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Stroke
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New Developments in Hormone Replacement Therapy
In July 2002, the government halted a major study of hormone therapy
three years early because of a slight but significant increase in the
risk of invasive breast cancer. Researchers concluded that the long-term
risks of taking hormones outweigh the benefits for a woman who still
has her uterus.
More than 16,000 women took part in the study, known as the Women's
Health Initiative, the largest to compare postmenopausal hormones with
a placebo. The therapy was a combination of estrogen and progestin (Prempro),
a treatment used by an estimated six million women to replace the declining
levels of hormones at menopause.
The study sought to determine whether this combination hormone therapy
could prevent such ailments as osteoporosis and heart disease. But while
there were small decreases in hip fractures and colorectal cancer, the
increases in breast cancer, heart attacks, strokes, and blood clots were
too unsettling.
The data suggested that for every 10,000 women on the estrogen-progestin
combination, an additional 8 will develop invasive breast cancer, when
compared with women not taking the therapy. An additional 7 will have
cardiovascular disease, 8 will have a stroke, and 8 will have blood clots
in the lungs (pulmonary embolism).
In the aftermath of the trial, it seems that many doctors will be reconsidering
prescribing estrogen and progestin. Some women may want to lower their
doses or limit the duration of the use of these combinations, while others
will elect to try other treatments to combat their hot flashes, vaginal
dryness, and other menopausal symptoms.
However, it is important for women already on hormone replacement therapy
(HRT) to know that there is no urgency to stop, and waiting until an
annual exam to discuss it with a doctor is fine. There is also no harm
in stopping immediately, if a woman is more comfortable doing so.
It's important to remember that only combination therapy appears to
have these effects. Estrogen alone taken by women who have had a hysterectomy
has not displayed such risks. A separate trial, with 10,000 women who
have had a hysterectomy randomly assigned to either estrogen or a placebo,
has not indicated an increased breast cancer risk. The trial is scheduled
to go until 2005.
The full report on the Women's Health Initiative appeared in the Journal
of the American Medical Association on July 17, 2002.
July 2002 Update
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New guidelines for stroke prevention
With more than 700,000 Americans having strokes each year, doctors and
patients need to focus on stroke prevention. In light of this, the American
Heart Association (AHA) has issued a statement that details how to identify
and modify risk factors. Here are the AHA's tips, along with other general
guidelines for lowering stroke risk:
Blood pressure. You should get your blood pressure checked
at least every two years because many people with high blood pressure
don't even know they have it (130–139 mm Hg systolic pressure over
85–89 diastolic pressure is considered high-normal, while anything
above 140 over 90 is considered high). If you have high blood pressure,
the following lifestyle changes can help lower it:
- Eat more fruits and vegetables. Potassium-rich foods like bananas
and oranges may be especially good.
- Pass on salt. Salt makes the body hold onto water, and the heart
has to work harder to pump the extra fluid.
- Lose weight. The heavier you are, the harder your heart has to work
to pump blood to all parts of your body.
- Exercise. Even if you don't need to lose weight, exercise can reduce
high blood pressure and may even prevent it.
- Limit your alcohol. Having more than two alcoholic drinks a day significantly
increases your risk of high blood pressure.
- Quit smoking. Smoking increases your risk of heart attack, as well
as many other diseases. And if you live with a smoker, make sure he
or she quenches his cravings outside. Exposure to secondhand smoke
can double your risk of stroke.
- Learn to relax. Various kinds of behavioral therapy, like biofeedback,
yoga, and tai chi may lower blood pressure.
These lifestyle changes can also help with other causes of stroke, like
atherosclerosis (hardening of the arteries) and high cholesterol. If
the changes don't lower your blood pressure, your doctor may prescribe
a medication such as a diuretic or beta blocker.
Other conditions. The AHA recommends that patients with
diabetes and children with sickle cell disease closely monitor their
blood pressure with screenings every six months.
Non-modifiable risk factors. Black, Hispanic, Chinese,
and Japanese people are at increased risk for stroke compared to whites.
Men and postmenopausal women are also at higher risks than others. If
one of your parents had a stroke, you are at greater risk as well, either
because of genetics or shared lifestyle traits.
While you can't do anything about non-modifiable risk factors it's helpful
to know if you fall into a high-risk group so you can carefully monitor
controllable factors.
July 2002 Update
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Blood Pressure Medication May Affect Stroke
Risk
Your choice of high blood pressure medication may affect your risk of
stroke. Research published in the March 23, 2002, issue of The Lancet comparing
the effectiveness of two high blood pressure is the first with solid
evidence showing the importance of how we treat high blood pressure.
In the trial, called the LIFE study, researchers compared the number
of strokes, heart attacks, and deaths due to cardiovascular events in
over 9,000 patients taking either losartan or atenolol.
According to the results, both losartan and atenolol decreased blood
pressure effectively, but patients who took losartan had a 25% lower
risk of stroke than patients taking atenolol. In an accompanying study,
researchers found similar results in patients with diabetes and high
blood pressure.
Researchers believe the difference in effectiveness may be a result
of the mechanisms by which each drugs works. Losartan belongs to a newer
class of drugs, called angiotensin II receptor blockers (ARBs). ARBs
lower blood pressure by preventing the smooth muscles of the arteries
from contracting. Atenolol, on the other hand, is a beta-blocker and
works to lower blood pressure by blocking substances that would otherwise
speed up the heart and increase the pressure at which it pumps blood.
Results of the LIFE study also showed that losartan provided benefits
beyond lowering blood pressure and reducing cardiovascular events. Patients
on this drug had a 25% lower incidence of new-onset diabetes compared
to patients on atenolol. In addition, patients in the losartan group
were less likely to discontinue the drug due to side effects than were
patients in the atenolol group.
Based on these findings, losartan or another ARB may quickly become
a vital part of the first line of treatment for high blood pressure.
Up until now, treatment with a beta-blocker, such as atenolol, and a
diuretic has been regarded as the best intervention. The results of an
upcoming National Institutes of Health study (due out in December) comparing
a larger array of high blood pressure medications may shed even more
light on the subject.
June 2002 Update
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White-Coat Hypertension
Most people feel a bit anxious during a doctor's visit. But for some
people, their anxiety causes temporary high blood pressure, detectable
during the time of the visit. Physicians have been debating whether or
not they should treat this phenomenon, referred to as "white-coat" hypertension.
Some believe the short-lived blood pressure elevation is harmless, while
others believe it should be treated like persistent high blood pressure.
In a recent study, researchers compared changes in the heart's function
and size among people with persistent, untreated high blood pressure, "white
coat" high blood pressure, and normal blood pressure. Participants
were carefully matched by age, sex, and weight, as well as in-clinic
and out-of- clinic blood pressures. Results of the study show participants
with "white coat" hypertension, when compared to participants
with normal blood pressure, had thicker walls in portions of their hearts,
increased heart mass, and alterations in the diastolic (relaxing) portion
of the heartbeat. Those people with persistent high blood pressure had
even greater changes in the heart. These findings suggest "white
coat" hypertension, while a temporary condition, may cause damage
to the heart. This study reinforces the argument for treating "white
coat" hypertension.
If you experience this condition, you should consult your doctor about
treatment options. Simple lifestyle changes may be all you need or medication
might be necessary. In any case, the possible benefits will outweigh
the risks.
January 2002 Update
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High-Normal Blood Pressure Bad for the Heart
People with high-normal blood pressure are more likely to suffer a heart
attack, stroke, or heart failure than those with lower blood pressure,
according to recent findings from the Framingham Heart Study.
The researchers followed the cardiovascular events of 6,859 participants
of the famed study, which has been monitoring subjects from the Boston
suburb for more than 50 years. A third of participants had normal blood
pressure (120–129 over 80-84 mm HG), a quarter had high-normal (130–139
over 85–89 mm Hg), and the remainder had optimal blood pressure
(less than 120 over less than 80 mm HG). People with high blood pressure
were excluded from the study.
Of those in the optimal category, 81 had cardiac events, over a ten-year
time period, compared to 136 people in the normal blood pressure category
and 180 in high-normal category. In all, people with high-normal blood
pressure were two to three times more likely to suffer a heart attack,
stroke, or heart failure than those with lower blood pressure. This held
true in both men and women, and was consistent in both age groups (35
to 64 and 65 and over), even after researchers adjusted for other cardiovascular
risk factors such as smoking and obesity. Indeed, the study found risk
increases in a stepwise fashion as blood pressure increases.
Blood pressure reflects how hard your heart is working and what conditions
your arteries are in. Risk factors include heavy drinking, smoking, eating
a diet high in salt, obesity, and family history. Doctors generally get
alarmed only if systolic blood pressure is above 140 mm Hg or if diastolic
blood pressure is above 90 mm Hg. However, this study calls for further
research to be done to see if patients in the high-normal group benefit
from lowering their blood pressure.
December 2001 Update
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Salt Restriction More Potent Than Exercise
Physicians often give patients with hypertension a daunting list of
lifestyle changes to help lower their blood pressure: lose weight, exercise
more, eat less salt, drink less alcohol, eat more foods rich in calcium,
potassium, and magnesium. Of course, these changes do work — people
who follow them can reduce their need for medications or even do without
blood pressure-lowering drugs. But which of these lifestyle changes gives
you the biggest bang for your buck?
University of Colorado researchers recently compared the impact of exercise
or moderate salt restriction in 35 healthy older women with high-normal
blood pressure or mild hypertension (systolic blood pressure 130–159
mm Hg), none of whom were using drugs to lower their blood pressure.
Half the women exercised for three months — starting at 30 minutes
a day three or four times a week and working up to 45 minutes a day every
day, if possible. The other half tried to reduce their daily salt intake
to less than 2.4 grams of sodium (the amount in a level teaspoon of table
salt) without otherwise changing their diets. All were asked to try to
avoid gaining or losing weight.
The clear winner, reported in the American Journal of Cardiology,
was sodium restriction. Among the women who ate less salt, average systolic
blood pressures fell 16 mm Hg, compared with a still-respectable 5 mm
Hg in the exercise group. By the study's end of the study, systolic blood
pressure was lower in 88% of the women who ate less salt and in 55% of
the exercisers.
So if you're trying to lower your blood pressure, should you just forget
about exercise and work harder at eating less salt? No. Exercise has
other benefits besides lowering blood pressure — it can help control
weight, improve the cholesterol profile, stave off diabetes, and keep
bones strong. The real message from this study is that everyone should
exercise, but that people who are trying to control blood pressure should
lower their sodium intake, too.
December 2001 Update
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Statins Associated With Lower Dementia Risk
Most people who develop dementia - poor memory and intellectual functioning
that often accompanies old age - have Alzheimer's disease. But a small,
yet sizable group of people appear to develop dementia from a narrowing
of the arteries supplying the brain. The lack of blood can lead to many
small areas of damage to the brain; each too small to be noticeable as
a "stroke," but collectively devastating in their effect. This syndrome
is called "vascular dementia" to differentiate it from Alzheimer's disease
and other types of dementia.
Presumably because high cholesterol levels contribute to the damage of
brain's blood vessels, researchers have looked for evidence that people
who use statins might have a lower rate of dementia. Statins are the
most widely used cholesterol-lowering drugs. In addition to protecting
the brain's arteries from atherosclerosis, some scientists believe statins
may also help protect the brain against non-vascular forms of dementia,
including Alzheimer's disease.
A recent study examined the relationship between statin use and types
of dementia among people living in the United Kingdom. The researchers
identified 284 people with dementia, and matched them with 1,080 "control" subjects
of similar age and sex, but without dementia. After adjusting statistically
for a wide range of clinical information, the researchers found statin
use was associated with a 71% reduction in dementia risk.
Could statins really cut the risk for dementia by two-thirds or more?
It seems unlikely, since other studies haven't suggested protective effects
of this size. On the other hand, this study adds to several other laboratory
and epidemiological investigations that suggest statins might provide
some benefit in the protecting the brain - if for no other reason than
lower cholesterol levels lead to healthier brain arteries. No one should
start taking statins as a strategy for preventing dementia, but these
data do provide another reason for people with elevated cholesterol levels
who are on these medications to be sure they take them as prescribed.
October 2001 Update
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Study Shows Fish Consumption Protects Against Stroke,
But FDA Suggests Pregnant Women Should Take Caution
A large study in the Journal of the American Medical Association (JAMA)
recently showed that regularly eating fish might protect against ischemic
stroke, which is the most common type of stroke. Numerous studies have
already shown an association between fish consumption and a reduced risk
of heart disease. But there is a caveat. The Food and Drug Administration
(FDA) recently warned that pregnant women and women who are of childbearing
age who may become pregnant, should avoid certain types of fish that
contain high levels of mercury, which may be harmful to their unborn
children.
Results of the Nurses' Health Study, published in the JAMA article,
involved nearly 80,000 women. It showed that women who ate fish two to
four times a week had a 48% lower risk of ischemic stroke — the
kind caused by blood clots — than women who ate fish less than once
per month. Even women who ate fish only once a week or less had a risk
reduction, but it was not statistically significant. These results held
true primarily among women who did not regularly take aspirin, which
prevents the formation of blood clots. Omega-3 fatty acids, the protective
substances found in fish, reduce levels of fats related to cardiovascular
disease and help prevent blood clotting. Dark, oily fish such as mackerel,
salmon, and sardines are a good source of omega-3 fatty acids.
Although pregnant women need not give up fish — and its beneficial
health effects — altogether, they should be careful about what types
of fish they eat. The FDA has advised that pregnant women and those who
may become pregnant stop eating shark, swordfish, king mackerel, and
tilefish. These large, long-living fish contain hazardous levels of methyl
mercury, a form of mercury that can accumulate in a woman's body
and affect the developing central nervous system of an unborn child.
This can lead to babies with slower cognitive development. As an extra
precaution, the FDA advised that nursing mothers and young children also
avoid these fish. Mercury gets into both fresh and salt water through
industrial pollution.
Some critics feel the FDA's mercury warnings are not strong enough. A
report by the National Academy of Sciences suggested the exposure limits
for mercury should be four times stricter.
While this controversy remains unresolved, the FDA encouraged pregnant
women to continue to eat a variety of other fish, containing very low
levels of mercury, as part of a balanced diet. Among other health benefits,
the fatty acids in fish enhance brain development. According to the FDA,
women can safely eat up to 12 ounces of fish per week. Fish that contain
low levels of mercury include shellfish, canned fish, smaller ocean fish,
and farm-raised fish. Women who eat fish caught by family or friends
should contact their local health department for advice on the safety
of fish from local waters.
May 2001 Update
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Products Containing Phenylpropanolamine (PPA) Pulled
From Shelves
Responding to concerns that phenylpropanolamine (PPA), an ingredient
found in many over-the-counter medications, may increase risk of hemorrhagic
stroke (see the Family Health Guide online update on phenylpropanolamine),
the U.S. Food and Drug Administration has asked manufacturers to remove
drugs containing PPA from the market. The following list may not be complete
and does not include drug store and supermarket brands, so please check
the label or ask your pharmacist. You should also discard any items in
your medicine cabinet that contain PPA.
Drugs Pulled From the Market:
Acutrim Diet Gum Appetite Suppressant Plus Dietary Supplements
Acutrim Maximum Strength Appetite Control
Alka-Seltzer Plus Children's Cold Medicine Effervescent
Alka-Seltzer Plus Cold Medicine (cherry or orange flavor)
Alka-Seltzer Plus Cold Medicine Original
Alka-Seltzer Plus Cold & Cough Medicine Effervescent
Alka-Seltzer Plus Cold & Flu Medicine Effervescent
Alka-Seltzer Plus Cold & Sinus Effervescent
Alka-Seltzer Plus Night Time Cold Medicine Effervescent
BC Allergy Sinus Cold Powder
BC Sinus Cold Powder
Comtrex Deep Chest Cold & Congestion Relief
Comtrex Flu Therapy & Fever Relief Day & Night
Contac 12 Hour Cold Capsules
Contac 12 Hour Cold Caplets
Coricidin D Cold, Flu & Sinus
Dexatrim Caffeine Free
Dexatrim Extended Duration
Dexatrim Gelcaps, Dexatrim Vitamin C / Caffeine Free
Dimetapp Cold & Allergy Chewable Tablets
Dimetapp Cold & Cough Liqui-Gels
Dimetapp DM Cold & Cough Elixir
Dimetapp Elixir
Dimetapp 4-Hour Liqui-Gels
Dimetapp 4-Hour Tablets
Dimetapp 12-Hour Extentabs Tablets
Naldecon DX Pediatric Drops
Permathene Mega-16
Robitussin CF
Tavist-D 12 Hour Relief of Sinus & Nasal Congestion
Triaminic DM Cough Relief
Triaminic Expectorant Chest & Head Congestion
Triaminic Syrup Cold & Allergy
Triaminic Triaminicol Cold & Cough
January 2001 Update
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Subarachnoid Hemorrhages Run in Families
Roughly one in 10,000 people experience subarachnoid hemorrhages (bleeding
onto the surface of the brain). This condition often affects individuals
in their 30s through 60s without warning. Subarachnoid hemorrhages are
life-threatening: about a third of people who suffer such hemorrhages
die. Of those who survive, more than half have major neurological deficits.
Very little can be done to prevent a hemorrhage, but it helps to know
your family history. A Danish research team has concluded that first-degree
relatives (parents, children, siblings) of people who've suffered subarachnoid
hemorrhages are more likely to have one themselves. The researchers identified
9,367 patients admitted to the hospital for the first time with subarachnoid
hemorrhages during the study period. They were able to identify nearly
15,000 first-degree relatives for 6,175 of the cases. When they compared
discharge data, the team found that these relatives had a threefold risk
of developing the condition compared with the general population.
Although past studies had reached similar conclusions, selection and
recall bias may have skewed the results. Here, the researchers reduced
selection bias and used national registries rather than asking patients
for information.
To learn more about subarachnoid hemorrhages, see page 350 of the Family
Health Guide.
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Combining Forces to Prevent Strokes
The U.S. Food and Drug Administration recently approved a new combined
medication that helps prevent a full-blown stroke in people who have
had transient ischemic attacks, (TIAs), or "mini-strokes" due
to blood clots in the brain. It also helps prevent a second stroke in
patients who have already had one ischemic (blood-clot related) stroke.
The new drug combines aspirin with another antiplatelet drug, dipyridaimole
(Aggrenox). (Antiplatelet drugs reduce blood clotting.) Research shows
that the combination works better than either drug alone and certainly
better than a placebo. A 24-month study evaluated aspirin alone, dipyridimole
alone, the combination drug, and placebo in 6,602 patients with a history
of either mini-stroke or stroke. The combination reduced stroke risk
by 36.8% when compared with placebo, 22.1% when compared with aspirin
alone, and 24.4% when compared with dipyridimole alone. The most common
side effects included headache and upset stomach, and the combined drug
carried a higher risk of bleeding than either drug alone or placebo.
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Aspirin for Preventing Stroke and Other Vascular
Problems
An aspirin a day keeps a stroke away in patients with a history of heart
disease, but a recent review in Archives of Neurology reveals
the drug’s stroke-preventing properties may not extend to healthy
people.
Researchers from the University of Texas Health Science Center and three
other institutions have concluded aspirin does not reduce the risk of
stroke in people without heart disease. Indeed, their results suggest
regular aspirin use might even slightly increase the risk in people at
low risk for vascular problems. These conclusions were reached after
the investigators performed a meta-analysis on five existing studies
examining the preventive effects of aspirin. (A meta-analysis is a mathematical
method used to compare the results of similar studies.) The researchers
also reviewed four large observational studies that looked at regular
aspirin use and stroke risk in low-risk individuals.
The five trials used in the meta-analysis involved a total of 52,251
participants with a mean age of 57 years. Three of the studies excluded
women, though women accounted for roughly 20% of the total number of
patients. Three studies used people at high risk for vascular disease,
such as those with high blood pressure or diabetes, while the other two
used healthy males at low risk. Dosage varied from 75 mg to 650 mg per
day. The mean rate of stroke was 0.3% per year during an average study
period of five years.
The meta-analysis found no significant risk reduction for patients taking
aspirin compared with those taking a placebo. In contrast, the participants
still enjoyed a 26% decrease in heart attack risk.
The researchers' review of four observational studies found aspirin modestly
increases the risk of bleeding into the brain in low-risk patients — such
bleeding can cause hemorrhagic stroke. However, hemorrhagic stroke accounts
for only 10-15% of all strokes. Most strokes are ischemic, meaning they
are caused by a temporary interruption in the blood flow to brain. When
the four studies were pooled, no significant increase in risk of ischemic
stroke was apparent.
The researchers stress that more information is needed before guidelines
regarding stroke risk and aspirin use can be generalized. Certainly,
people with a history of heart disease or whose risk of a heart attack
eclipses their risk of stroke can benefit from aspirin. However, the
majority of the subjects in the reviewed studies were middle-aged males.
Men in this age group are more likely to suffer heart attacks, not strokes.
Women and the healthy elderly were underrepresented, yet they are more
prone to strokes rather than heart attacks. As a result, it’s still
unclear whether anyone with a low risk of heart problems should be regularly
taking aspirin.
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Phenylpropanolamine Safety Concerns
A recently released study reports that use of phenylpropanolamine (PPA) — an
ingredient in many over-the-counter medications — is associated
with an increased risk of hemorrhagic stroke (stroke caused by bleeding
into the brain). Phenylpropanolamine causes blood vessels to contract,
which can help relieve nasal congestion. It also stimulates the central
nervous system, thereby acting as an appetite suppressant. Many cold
and allergy products (for example, Contac, Sudafed, and Robitussin-CF)
and diet aids (Acutrim, Dexatrim) contain PPA.
Over the past 20 years, more than 30 published case reports have linked
PPA intake with bleeding in the brain. One of the earliest reports concerned
a diet pill (which is no longer available) that contained both PPA and
caffeine. The report’s authors concluded that PPA might cause brain
bleeding more often than believed and may trigger episodes of high blood
pressure. Later reports implicated products that contained only PPA.
Most of these were related to PPA in diet pills, although at least five
involved PPA found in cold remedies.
An epidemiological study of PPA and stroke was published in 1984. This
research looked at the number of cerebral hemorrhages that occurred among
HMO patients who had filled a prescription for phenylpropanolamine between
1977 and 1981. This analysis concluded that PPA users were no more likely
to experience bleeding in the brain than people who hadn’t used
PPA. Yet, the FDA and the manufacturers of products containing PPA agreed
that more study was needed. In 1992, they commissioned the Hemorrhagic
Stroke Project (HSP) in which investigators compared 702 individuals
who had experienced a brain hemorrhage with 1,376 control subjects. The
study volunteers included men and women ages 18-49 years old.
After researchers adjusted for the impact of race, history of high blood
pressure, cigarette smoking, and educational level, they found users
of cold-remedies or diet pills containing PPA were 49% more likely to
have a hemorrhagic stroke when compared to individuals who had not taken
PPA. Users of PPA in cold medicines (but not diet pills) had a 23% higher
risk of hemorrhagic stroke when compared to non-users.
PPA consumed in diet pills increased that risk substantially,
however, being 15 times greater for users than nonusers — even after
statistical adjustments. For women, the association between PPA in appetite
suppressants and hemorrhagic stroke was 17 times higher (after statistical
adjustment) for users versus nonusers. For first dose PPA users, the
statistically adjusted risk for brain bleeding was three times greater
than for controls.
Study investigators also observed that bleeding in the brain was more
likely to occur in people who took greater than the median dose (75 mg).
Interestingly, when compared to control subjects, case subjects were
significantly more likely to have other risk factors for hemorrhagic
stroke. For example, they were nearly twice as likely to have a history
of high blood pressure, a family history of hemorrhagic stroke, heavy
alcohol use, and were also more likely to report cocaine use. The PPA
users were more likely to have taken aspirin (which may raise hemorrhagic
stroke risk) and more than twice as likely than controls to have consumed
caffeine and more than 10 times as likely to have had recent nicotine
exposure. Like PPA, caffeine and nicotine also constrict blood vessels,
perhaps exaggerating this effect and contributing to bleeding risk.
Certainly, this research strongly suggests that taking PPA in diet pills
might increase hemorrhagic stroke risk. Because weight loss achieved
through the use of these drugs is not apt to be healthy or long lasting,
there is little to justify the apparent increased risk of using PPA-containing
diet pills. The associated risk for stroke with PPA use in cold medicines
is not as dramatic, yet these data are a sobering reminder to take seriously
the directions and warnings on products containing PPA. Specifically,
people with heart disease and high blood pressure should not take PPA
without consulting their doctors. Individuals who take monoamine oxidase
inhibitors (used for depression, psychiatric or emotional conditions,
and Parkinson’s disease) — or who have stopped taking them
only within the last two weeks — also should not take products containing
PPA until they clear it with their physicians. Finally, these data bring
home the message that over-the-counter drugs are drugs, and like
prescription medications, they come with potential risks and side effects.
Right now it is uncertain whether the FDA will vote to restrict medications
with PPA to prescription-only status, but it is taking these results
under advisement.
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Ramipril for Diabetics with Heart Disease
The incidence of heart disease in the general population has been dropping.
This is good news of course, but for individuals with diabetes, the statistics
are not so promising. In fact, men with type 2 diabetes have experienced
only a modest decline in heart disease rates, while women with diabetes
have actually experienced an increase.
Heart disease accounts for 70% of deaths in people with diabetes. So,
the outcome of a recent study, which demonstrated that the angiotensin-converting
enzyme (ACE) inhibitor, ramipril, significantly lowered the incidence
of heart disease, stroke, and death in people with diabetes who had a
history of heart disease and hypertension, should be welcome news.
The Heart Outcomes Prevention Evaluation (HOPE) study included people
with and without diabetes. More than one third of the participants had
diabetes. Of the participants with diabetes, the average age was a little
over 65 years old, and one third were women. All had a history of heart
disease and half had a history of high blood pressure as well. All study
volunteers were randomly assigned to either ramipril or a placebo. While
ramipril did not lower the blood pressure of participants much — as
it was originally intended to do — it did lower their risk for heart
attack by 22%, their risk for heart disease by 37%, and their risk for
stroke by 33%. Other studies conducted to evaluate the effects of ACE
inhibitors on blood pressure in people with diabetes have had similar
outcomes.
October 2000 Update
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