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Diabetes and cardiovascular diseases: It’s time to act

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According to International Diabetes Federation’s ‘Diabetes and Cardiovascular Disease report, in 2015, approximately five million were estimated to have died from diabetes, the majority of these as a result of cardiovascular complications. The report adds that populous countries have the largest absolute number of people dying from CVD, and include China, India and the Russian Federation.

While India is ranked at Number 67 in terms of age-standardised CVD mortality rate (306 deaths per 100,000 people per year), it has the second-largest number of people dying from CVD (over two million deaths per year).

One of the significant outcomes of cardiovascular disease is poor circulation in the legs, resulting in heightened risk of foot ulcers and amputations leading to disability. When people with diabetes develop CVD, their probability of survival is lower than those CVD patients without diabetes.

Diabetes can lead to cardiovascular damage in multiple ways. When a person has uncontrolled diabetes, the blood sugar levels are usually higher. And too much sugar in the blood damages blood vessels.

Although diabetes is regarded as the strongest risk factor for CVD, it is not just high blood glucose levels, but a variety of mechanisms that lead to CVD. The blood vessels in people with diabetes are more susceptible to well-established risk factors such as smoking, high cholesterol, high blood pressure and obesity. More than 80 per cent of people with type 2 diabetes are overweight. About 70 per cent of people with diabetes have high blood pressure and 67 per cent of adults with type 2 diabetes have one or more lipid (cholesterol) abnormalities.

Traditionally, the treatment of diabetes has been focused solely on good control of blood sugar levels.

Evidence now suggests that to prevent diabetes-related complications, one needs to look beyond glucose control and focus on other conditions like reducing weight, controlling high blood pressure and abnormal lipid profile.

In short, a person with diabetes needs to take care of the A, B and C of diabetes:

A stands for HbA1C (the test gives average blood glucose for last three months). It should be ideally less than seven per cent and is recommended at least three times a year.

B stands for blood pressure. The goal of blood pressure control is to reduce it to <130/80 mm Hg. Checking blood pressure at every doctor’s visit is essential.

C stands for cholesterol. The cholesterol that needs to be checked is the HDL, LDL and the triglycerides. The three should be within the specified limits. The optimal target is less than 100 milligrams per deciliter (mg/dL) for LDL cholesterol. For HDL cholesterol, the recommended level is more than 50 mg/dL for women and more than 40 mg/dL for men. Lipid profile is recommended at least once in a year.

If blood glucose, blood pressure, and cholesterol levels are not on target, then a person with diabetes needs to reach out to their doctor. Appropriate medicine and few changes in diet and activity can help him/her reach these goals. Here are four things you can do to lower your risk:

* Take medicines as prescribed by the doctor. In some instance, insulin is required for optimal control of diabetes. New-age insulin delivery devices like pens with thin needles have made taking insulin really convenient. Control of blood pressure and cholesterol is as important and you may require medication if they are above target. The doctor, after seeing complete reports, can decide on any change in medication.

Newer and more efficient medicines are being discovered. GLP-1 based therapies represent a latest class of treatment for type 2 diabetes. In addition of blood sugar control, GLP-1 also has other beneficial effects in the body that could be useful in the management of type 2 diabetes and CVD. These include lowering weight and blood pressure and improving lipid profile and heart function, thus reducing cardiovascular risk factors in type 2 diabetes.

* One need not have a special diet. In fact, the traditional Indian thali which includes naturally available nutrients and fibre from whole grains, fruits and vegetables with less oil is best. Eat natural foods that have less salt, less sugar and less fat. Transfats need to be avoided.

* Weight control and ceasing to smoke are two important lifestyle measures that have an impact on preventing CVD.

* Try to get 30 to 60 minutes of physical activity for most days of the week. Physical activity helps you keep a healthy weight and lower blood sugar and blood pressure. If a person with diabetes hasn’t been physically active recently, it is necessary to visit a doctor for a check-up before starting an exercise programme.

In conclusion, be aware, be active and be prompt to save yourself from diabetes and its complications – it’s time to act.

(Dr. C.M. Batra is an endocrinologist ar Indraprastha Apollo Hospitals, New Delhi. The views expressed are personal. He can be contacted at [email protected] )

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Anti-inflammatory drugs may put you at heart attack risk

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If you have been hit by the winter cold and are thinking about taking medicines that relieve your aches, pains and congestion, be careful. Those may also put your heart at risk, the American Heart Association has warned.

A study has showed that both decongestants and non-steroidal anti-inflammatories (NSAIDs), found in many cold medicines, were listed as medications that could increase blood pressure.

People who used NSAIDs while sick were more than three times as likely to have a heart attack within a week compared with the same time period about a year earlier when participants were neither sick nor taking an NSAID.

“People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants. And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a health care provider,” said Sondra DePalma, from the University of Pittsburgh in the US.

Decongestants like pseudoephedrine or phenylephrine constrict blood vessels. They allow less fluid into your sinuses, “which dries you up”, said Erin Michos, associate director of preventive cardiology at the Johns Hopkins Univerity’s Ciccarone Center in Baltimore.

The biggest concerns are for people who have had a heart attack or stroke, or have heart failure or uncontrolled high blood pressure, Michos said, in the paper published in the Journal of Infectious Diseases.

Importantly, healthy people might also be at risk.

For the study, researchers looked at nearly 10,000 people with respiratory infections who were hospitalised for heart attacks.

Participants were 72 years old on average at the time of their heart attacks and many had cardiovascular risk factors, such as diabetes and high blood pressure.

People who are sick should use both classes of medications — decongestants and NSAIDs — judiciously and understand the potential side effects.

In addition, decongestants should not be taken longer than seven days before consulting with a healthcare provider, DePalma said.

One should also rest and drink plenty of fluids if symptoms are mild or moderate, DePalma noted.

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What is to be blamed for childhood cancer?

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Representative Image , Image Credit : J Pat Carter/AP

A team of researchers has thrown light on the community beliefs about what causes cancer in children, an area which remains understudied, finds a latest research.

“Few childhood cancers are attributed to genetics or environmental factors, so when children are diagnosed with cancer, families often wonder ‘why me/why us’?” said lead author Janine Vetsch, postdoctoral research candidate from UNSW Sydney in Australia.

For the study, the team examined the beliefs of more than 600 participants — parents and childhood cancer survivors — about the causes of childhood cancer, and compared them with beliefs of 510 members of the general population.

Findings, published in Acta Oncologica, revealed that more than seven out of 10 childhood cancer survivors and survivors’ parents believed that chance or bad luck caused the cancer.

This led to most parents and survivors seem to understand that there is nothing they could have done to prevent the cancer, according to Vetsch.

However, around one in five families did believe that environmental factors and genetics played a role, despite only limited available scientific evidence, results further showed.

“It looks like healthcare professionals are successfully helping most families arrive at that view,” said Vetsch.

Such views could lead to stigma. Hence, it is important to increase community knowledge of childhood cancer causes in general.

There is a need to encourage doctors to talk about the causes with affected families to address unhelpful misconceptions,” Vetsch suggested.

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Does your dental floss contain toxic chemicals?

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Dental Health, Image: Bigstock

New York, Jan 9: Using Oral-B Glide dental floss could contribute to elevated levels of toxic chemicals that can lead to health problems, especially in women, including kidney and testicular cancer, high cholesterol, low birth weight, among others, says a study led by US-based Silent Spring Institute.

In the study, the team measured the presence of 11 different PFAS (per- and polyfluoroalkyl substances) — water- and grease-proof substances — in blood samples of 178 middle-aged women.

The findings, appearing in the Journal of Exposure Science and Environmental Epidemiology (JESEE), showed that women who flossed with Oral-B Glide tended to have higher levels of a type of PFAS called PFHxS (perfluorohexanesulfonic acid) in their body compared with those who did not.

“This is the first study to show that using dental floss containing PFAS is associated with a higher body burden of these toxic chemicals,” said lead author Katie Boronow, a scientist at the institute.

“The good news is, based on our findings, consumers can choose flosses that don’t contain PFAS,” she added.

Further, the team also tested 18 dental flosses (including three Glide products) for the presence of fluorine — a marker of PFAS, all of which tested positive for fluorine. The new findings are consistent with previous reports that Glide is manufactured using Teflon-like compounds.

In addition, the study also showed that women who frequently ate prepared food in coated cardboard containers, such as French fries or takeout, had elevated blood levels of PFAS chemicals.

“Overall, this study strengthens the evidence that consumer products are an important source of PFAS exposure,” Boronow said. “Restricting these chemicals from products should be a priority to reduce levels in people’s bodies.”

Other behaviours that were associated with higher PFAS levels included having stain-resistant carpet or furniture and living in a city served by a PFAS-contaminated drinking water supply.

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