Health for life

The American Heart Association last week published an update to their guidelines for the prevention of cardiovascular disease (CVD). Their paper addressed women specifically.

Here is the table of recommendations included in their paper:



You can click the pictures above for a larger version, or you can download their entire paper at:
Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update

For people with diabetes, heart disease looms as the most fatal complication. The National Diabetes Education Program (NDEP) describes some links between the two:

• CVD is the leading cause of early death among people with diabetes - about 65% of them die from heart disease and stroke.
  
  
• Adults with diabetes are 2 to 4 times more likely to have heart disease or suffer a stroke than
  people without diabetes.
  
  
• High blood glucose in adults with diabetes increases the risk for heart attack, stroke, angina, and
  coronary artery disease.
  
  
• People with type 2 diabetes also have high rates of high blood pressure, lipid problems, and obesity,
  which contribute to their high rates of CVD.
  
  
• Smoking doubles the risk of CVD in people with diabetes.
  
  - NDEP, The Link Between Diabetes and Cardiovascular Disease

In addition to their recommendations for all women (e.g. dont smoke, be physically active, eat a healthful diet), the AHA 2007 Guidelines gave some special advice for women with diabetes.

• * Achieve an HbA1c of <7% through medication (and lifestyle)
  
• * Blood pressure of >130/80 mm Hg should be treated with medication (and lifestyle)
  
• * LDL cholesterol of >100 mg/dl should be treated with medication (and lifestyle)
  
• * Aspirin (75 to 325 mg/day) should be used in high risk (i.e. diabetic) women unless it cannot be tolerated.
  
• * ACE inhibitors or ARBs (for blood pressure management) should be used.

If you fall into any of the above categories and are not receiving treatment, you may want to discuss your therapies with your doctor. You could even bring the above AHA Tables, or their entire paper, with you.

Recognizing that...

"Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners,"

... the British Association for Psychopharmacology (BAP) on Tuesday released guidelines for the diagnosis and treatment of insomnia and other sleep disorders. The recommendations do not address sleep problems from apnea/hypopnea, restless legs, narcolepsy, and other conditions:

British Association For Psychopharmacology Consensus Statement On Evidence-Based Treatment Of Insomnia, Parasomnias And Circadian Rhythm Disorders, Journal of Psychopharmacology, Sept, 2010

The guidelines emphasize that insomnia should be diagnosed and treated because it is associated with increased risk for depression, anxiety, and cardiovascular disorders.

Treatments included:¹

• Cognitive behavioral therapy (CBT). This is talk therapy which "consists of sessions with a therapist that focus on helping you change your habits and thoughts in a way that helps you sleep."² It is considered so effective and long lasting (compared to drugs) that BAP says it should be offered as first-line treatment.
  
• Hypnotic drugs (sleeping pills). BAP recommends that efficacy, safety, duration of action, and history of substance abuse or dependence be considered. They also say patients should take breaks from these meds every 3 or 6 months to reduce risk of dependency.
  
• Antidepressants.
  
• Antipsychotic drugs. Because of adverse effects and possible abuse these arent indicated as first-line treatment for sleep disorders.
  
• Antihistamines (Sominex, Nytol). These have a limited role and can cause drowsiness.

Other treatments noted for special populations included:

• Hormone therapy for women after menopause
  
• Melatonin
  
• Scheduled light exposure
  
• Behavioral strategies

Do you suffer from insomnia? What have you found helpful?
________
¹New Guidelines Issued For Insomnia And Other Sleep Disorders, Medscape, Sept 2 2010
² Talking Therapy ‘Best Option For Insomnia’, WebMD, Sept 2 2010

Achieving and maintaining a healthy body weight, staying physically active and maintaining a healthy diet improved survival after cancer diagnosis in an elderly female cancer survivor population, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held here Oct. 16-19, 2012.

Researchers examined cancer survivors adherence to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines for body weight, physical activity and diet.

"Elderly female cancer survivors who achieve and maintain an ideal body weight, stay physically active and eat a healthy diet have an almost 40 percent lower risk for death compared with women who do not follow these recommendations," said Maki Inoue-Choi, Ph.D., R.D., research associate in the Division of Epidemiology and Community Health in the School of Public Health at the University of Minnesota.

Study participants included 2,080 women from the Iowa Womens Health Study who had a confirmed cancer diagnosis between 1986 and 2002 and who completed a follow-up questionnaire in 2004. Women provided information on body weight, physical activity level, dietary intake and other demographic and lifestyle factors.

Through annual linkage with the State of Health Registry of Iowa and the National Death Index, researchers identified 495 deaths from 2004 to 2009, including 197 from cancer and 153 from cardiovascular disease. Researchers adjusted for age, number of comorbid conditions, general health, smoking, type and stage of cancer, current cancer treatment and subsequent cancer diagnosis. They found all-cause mortality was 37 percent lower for women with the highest (6 to 8) versus the lowest (0 to 4) adherence scores.

Reaching the WCRF/AICR physical activity recommendation was also associated with lower risk for death from any cause, from cardiovascular disease or from cancer after the researchers adjusted for dietary and body weight recommendation adherence scores and other covariates.

However, reaching the dietary recommendations was not associated with mortality following adjustment for body weight and physical activity recommendation adherence scores.