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Drugs - best defense against heart disease for Diabetics.

Drugs should be the first line of treatment for diabetics who are also battling heart disease.

Only if further steps are deemed necessary should invasive interventions such as angioplasty or bypass surgery be added, the experts said.

The issue is crucial to millions of Americans, since diabetes is a major risk factor for coronary artery disease and stroke.

The trial enlisted almost 2,400 people with type 2 diabetes, the kind that generally develops in adulthood. These patients also had coronary artery blockages. Outcomes for the entire group were tracked for five years after treatment.

All got intensive drug therapy, either with insulin or with drugs such as metformin that increase the body's sensitivity to insulin, while some also had procedures to improve blood flow.

At five years, 87,8% of those getting drug therapy alone were still alive, compared to 88,3% of those getting drug therapy plus a surgical procedure -- not a significant difference. The incidence of major cardiovascular events such as heart attacks and stroke was also similar, at 75,9% in the medical treatment group and 77,2% in the drug-plus-procedure group. In drug only group, those getting insulin sensitization treatment did slightly better than those who got insulin therapy.

What the study did show was that for people with diabetes and stable coronary artery disease, "a strategy of prompt revascularization did not benefit patients relative to medical therapy alone," said trial leader Maria Mori Brooks, associate professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

The results of the new trial are a testament to the ability of new medicines to help people with diabetes avoid heart problems, Boden said.

"We have very powerful medications today," he said. "These are disease-modifying therapies that can alter the course of the disease. We in this country have been enamored of the benefits of angioplasty and stents. It is reassuring to me, and hopefully other physicians, to see what can be accomplished by optimal medical therapy."

By Ed Edelson, HealthDay Reporter

9 Jun, 2009

Changes in the Earth's climate - increase in people with asthma and allergies.

Climate change isn't only bad for the Earth, it may be bad for your health - especially if you have allergies or asthma.

Global warming is making pollen seasons last longer, creating more ozone in the air, and even expanding the areas where insects flourish, putting more people with bee allergies at greater risk, experts say.

Last month, the U.S. Environmental Protection Agency announced that it believes carbon dioxide and five additional greenhouse gases are dangerous to human health. This finding may eventually lead to environmentally friendly changes, such as regulations for cleaner energy and more fuel-efficient cars.

"Climate change will cause impacts in every area. Wet areas will get wetter, and drier climates are getting drier," said Dr. Jeffrey Demain, director of the Allergy, Asthma and Immunology Center of Alaska, and a clinical associate professor at the University of Washington.

Those changes will mean more people with allergies and asthma will suffer. In wet areas, mold allergies will spike, while in drier areas pollens and other airborne irritants will become more of a problem, he said.

"We're having warmer, wetter winters, which lead to long springs and an increase in seasonal allergens," said Dr. David Peden, director of the Center for Environmental Medicine, Asthma and Lung Biology at the University of North Carolina, Chapel Hill.

So, what can you do to protect yourself? Both Peden and Demain said that just being aware of the problem is the first step. Next, is to be sure you know specifically what you're allergic to, and then be aware of pollen and mold cycles so you can properly adjust your behavior when those levels are high.

"Pollens are usually highest in the mornings, but grass is elevated in the morning and evening. If you're tree- or weed-allergic, plan outdoor activities for the afternoon or evening. If you're grass-allergic, you might want to plan to be outside midday. Warm, sunny, dry days are usually the ones with the greatest pollen," Demain said.

Of course, it's not always possible to stay indoors, and treatments are available that can help you live with allergies and asthma.

"As mundane as this sounds, if you have allergic disease or asthma, consult with an allergist so that you have maximal therapy and information on seasonal concerns. If you're in an area with lengthy pollen seasons, allergy shots might be useful," Peden said.

"The climate is changing, and it's changing at an unprecedented rate. Whether it's a natural cycle, or whether humans are the cause, we have to recognize that this is happening," said Demain, who added, "Every small step (such as using compact fluorescent bulbs or driving less) is important. If we all take that step, we can have a big impact."

11 May, 2009

Osteoporosis Drugs not increase the risk of cancer.

Two new studies find that the class of osteoporosis drugs known as bisphosphonates may not, in fact, raise the risk of esophageal cancer.

This is in contrast to news earlier this year that the U.S. Food and Drug Administration had received reports of 23 patients taking the oral bisphosphonate Fosamax (Alendronate Sodium), who had been diagnosed with cancer of the esophagus.

"The adverse affects reporting agency only reports cases but does not look at the science behind it," said Dr. Robert C. Ashton Jr., director of minimally invasive thoracic surgery at Montefiore Medical Center in New York City. "Given the wide use of bisphosphonates and low incidence of esophageal cancer overall, individuals should continue taking them and discuss any concerns with there doctors."

"Don't panic," echoed Dr. Daniel H. Solomon, lead author of one of the new reports being published as a letter-to-the-editor in the April 23 issue of the New England Journal of Medicine. "A series of cases is useful to prompt an epidemiologic study but it should not be used to guide prescribing."

Another large study in the same issue of the journal actually found a reduced risk of esophageal cancer among individuals taking bisphosphonates, and no increased risk for gastric cancer, when compared with a much larger control group. There was no overall increased risk when the two types of cancer were grouped together.

The prescribing information for Fosamax, made by Merck & Co., said that people with "certain disorders of the esophagus" should not use the drug.

And, as always, risks should be weighed against benefits.

"Esophageal cancer occurs extremely rarely, thus, while one should be concerned about a potential increase in risk, a doubling of a very, very rare cancer is still a rare event," Solomon stated. "Fractures are not rare events, and bisphosphonates are proven beneficial in many types of patients at reducing fracture risk.

By Amanda Gardner, HealthDay Reporter

22 Apr, 2009



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