LOWER BLOOD PRESSURE AND LDL CHOLESTEROL TARGETS HAVE CARDIOVASCULAR BENEFITS IN DIABETES

According to this article:

* Lower than standard levels of systolic blood pressure and low-density lipoprotein cholesterol curbed atherosclerosis and decreased left ventricular mass in patients with type 2 diabetes.

Aggressively lowering low-density lipoprotein (LDL) cholesterol and systolic blood pressure levels to below those recommended in standard protocols led to regression of carotid artery intimal medial thickness and significant decreases in left ventricular mass in patients with type 2 diabetes.

Researchers randomly assigned 499 American Indians with type 2 diabetes and no history of cardiovascular disease events to aggressive or standard treatment. The goal for aggressive treatment was an LDL cholesterol level of 70 mg/dL or less and a systolic blood pressure of 115 mmHg or lower. The goal for standard treatment was an LDL cholesterol level of 100 mg/dL or less and a systolic blood pressure of 130 mmHg or lower. The common carotid artery intimal medial thickness was regularly measured to determine the primary end point, the progression of atherosclerosis; secondary end points included left ventricular measurements and the rate of cardiovascular disease events.

Both treatment groups reached and maintained their respective mean LDL cholesterol and systolic blood pressure targets during the 36 months of the study. Compared with baseline values, the carotid intimal medial thickness decreased in the aggressive treatment group but increased in the standard treatment group (-0.012 mm versus 0.038 mm). The aggressive treatment group had higher rates of adverse events associated with blood pressure medications. The low rates of cardiovascular disease events seen weren't significantly different between groups.

Aggressive lowering of LDL cholesterol and systolic blood pressure levels in a sample of American Indians with diabetes demonstrated cardiovascular benefits. Other populations should be studied, as should the long-term effects of such treatment on cardiovascular disease event rates, report the researchers.-JC

Howard BV, et al. JAMA 2008;299(14): 1678-89.

ELDERLY MEN AND BONE LOSS WITH LOOP DIURETICS

According to this study:

* Men over age 65 using loop diuretics had higher rates of hip bone loss than did nonusers of that class of drug.

Loop diuretics, which are prescribed to treat fluid overload and hypertension, can also increase excretory loss of calcium. An investigation involving older adult men revealed that constant use of this class of drug can lead to increased rates of hip bone loss.

The researchers interviewed eligible men over age 65 about their use of loop diuretics such as furosemide (Lasix). An interviewer classified the study population of 3,269 men as "continuous users" (n = 84)-those who were using the drug at a baseline evaluation and at a second visit a mean 4.6 years later; "intermittent users" (n = 181)-those who were using the drug at only one of the evaluations; and "nonusers" (n = 3,004)-those who were using the drug at neither evaluation. Hip bone mineral density (BMD) studies were performed at both evaluations. Patients also completed a questionnaire about lifestyle and demographics at the first evaluation.

Ninety-one percent of the participants were white. The mean age was 72.7 years. Over the evaluation time frame, continuous users of loop diuretics had the greatest amount of hip bone loss, with an average BMD loss rate of -0.78%, compared with -0.58% for intermittent users and -0.33% for nonusers. Adjusting for potentially confounding factors, such as age, physical activity level, comorbid conditions, kidney function, and statin use, did not change the significance of the findings.

In light of the nearly threefold higher rate of bone loss in continuous users of loop diuretics as compared with nonusers and the 1.5-fold higher rate in continuous users as compared with intermittent users, the authors warn that older men taking these drugs have a greater risk of fracture and other bone-loss-related conditions. Health care providers should be aware of the increased risk of bone density loss in elderly men taking loop diuretics.-AK

Lim LS, et al. Arch Intern Med 2008; 168(7):735-40.