Monday, February 13, 2006

Good blood bad?

Blood sugar levels should be kept as low as possible in men with heart disease, suggests a new study scheduled to appear in the Feb 15 issue of the American Journal Epidemiology.

The study by a team of scientists at UCLA and Cedars-Sinai Medical Center in Los Angeles found that even in the normal range, a lower blood sugar level was linked with a lower risk of death from cardiovascular disease. "Our findings suggest that for men with cardiovascular disease, there is apparently no 'normal' blood sugar level."

"For these men, across the normal range, the lower their blood sugar, the better. Their death rate over a two-year period soars from slightly more than 4 percent at a glucose level of 70 (mg/dl) to more than 12 percent at 100 (mg/dl) -- an enormous increase."

Interestingly, a blood sugar level higher than 100 mg/dl is no different from 100 mg/dl in the death risk. Men with a blood sugar at 100 and men with 150 mg/dl had the same risk of death from heart disease and stroke.

Women, however, had a different pattern of death risk. "For women, we found no evidence of any change in risk across the normal range, from 70 to 100, but then their risk seems to rise quickly through the impaired range and continues to increase with higher glucose in the diabetic range; therefore a blood sugar level of 100 seems to be a sensible cut point for women with cardiovascular disease," the authors said.

This is a fascinating study with extremely important implications. I remember meeting Willaim Castelli, third director of the Framingham Heart Study, in 1997, and I asked him how he treats a non-diabetic's (less than 126) blood glucose. He stated that he treats anyone with a glucose at or above 100 with diabetes medications along with lifestyle changes. Nine years later, we have good evidence that pre-diabetes should be treated agressively.


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