(Thread from Diabetes) #: 748167 S8/Complications (CIS:DIABETES) 12-Aug-97 21:36:20 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: all Replies: 0 TID: 106095 Par: 0 Chd: 0 Sib: 0 Heart disease is a major problem and, in fact, killer for diabetics. ONe of the sysops can chip in with statistics on that, for both Type 1 and Type 2, I hope. So in Boston at the annual meeting of the ADA: two hour session "Heart Disease and Diabetes" was a real winner. All doctors clearly had treated many diabetics and had useful generalizations. The first material I've heard on the subject that said something specific about diabetic problems beyond the obvious Type 2 BMI, CHL and triglycerides that are widely advertised risk factors for everyone. Heart disease is notorious in all populations for first showing up without prior symptoms as a heart attack. IMO a stress test, even if chemically induced due to exercise limitiations, is a wise idea for all diabetics. Think of the following talks as following the sequence that one would go through if heart problems developed and progressed through all treatments for therapy. Dr Lawrence Young from Yale spoke on "Non-invasive Evaluation: Pathways and Pitfalls". This was in terms of when, how, and why. Stress testing with electrocardiography, stress testing with either thallium or technetium(better)imaging, and stress echocardiography were discussed. No discussion of the still uncertain ultra fast calcium x-ray imaging according to my notes. All these tests had two-fold grading, one for the work load you got up to for the nominal 85% of your age adjusted aerobic level heart rate and one for the quantity being monitored. The higher the work load, the lower the risk. LOW exercise level: less than 4 METS (ask the DR for its definition when you ask for your value.) INTERMEDIATE level: 4-7 METS HIGH exercise level: greater than 7 METS. Dr. Michael Stern spoke on "Risk factor assessment for diabetics". Most was on how he had already done this kind of analysis for non-diabetics(given your current measures, what are the odds of some cardia event?), but then some good diabetic data. PDAY (sigh, how to look this up to see size of effects) study of 15-34 year old diabetics who had died for other reasons. Measured fatty streaks or raised lesions in coronary arteries. DIvided into two groups: A1c greater or less than 8. Huge difference between the two groups. LESSON: A1c matters for heart disease. Kausis et al Diabetes 43, 960 (1994) also effect of A1c but outcome measure unknown. Same direction as above. Dr. Richard Nestor spoke on "PTCA/CABG Mediacl Therapy in the diabetic patient. Main message was that diabets dramatically lowers 30 day and 1 year survival after a heart attack. He says it's due to deterioration of left ventricular function (lousy LV remodeling), has a diabetic specific fatty acid high BG mechanism to account for it, and strongly pushes his post heart attack patients to get their A1cs down. Beta blockers work extra dividends for diabetics because they tend to have higher sympathetic tone, a known risk factor. Baby aspirin won't cut the mustard in this case on platelet adhesion so more. If bypass then mammary graft the best --can't recall whether that was diabetic specific. This session available on tape for $22 + S&H--see the library for details. Kemp #: 748323 S8/Complications (CIS:DIABETES) 13-Aug-97 21:20:00 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: Kemp Randolph 72370,3642 Replies: 0 TID: 106095 Par: 748167 Chd: 0 Sib: 0 >>Heart disease is a major problem and, in fact, killer for diabetics. ONe of the sysops can chip in with statistics on that, for both Type 1 and Type 2, I hope.<< Waiting for this.... sysop? >>Dr. Richard Nestor spoke on "PTCA/CABG Mediacl Therapy in the diabetic patient. Main message was that diabets dramatically lowers 30 day and 1 year survival after a heart attack.<< PTCA/CABG is angioplasty and bypass. Also see antioxidents in section 8. Kemp #: 748389 S8/Complications (CIS:DIABETES) 14-Aug-97 02:00:26 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 (X) Replies: 1 TID: 106095 Par: 748323 Chd: 748432 Sib: 0 Um, that's been known for years, Kemp. How much was wasted on this restudy? #: 748432 S8/Complications (CIS:DIABETES) 14-Aug-97 08:13:25 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: WIZOP-Dave Groves 76703,4223 (X) Replies: 0 TID: 106095 Par: 748389 Chd: 0 Sib: 0 >>How much was wasted on this restudy?<< Wake up ---this was part of a two hour symposium of review of the whole topic. #: 748561 S8/Complications (CIS:DIABETES) 14-Aug-97 23:07:03 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 (X) Replies: 0 TID: 106095 Par: 748432 Chd: 0 Sib: 0 Oooooh, lots? #: 749006 S8/Complications (CIS:DIABETES) 16-Aug-97 16:08:27 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 Replies: 0 TID: 106095 Par: 748167 Chd: 0 Sib: 0 Diabetics are 2-4x more likely to die of heart failure or stroke than non-diabetics and about 75% of us will die of heart failure. Type 2 diabetics are more prone to heart trouble than Type 1 but the differentiation is cloudy. #: 749030 S8/Complications (CIS:DIABETES) 16-Aug-97 17:57:10 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: WIZOP-Dave Groves 76703,4223 Replies: 0 TID: 106095 Par: 749006 Chd: 0 Sib: 0 >>about 75% of us will die of heart failure.<< It's too much to hope for that they have the % less than 50 years old or whatever. Surely that's where it gets shocking. Thanks for that. (BTW heart failure has a technical definition is cardiac death more appropriate?) Relative risk is always quoted but oh so cloudy. For absolute risk, 100% is always clear. In this case, of course, . >>Type 2 diabetics are more prone to heart trouble than Type 1 but the differentiation is cloudy.<< "Cloudy" is an understatement --given most "subjects" are aged. That PDAY study with young people may be unique. Wish I could find it and hope that's because it is "in press" or in the three or four month delay of entry into on-line Grateful Med (or PubMed or Internet Grateful Med). Easy to search for with YOUNG and IDDM and CARDIAC and perhaps HUMAN. Have a stress test, one and all. Kemp (Message in Diabetes) #: 749157 S8/Complications (CIS:DIABETES) 17-Aug-97 04:58:17 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 (X) Replies: 0 TID: 106095 Par: 749030 Chd: 0 Sib: 0 >> It's too much to hope for that they have the % less than 50 years old or whatever. Surely that's where it gets shocking. << Kemp, You've heard my comments that I am 25% and the only surviving member of my cadre/cohort. 1 congestive heart failure, age 36, 1 stroke, age 37, and one hypoglycemia unawareness in sleep on human insulin. I have no statistics to show how it is distinguished and with the screwed up system we have, no stats could show anything meaningful. Yes I meant cardiac "condition" death rather than heart attack/failure apologies for my inartful commentary. For all we spend on ADA and CDC the best they can give us is "2-4x" risk for diabetics. "Cloudy is an understatement" -- Yup, but I can't create statistics that don't exist. For a national shame, consider that we have no national registry for diabetes and get our diabetes death stats based on death certificates which are widely touted as understating diabetic deaths by 66.7% There's one that plays against me! Suppose the ADA is deliberately overstating it for the cash benefit? Nah, that couldn't be since even on the BAD sats we do have WHO shows us a 17% mortality within 25 years of Type 1 dx. Pull in Type 2 and who knows what we have. I will have to rely on you and Jim and others to do the research. I cannot do it. FWIW, I do appreciate both your contributions here even as I may appear to downplay (ridicule?) your excellent works. I am told I've had a heart attack, but that's a whole other tale. (Message in Diabetes) #: 749203 S8/Complications (CIS:DIABETES) 17-Aug-97 12:21:02 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: WIZOP-Dave Groves 76703,4223 Replies: 0 TID: 106095 Par: 749157 Chd: 0 Sib: 0 THey report that so many of the heart attacks occur in people with what is still considered normal CHL, etc. levels. Asymptomatic --not even angina. Heart disease research has a ways to go despite the much larger sums available for years. The stress test, either exercise induced or chemically induced, just plain makes good sense for all diabetics whether they want to start an exercise program or not. Kemp (Message in Diabetes) #: 749388 S8/Complications (CIS:DIABETES) 18-Aug-97 01:03:16 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 (X) Replies: 0 TID: 106095 Par: 749203 Chd: 0 Sib: 0 I cannot agree about stress testing Kemp. Some medical facilities have a 5-10% death rate from such testing!! (Message in Diabetes) #: 749542 S8/Complications (CIS:DIABETES) 18-Aug-97 20:39:21 Sb: heart disease & diabetes Fm: Kemp Randolph 72370,3642 To: WIZOP-Dave Groves 76703,4223 Replies: 0 TID: 106095 Par: 749388 Chd: 0 Sib: 0 >>I cannot agree about stress testing Kemp. Some medical facilities have a 5-10% death rate from such testing!!<< ??? How could they stay in business with that? Granted, you get your own doctor to approve the decision and likely recommend a facility. Test designed to test you whatever your level of "fitness" with the chemically induced for those unable to treadmill due to arthritis or whatever. I suspect those 5 non-invasive tests for autonomic neuropathy could be be prudent for questionable cases. Kemp (Message in Diabetes) #: 749754 S8/Complications (CIS:DIABETES) 20-Aug-97 02:55:03 Sb: heart disease & diabetes Fm: WIZOP-Dave Groves 76703,4223 To: Kemp Randolph 72370,3642 (X) Replies: 0 TID: 106095 Par: 749542 Chd: 0 Sib: 0 They stay in business like that by slaughtering anyone in competition who does better with lawsuits, Kemp. I can introduce you to several cardiologists who can testify, if you'll take their discredited but statistically proveable word. You can probably kill a diabetic with a poorly timed and executed OGTT. The simplest and best test for autonomic neuropathy is the pulse rate before and after a "squat and grunt."