Two reports released this week shed light on the current state of type 2 diabetes in this country, and their conclusions are promising and sobering. First, the good news: An article in The New England Journal of Medicine shows that rates of diabetes-related problems like heart attack, stroke, and lower-limb amputation are down by more than 50% over the last two decades. Now the bad news: during the same time period, the number of people with diabetes has soared, according to a report in the Annals of Internal Medicine. Today, about 21 million American adults are living with diabetes, and that number is on the upswing. Nearly 70% of Americans are overweight or obese. Unless something is done to reverse this trend, millions more Americans could edge closer to diabetes. Dr. Osama Hamdy, medical director of the Obesity Clinical Program at Harvard-affiliated Joslin Diabetes Center and author of The Diabetes Breakthrough, a newly published book from Harvard Health Publications, offers some strategies for preventing diabetes.
Harvard Health Blog
One year ago today, the detonation of two improvised bombs near the finish line of the Boston Marathon killed three people, injured more than 260 others, and shattered a day traditionally filled with joy and camaraderie. Although the bombing immediately extinguished the celebration, it sparked an outpouring of extraordinary work and compassion that continues to this day. Residents of Boston, the Commonwealth of Massachusetts, and beyond rallied to help those injured by the bombs. It is a testament to the extraordinary care and preparation by first responders and staff members at all Boston-area hospitals that only three people died. Many of the wounded were taken to teaching hospitals affiliated with Harvard Medical School. The medical school and its institutions take time today to mourn this senseless tragedy, pray for those who lost a loved one or who themselves still bear physical and emotional scars from the bombing, and acknowledge the work of first responders, emergency department staff, and others who have been part of the healing effort.
There are plenty of good reasons to be physically active. Big ones include reducing the odds of developing heart disease, stroke, and diabetes. Maybe you want to lose weight, lower your blood pressure, prevent depression, or just look better. Here’s another one, which especially applies to anyone experiencing the brain fog that comes with age: exercise changes the brain in ways that protect memory and thinking skills. In a study done at the University of British Columbia, researchers found that regular aerobic exercise, the kind that gets your heart and your sweat glands pumping, appears to boost the size of the hippocampus, the brain area involved in verbal memory and learning.
For the past few years, vitamin D has been gaining a reputation—not entirely earned—as a wonder vitamin that offers protection against some cancers, bone-weakening osteoporosis, heart attack, Alzheimer’s disease, and other chronic conditions. Not so fast, caution two reports in the journal BMJ. One concluded that “highly convincing evidence of a clear role of vitamin D does not exist for any outcome.” The other showed a link between low blood levels of vitamin D and increased risks of dying prematurely from cardiovascular disease, cancer, and other causes. But it isn’t clear if low vitamin D causes chronic conditions, or whether chronic conditions cause low vitamin D levels. To play it safe, get the amount of vitamin D recommended by the Institute of Medicine: 600 IU of vitamin D a day for everyone ages 1 to 70 and 800 IU for those 71 and older. Eating foods rich in vitamin D or getting a few minutes of sunshine a day can do the trick.
Cardiologists from around the world have gathered in Washington, DC, for the 65th annual meeting of the American College of Cardiology in Washington, DC. During the opening lecture, Dr. Gary Gibbons, director of the National Heart, Lung, and Blood Institute, talked about the “challenge of success.” What does that mean? Since 1950, death rates from cardiovascular disease have plummeted by 70%, thanks to two major trends. One is the decline in smoking and improvements in cholesterol and blood pressure. The other is the boom in new therapies, including better medications, surgeries, and high-tech procedures to repair an array of heart problems. The challenge today is finding a new drug or procedure that raises this already high bar. Here’s a summary of four reports, two negative and two positive, of studies on new treatments for heart disease.
For anyone who has had a stroke, working to prevent a second one should be Job No. 1. Keeping blood pressure under control is an important part of that job. A study published yesterday in the journal Stroke shows that good blood pressure control after a stroke cuts the chances of having a repeat stroke by more than half. But the study also brought some bad news: less than one-third of stroke survivors in the study managed to get their blood pressure under control. Measuring blood pressure at home is one way to help control blood pressure—seeing that it is high can help you take steps to bring it down. These include lifestyle changes and medications.
A new report from the Alzheimer’s Association says that as many as 5 million Americans have Alzheimer’s disease or some other form of dementia. Every 67 seconds someone in the United States develops Alzheimer’s disease or dementia. That’s 470,000 Americans this year alone. Given that these thieves of memory and personality are so common and so feared, should all older Americans be tested for them? In proposed guidelines released yesterday, the U.S. Preventive Services Task Force said “no.” Why not? Even after conducting a thorough review of the evidence, the panel said that there isn’t enough solid evidence to recommend screening, especially since not enough is known about the benefits and the harms. In part, the recommendation is based on the sad fact that so far there aren’t any truly effective approaches to stop the forward progress of dementia.
Some good news on the cancer front: between 2000 and 2010, rates of colorectal cancer in American adults fell by about one-third. That decline mirrored a sharp rise in colorectal cancer testing during the same period. American Cancer Society researchers found that the drop in colorectal cancer rates was highest among Americans aged 65 years and older. Cases fell 3.6% a year from 2001 to 2008, then dropped even more by 7.2% a year from 2008 to 2010. But the researchers saw a troubling trend in younger adults: an increase in colorectal cancer of 1.1% a year among people under age 50. Rising obesity rates may be to blame. The researchers attribute the decline in colorectal cancer to early testing for the disease. Despite the optimistic findings, colorectal cancer is still a scourge. In the U.S. this year, an estimated 72,000 men and 65,000 women will be diagnosed with colorectal cancer; 26,000 men and 24,000 women will die of it.
Severe headaches are a misery, whether they cause a dull ache or a steady, stabbing, or blinding pain. Such pain rarely comes from something catastrophic, like a tumor or a bleeding in the brain. Yet an estimated 12% of people with headaches get brain scans. A new study shows that these unnecessary scans add several billion dollars a year to health care costs for very little benefit. Excessive brain scanning costs more than just dollars. Repeated CT scans deliver enough radiation to increase the odds of developing cancer. Scans also tend to lead to more scanning if the test turns up something strange. Many people who see a doctor because of severe and recurrent migraine headaches don’t need brain scans. They need the right therapy to stop their pain.
How bad can a little high blood pressure be? It turns out that it might be worse than we thought. Researchers from Southern Medical University in Guangzhou, China, examined the results of 19 high-quality studies looking at links between prehypertension and stroke. The studies included more than three-quarters of a million people, whose health and wellbeing was followed for 36 years. Those with “high-range prehypertension” (blood pressure between 130/85 and 139/89) had a 95% higher stroke risk compared to people with healthy blood pressures. Those with “low-range prehypertension” (blood pressure between 120/80 and 129/84) had a 44% higher stroke risk. The size of the study and the length of the followup make the results believable. They don’t mean that we should elevate prehypertension to a disease. But they do signal that we need to take it seriously. The best way to treat prehypertension is with lifestyle changes.