0.5% decrease in HbA1c and a 10 Hg/mm decrease in systolic blood pressure could avert 10% of such events over 5 years,

Those patients with the greatest risk factors – elevated HbA1c, high blood pressure, and higher body mass index – stand to gain the most when they improve those factors, she said.

Dr. Heintjes’ analysis included 5,841 Dutch patients with a diagnosis of type 2 diabetes for at least 2 years. The patients were all taking some form of treatment – oral medications, insulin, or both – for at least 6 months to be included in the study. After examining both baseline data and 5-year outcomes, she was able to extrapolate how improvements in the three risk factors might impact the expected number of cardiovascular events.A multivariable analysis allowed her to extrapolate that 796 cardiovascular events (heart attack, ischemic heart disease, stroke, and chronic heart failure) would occur if all of the patients were followed for 5 years

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My interest in this study faded quickly after I realized that she did not actually follow the patients for 5 years . It appears to me the results are the result of a mathematical calculation. This is interesting data but I prefer studies done by researchers following patients in clinics and analyzing actual collected data.

Wait a minute . don't give up on the idea.

I recall one classic study completed in 1998, THe UKPDS study( the United Kingdom Prospective Study. This was a study done on patients with Type 2 diabetes. They found that a small reduction in BP 154/87 to 144/82 resulted in a 34 % reduction in death related to diabetes , a 34% reduction in small vessel disease (eye and kidney damage) , a 44% reduction in strokes and a 56% reduction in heart failure.

This same study also revealed that a 1 point drop in A1c from 8 to 7 reduced the development of eye damage 17 to 21 % ,kidney damage 24 to 33 % and cardiovascular disease 16%. If you were taking metformin the result were even better with a 29% reduction in eye and kidney damage , 39% reduction in heart attacks and a 36% reduction in all cause mortality

Little changes do have a big impact. You can beat this disease with little steps. Celebrate a victory with ever little improvement in this game of numbers.

Play hard , have fun. Dr Calder

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Your comments and questions are appreciated. David Calder,MD