Statins' Heart Benefits Outweigh Diabetes Risk: Study

The cardiac benefits of statins outweigh any increased chances for developing diabetes, even among those who run the highest risk of developing the blood sugar disease, Harvard researchers report.

The concern that these cholesterol-lowering drugs, which include the widely prescribed medications Lipitor, Crestor and Zocor, increased the risk for diabetes prompted the U.S. Food and Drug Administration to require labeling that warns users of the risk.

"Earlier this year, concern was raised that patients taking statins had an increased risk of developing diabetes, and on that basis many patients stopped taking their medications," explained lead researcher Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital, in Boston. "Unfortunately, little if any data was available at that time to address not only the risks, but also the benefits of treatment. This is crucial since it is the benefit-to-risk ratio that physicians and their patients need to understand."

The clinical message of this new research is clear, Ridker noted. "The cardiovascular benefits of statin therapy outweigh the diabetes hazard, even among those with highest risks for diabetes," he said. "We hope these new data will better inform discussions between physicians and patients who are considering the use of statin drugs as a possible addition to diet, exercise and smoking cessation."

The report was published Aug. 9 in the online edition of The Lancet.

Ridker's team used data from a trial that was conducted to find out if one particular statin, Crestor (rosuvastatin), could prevent heart disease in patients who never had heart disease. The trial, which included nearly 18,000 patients, was the first to reveal the possibility that statins could increase the risk for diabetes.

However, Ridker's group found that the risk of developing diabetes while on Crestor was greatly influenced by a person's existing risk for developing diabetes.

Over the five years of the trial, patients taking Crestor who didn't have any risk factors for developing diabetes didn't show an increased risk for developing the disease.

Patients taking a statin who had one risk factor for diabetes, however, saw a 28 percent increase in their risk of developing the disease.

Moreover, although statins did increase the risk for diabetes among those with risk factors for diabetes, these patients were 39 percent less likely to develop heart disease and 17 percent less likely to die, the researchers found.

"Among those with one or more major risk factors for diabetes, there were 134 fewer heart attacks, strokes and other major cardiovascular events among those who got the statin, but this came with the hazard of 54 new cases of diabetes being diagnosed. This group is already at high risk for getting diabetes, a group who are already considered candidates for statin therapy," Ridker noted.

Patients taking statins who were not at risk for diabetes had a 52 percent lower risk of developing heart disease and no increased risk of developing diabetes, the research team added.

"Among those with no risk factors for diabetes, there were 86 fewer heart attacks, stroke and other major vascular events among those who got the statin as compared to placebo, with no new cases of diabetes at all. So, for this group, there was cardiovascular benefit with no diabetes risk," Ridker said.

Dr. Gerald Watts, the Winthrop Professor of Medicine at the Cardiometabolic Research Center of the University of Western Australia and co-author of an accompanying journal editorial, said that "statins can lead to diabetes if you are predisposed to diabetes and this could be an issue when treating people at low risk of heart disease."

The benefit of statins in preventing heart disease, however, outweighs their risk in leading to diabetes, he added.

"Watch out for diabetes if you are on a statin and are at risk of diabetes," Watts said. Risk factors for diabetes include obesity, family history and abnormal blood sugar levels, he said. "If you are on a statin make sure you lead a healthy lifestyle," he added.

Another expert, Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles, said that "statin therapy has been clearly demonstrated to prevent cardiovascular events and premature cardiovascular death in men and women."

"This study confirms there is substantial net benefit of statin therapy even when fully accounting for the diabetes risk," he said.

Iron, vitamins could affect physical fitness in adolescents

Adolescence is an important time not only for growing but for acquiring healthy habits that will last a lifetime, such as choosing foods rich in vitamins and minerals, and adopting a regular exercise regimen. Unfortunately, several studies have shown that adolescents' intake of important nutrients, as well as their performance on standard physical fitness tests, has fallen in recent years. Because nutrition and fitness are intertwined—for example, iron forms part of hemoglobin, which carries oxygen to muscles, and antioxidants such as vitamin C aid in rebuilding damage after intense training—these two findings could be related. In a new study, researchers have found that adolescents' blood levels of various micronutrients are correlated with how well they performed in certain physical fitness tests. Though these results don't prove causality, they suggest a new relationship between different measures of adolescent health.

The article is entitled "Iron and Vitamin Status Biomarkers and its Association with Physical Fitness in Adolescents. The HELENA Study." and is online at http://bit.ly/Q2j6lJ. It appears in the online edition of the Journal of Applied Physiology, a publication of the American Physiological Society.

Methodology

Researcher Luis Gracia-Marco of the University of Zaragoza, Spain and his colleagues relied on data from a larger, long-term research project known as the Healthy Lifestyle in Europe by Nutrition in Adolescents Cross-Sectional Study, or HELENA-CSS. Part of this study, which involved thousands of volunteers between the ages of 12.5 and 17.5 in cities scattered across Europe, gathered nutrition and physical fitness data. Blood samples taken in one third of the volunteers (n=1089) were tested for a variety of micronutrients, including hemoglobin, indicative of iron intake, soluble transferrin receptor, serum ferritin, retinol, vitamin C, beta-carotene, alpha-tocopherol, vitamin B6, cobalamin, holo-transcobalamin, plasma folate, RCB folate and vitamin D. The volunteers' physical fitness was also assessed through a standing long jump test, which assesses lower-body muscular strength, and a 20 meter shuttle run test, which assesses cardiovascular fitness through maximal oxygen consumption (VO2max). When looking for correlations between the micronutrient levels and physical fitness, they took into account the adolescents' age, time of year, latitude of the city they lived in, body mass index, age of menarche in females, and amount of regular physical activity (using accelerometers).

Results

The researchers found that blood levels of certain micronutrients were intimately connected with the volunteers' performance on the physical fitness tests. For cardiorespiratory fitness, concentrations of hemoglobin, retinol, and vitamin C in males and beta-carotene and vitamin D in females was associated with VO2max. For muscular fitness, concentrations of hemoglobin, beta-carotene, retinol, and alpha-tocopherol in males and beta-carotene and vitamin D in females was associated with performing better on the standing long jump test.

Importance of the Findings

The authors suggest that studies connecting micronutrients, such as the ones they measured, with physical fitness in any population has been controversial and limited. This is especially true for adolescents, a group that's often difficult to gather information on. This new study, they say, is one of the first to find connections between micronutrients and physical fitness in this age group, with the strength of controlling the results for a complete set of relevant confounders. Yet, they note that more research still needs to be done.

"The associations between physical fitness and iron or vitamin status observed in this cross-sectional study in adolescents should be followed up by a study specifically designed to evaluate causal relationships," the authors write.

Weight training associated with reduced risk of type 2 diabetes

Men who do weight training regularly—for example, for 30 minutes per day, five days per week—may be able to reduce their risk of type 2 diabetes by up to 34%, according to a new study by Harvard School of Public Health (HSPH) and University of Southern Denmark researchers. And if they combine weight training and aerobic exercise, such as brisk walking or running, they may be able to reduce their risk even further—up to 59%.

This is the first study to examine the role of weight training in the prevention of type 2 diabetes. The results suggest that, because weight training appears to confer significant benefits independent of aerobic exercise, it can be a valuable alternative for people who have difficulty with the latter.

The study will be published online in Archives of Internal Medicine on August 6, 2012.

"Until now, previous studies have reported that aerobic exercise is of major importance for type 2 diabetes prevention," said lead author Anders Grøntved, visiting researcher in the Department of Nutrition at HSPH and a doctoral student in exercise epidemiology at the University of Southern Denmark. "But many people have difficulty engaging in or adhering to aerobic exercise. These new results suggest that weight training, to a large extent, can serve as an alternative to aerobic exercise for type 2 diabetes prevention."

Type 2 diabetes is a major public health concern and it's on the rise. An estimated 346 million people worldwide have type 2 diabetes, and diabetes-related deaths are expected to double between 2005 and 2030, according to the World Health Organization. More than 80% of these deaths occur in low- and middle-income countries.

The researchers, including senior author Frank Hu, professor of nutrition and epidemiology at HSPH, followed 32,002 men from the Health Professionals Follow-up Study from 1990 to 2008. Information on how much time the men spent each week on weight training and aerobic exercise came from questionnaires they filled out every two years. The researchers adjusted for other types of physical activity, television viewing, alcohol and coffee intake, smoking, ethnicity, family history of diabetes, and a number of dietary factors. During the study period, there were 2,278 new cases of diabetes among the men followed.

The findings showed that even a modest amount of weight training may help reduce type 2 diabetes risk. The researchers categorized the men according to how much weight training they did per week—between 1 and 59 minutes, between 60 and 149 minutes, and at least 150 minutes—and found that the training reduced their type 2 diabetes risk by 12%, 25%, and 34%, respectively, compared with no weight training. Aerobic exercise is associated with significant benefits as well, the researchers found—it reduced the risk of type 2 diabetes by 7%, 31%, and 52%, respectively, for the three categories above.

The researchers also found that the combination of weight training and aerobic exercise confers the greatest benefits: Men who did more than 150 minutes of aerobics as well as at least 150 minutes of weight training per week had a 59% reduced risk of type 2 diabetes.

Grøntved said that further research is needed to confirm the results of the study as well as to analyze whether or not the findings can be generalized to women.

"This study provides clear evidence that weight training has beneficial effects on diabetes risk over and above aerobic exercise, which are likely to be mediated through increased muscle mass and improved insulin sensitivity," said Hu. "To achieve the best results for diabetes prevention, resistance training can be incorporated with aerobic exercise

Basal cell carcinoma is a chronic disease

Here's yet another reason to go easy on the tanning this summer: A new study affirms that basal cell carcinoma, the most common form of skin cancer, should be viewed as a chronic disease.

That's because once most people have a single occurrence, they are at risk of getting another.

"Basal cell carcinoma has generally been viewed as something that comes up, is treated and cured," said Dr. Martin Weinstock, a study co-author and professor of dermatology at the Warren Alpert Medical School at Brown University in Providence, R.I. "For someone with an isolated lesion, that's a reasonable way of looking at it. But most people are constantly at risk of this and will be getting more."

The study confirmed what was commonly understood about the disease: a prior history of basal cell carcinoma is the greatest risk for another lesion. But the research found that eczema may also predict a recurrence among those at high risk for the disease. Those with a family history of eczema had a 1.54 times greater risk than those without.

Older age, sun sensitivity, intense sun exposure before age 30, and use of certain blood pressure-lowering medications (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) were also associated with increased risk.

Why would eczema, a chronic skin disorder that involves scaly and itchy rashes, be associated with basal cell carcinoma? Weinstock said it's unclear. "There may be some differences in these people's immune systems compared to people without eczema," he said, noting that other investigators need to confirm the findings.

Having other types of skin cancer or actinic keratoses (scaly or crusty growths caused by sun damage) did not appear to raise the chances for basal cell carcinoma.

The study was published online July 19 in the Journal of Investigative Dermatology and funded by the U.S. Department of Veterans Affairs. It involved more than 1,100 people, nearly all men, all veterans, with a median age of 72.

On average, each participant had more than three instances of basal cell cancer or squamous cell cancer (another type of skin cancer) before participating in the research. During the study period, 44 percent developed new basal cell cancers, and those with the most basal cell cancers in the five years before the study had the most recurrences.

Study participants with more than five prior basal cell cancers were nearly four times as likely to develop a new one as those with one or no prior skin cancers. And their risk was twice as high as those with three previous skin cancers, the study found.

Now the most common cancer in the United States, basal cell carcinoma begins in the outer layer of the skin, often as a small white or flesh-colored bump that grows slowly and sometimes bleeds. While these cancers rarely spread, they must be removed or treated, usually in a physician's office with local anesthetic.

Weinstock said researchers are eager to find a preventive medication to guard against the recurrence of basal cell carcinoma. Last year a team he led concluded that topical tretinoin did not prevent new basal cell cancers in high-risk patients. Now he is involved in a study looking at whether 5-Fluorouracil, a compound used to treat actinic keratoses, may prevent basal cell cancer when given intravenously.

Dr. Jean Tang, an assistant professor in the department of dermatology at Stanford University School of Medicine who is familiar with the study, said the most important thing for patients to know is that if you have had a basal cell carcinoma, you have a 44 percent chance of getting another.

"This study doesn't change any clinical guidelines or recommendations," she added. Current advice still stands: "Get an annual skin assessment by your dermatologist," she said.

Iced Tea Can Contribute to Painful Kidney Stones

This is the peak season for drinking iced tea, but a Loyola University Medical Center urologist is warning the popular drink can contribute to painful kidney stones.

Iced tea contains high concentrations of oxalate, one of the key chemicals that lead to the formation of kidney stones, a common disorder of the urinary tract that affects about 10 percent of the population in the United States.

"For people who have a tendency to form the most common type of kidney stones, iced tea is one of the worst things to drink," said Dr. John Milner, assistant professor, Department of Urology, Loyola University Chicago Stritch School of Medicine.

The most common cause of kidney stones is not drinking enough fluids. And during the summer, people can become dehydrated from sweating. Dehydration, combined with increased iced tea consumption, raises the risk of kidney stones, especially in people already at risk.

"People are told that in the summertime they should drink more fluids," Milner said. "A lot of people choose to drink more iced tea, because it is low in calories and tastes better than water. However, in terms of kidney stones, they might be doing themselves a disservice."

Though hot tea also contains oxalate, it's hard to drink enough to cause kidney stones, Milner said. About 85 percent of tea consumed in the United States is iced, according to the Tea Association of the USA.

Men are four times more likely to develop kidney stones than women, and the risk rises dramatically after age 40. Postmenopausal women with low estrogen levels and women who have had their ovaries removed also are at increased risk.

Kidney stones are small crystals that form from minerals and salt normally found in the urine in the kidneys or ureters, the small tubes that drain urine from the kidney to the bladder. Kidney stones usually are so small they are harmlessly expelled from the body. But stones sometimes grow large enough to become lodged in the ureters.

To quench thirst and properly hydrate, water is the best choice, Milner said. Real lemonade (not powdered) is another good option. "Lemons are high in citrates, which inhibit the growth of kidney stones," Milner said.

Milner advised that people at risk for kidney stones should cut back on foods that contain high concentrations of oxalates, such as spinach, chocolate, rhubarb and nuts. They should ease up on salt, eat meat sparingly, drink several glasses of water a day and eat foods that provide adequate amounts of calcium, which reduces the amount of oxalate the body absorbs.

Milner also advises that if you drink iced tea and have kidney stones, ask your specialist if the drink could be a contributing factor. (Patients aren't always asked.) If so, it is relatively easy to check if you are producing too many oxalates.

"Like many people, I enjoy drinking iced tea in the summer," Milner said. "But don't overdo it. As with so many things involving a healthy lifestyle, moderation is key."

Beneficial effect of moderate alcohol consumption on osteoporosis in women

Women after menopause tend to develop weaker bones from what is known as osteoporosis, which may lead to fractures (especially hip fractures) from falling. The weakness of the bones results from an imbalance between the normal resorption (a type of dissolving of old bone) and the laying down of new bone, an ongoing process for both men and women referred to as "bone turnover." For poorly understood reasons, after menopause the resorption of old bone in women continues but new bone is laid down less well, leading to a decrease in bone density. A variety of substances (calcium, vitamin D and various medications) have been used in an attempt to prevent the development of osteoporosis; in epidemiologic studies, moderate drinking of alcohol has also been shown to lower this risk.

An intervention by Marrone JA et al published in Menopause, involved 40 healthy postmenopausal women of an average age of 56. The authors measured factors that relate to osteoporosis in post-menopausal women while subjects were consuming alcohol (19g a day), after they had stopped drinking, and after they had resumed their alcohol consumption. The authors state that excessive bone turnover, combined with an imbalance whereby bone resorption exceeds bone formation, is the principal cause of post-menopausal bone loss and conclude that alcohol decreases the turnover of bone in post-menopausal women, which leads to less resorption of bone, hence less osteoporosis. The study also showed that abstinence from alcohol resulted in increased markers of bone turnover (hence, higher risk of developing osteoporosis), whereas resumption of alcohol consumption reduced bone turnover markers.

The authors attribute a cellular mechanism for the observed lower risk of osteoporosis among women who consume moderate amounts of alcohol.

International Scientific Forum on Alcohol Research reviewers considered this to be an innovative and well-done study. The key questions raised were how alcohol may affect bone metabolism in a longer period of time than was tested in this study. Reviewers realized that such long-term intervention trials are very difficult and expensive to carry out. On the other hand, many prospective epidemiologic studies in the elderly have shown greater bone mineral density and a lower risk of fractures among regular moderate drinkers than among abstainers. The most important aspect of this study may be that it has helped identify cellular mechanisms for the increased bone density observed in post-menopausal women who are moderate alcohol consumers.

Vitamins and Supplements: Ten Dangers That May Surprise You

In a new report in its September issue and online at www.ConsumerReports.org, Consumer Reports identifies ten hazards that might surprise the large swath of American adults—more than 50 percent—who take vitamins, herbs, or other nutritional supplements.

“Patients sometimes assume that supplements are safe because they are ‘all natural,’ but not all supplements are truly natural. In fact, one of the greatest safety hazards to consumers involves supplements that have been spiked with prescription drugs or toxic metals,” said Jose Luis Mosquera, M.D., medical adviser, Consumer Reports, and an internist who specializes in integrative health and medicine.

Consumer Reports identifies ten hazards distilled from interviews with experts, published research, and its own analysis of reports of serious adverse events submitted to the Food and Drug Administration (FDA), obtained through a Freedom of Information Act request. Here are some of the hazards discussed in the report, plus advice for staying safe:

Supplements are not risk-free. More than 6,300 reports describing an excess of 10,300 serious outcomes, including 115 deaths and more than 2,100 hospitalizations, 1,000 serious injuries or illnesses, 900 emergency-room visits, and some 4,000 other important medical events, streamed into the FDA from supplement companies, consumers, health-care providers, and others between 2007 and mid-April 2012. CR notes that the reports by themselves don’t prove that supplements caused the problems, but the raw numbers are cause for concern. Current laws make it difficult for the FDA to order a problem product off the market. In fact, to date, the FDA has banned only one ingredient, ephedrine alkaloids.

Protect yourself: Search the FDA’s website at www.fda.gov for warnings, alerts, or voluntary recalls involving a supplement you are thinking of taking. If you suspect you’re having a bad reaction to a supplement, tell your doctor. You can also report your problem to the FDA at 800-332-1088 or www.fda.gov/medwatch.

Some supplements are really prescription drugs. According to Daniel Fabricant, Ph.D, director of the FDA’s Division of Dietary Supplement Programs, dietary supplements spiked with prescription drugs are the “largest threat” to consumer safety. Many recalled products have the same or similar active ingredients as prescription drugs such as sildenafil (Viagra), tadalafil (Cialis), and sibutramine (Meridia, a weight-loss drug that was removed from the market in 2010 because of evidence that it increased the risk of heart attacks and strokes). Others contained synthetic steroids. “As a result, adulterated products can cause some of the same side effects and interactions that a consumer may be trying to avoid by opting for supplements instead of prescription drugs,” says Dr. Mosquera.

Protect yourself. Consult your doctor if you are having trouble in the bedroom (it could indicate an underlying health problem). And try to slim down with diet and exercise. Build muscle by weight training.

You can overdose on vitamins and minerals. Unless your health-care provider tells you that you need more than 100 percent of the recommended daily intake of a particular nutrient, you probably don’t. Megadoses of the fat-soluble vitamins A, D, E, and K can cause problems, and even some standard doses may interfere with certain prescription medicines. “Surprisingly, some people may experience adverse effects from even normal doses of a vitamin or mineral supplement, especially patients with digestive issues or those who take blood thinners,” says Dr. Mosquera.

Protect yourself: Using information from the labels on the supplements and food you routinely consume, add up your daily exposure to everything, and then check CR’s “How much is too much?” table to see if you’re overdoing it.

You can’t depend on warning labels. For one thing, the FDA doesn’t require them on supplements with one important exception, iron. In a market basket study of 233 products purchased online and in the New York City metropolitan area, Consumer Reports found wide variations and inconsistencies in labeling.

Protect yourself: Make sure your doctor or pharmacist knows what supplements and prescription drugs you are taking or thinking of taking. You can also check for interactions by using Consumer Reports’ “Guide: 100+ Commonly Used Supplements.” To access the free guide, go to www.ConsumerReports.org/health and click on “Natural Health.”

Heart and cancer protection: not proven. Omega-3 pills and antioxidants are widely thought to reduce the risk of heart disease and cancer, respectively, and millions of women take calcium to protect their bones. But recent evidence casts doubt on whether those supplements are as safe or effective as assumed. The report notes that the widely held view that fish-oil pills help prevent cardiovascular disease hit a snag when a study of 12,500 people with diabetes or prediabetes and a high risk of heart attack or stroke found no difference in the death rate from cardiovascular disease or other outcomes between those given a 1-gram fish-oil pill every day and those given a placebo. These findings were published in a June 11, 2012, issue of New England Journal of Medicine online report.

Consumer Reports also notes a recent blow against calcium supplements by German and Swiss researchers who followed almost 24,000 adults for an average of 11 years. They found that regular users of calcium supplements had an 86 percent increased heart-attack risk compared with those who didn’t use supplements, as reported in the June 2012 issue of the Journal Heart.

Protect yourself: Lay off the antioxidant supplements and reduce your cancer risk safely by quitting smoking, avoiding excessive alcohol, and eating a healthy diet that includes plenty of fruit, vegetables, nuts, legumes, and whole grains.