Younger women 'face work stress risk'

Stress at work raises the risk of heart disease for women under 50, a study of more than 12,000 nurses suggests.

Danish research in Occupational and Environmental Medicine concludes work pressure has a greater effect on young women than those in their 50s and 60s.

It suggests other risk factors may play a bigger role in the development of heart disease for older women.

The British Heart Foundation says people facing stress at work should try to tackle it in a positive way.

There is a lot of evidence indicating that stress at work raises the risk of heart disease in men, but there has been much less research examining the impact on women.

Risk profile

In this study, the researchers asked more than 12,000 female nurses aged between 45 and 64 about pressure at work and tracked their health for 15 years up to 2008.

By then 580 nurses had been admitted to hospital with ischaemic heart disease, including 369 cases of angina and 138 heart attacks.

After accounting for risk factors such as smoking and diabetes, the researchers found that those who described pressure at work as "much too high" were 35% more likely to have developed heart disease than those who were comfortable with the pressure.

But when they broke the results down by age, they found it was only the women aged 50 and under who were affected significantly.

The researchers from Glostrup University Hospital, in Denmark, say this could be down to a changing risk-profile in different age groups.

"It seems as if the effect of work pressure has a greater impact on younger women," they said.

"This is in agreement with findings from previous studies looking at age-specific effects in both men and women.

"The lower risk among the older nurses may be due to other risk factors that become relatively more important with increasing age."

'Worrying'

June Davison, a cardiac nurse with the British Heart Foundation, said people who were stressed at work should talk to colleagues or managers about how to manage the pressures.

"If you feel under pressure you should try and tackle it in a positive way and get active during work hours," she said.

"Using the stairs and walking some of the way to work could help act as a stress buster and boost heart health too."

Josie Irwin, head of employment relations at the Royal College of Nursing, said the paper raised important concerns.

"Our latest employment survey found that 55% of nurses feel they are under too much pressure at work, making this research worrying reading," she said.

"We know that safe staffing levels are key to providing the best quality care for patients - this research also suggests under-staffing and excess pressure can have a damaging effect on nurses' health."

Too much sugar increases heart disease risk

High cholesterol a dangerous side effect to extra sweeteners

 

CHICAGO - Eating a lot of sugar not only makes you fat. It may also increase a person's risk for heart disease, U.S. researchers said.

They said people who ate more added sugar were more likely to have higher risk factors for heart disease, such as higher triglycerides and lower levels of protective high-density lipoprotein or HDL cholesterol.

"Just like eating a high-fat diet can increase your levels of triglycerides and high cholesterol, eating sugar can also affect those same lipids," Dr. Miriam Vos of Emory School of Medicine, who worked on the study published in the Journal of the American Medical Association, said in a statement.

The study adds to mounting pressure on U.S. food companies to make their foods healthier as newly passed U.S. health reform legislation shifts the nation's focus on ways to prevent, rather than simply treat disease.

A report by the influential Institute of Medicine released on Tuesday recommended that the U.S. Food and Drug Administration start to regulate sodium intake in foods.

And several states, including New York and California, have weighed a tax on sweetened soft drinks to defray the cost of treating obesity-related diseases.

The addition of sweeteners to prepared foods and beverages in recent decades has sharply increased Americans' daily intake of sugar and overall calories, according to Vos and colleagues.

But no major studies have looked at the impact of too much sugar on levels of fat in the blood.

The researchers asked 6,000 adults what they ate and then grouped them by sugar intake and cholesterol levels.

On average, nearly 16 percent of people's daily calories came from added sugar.

The highest-consuming group ate an average of 46 teaspoons of added sugar per day, while the lowest-consuming group ate an average of only about 3 teaspoons daily.

"It would be important for long-term health for people to start looking at how much added sugar they're getting and finding ways to reduce that," Vos said in a statement.

Too much sugar not only contributes to obesity, but also is a key culprit in diabetes, high blood pressure, heart disease and stroke, according to the American Heart Association.

 

Walking shrinks women's stroke risk

Study: 2 hours a week lowers stroke chance by 30 percent

DALLAS - Women can lower their stroke risk by lacing up their sneakers and walking, a new study suggests.

Women who said they walked briskly had a 37 percent lower risk of stroke than those who didn't walk. Women who reported walking at least two hours a week at any pace had a 30 percent lower risk, according to a study published online Tuesday in the American Heart Association journal Stroke.

While previous studies have shown that physical activity decreases the chances of having a stroke, the new study focused on what kind of exercise might be most beneficial for women.

"This certainly speaks to walking for a certain amount of time and walking briskly as well," said Jacob Sattelmair, lead author of the study and a doctoral student at Harvard School of Public Health in Boston.

Those walking at a brisk pace should be able to talk — but not sing, he said.

The research involved about 39,000 female health workers 45 or older enrolled in the Women's Health Study. The women were periodically asked about their physical activity. During 12 years of follow-up, 579 had strokes.

Besides walking, the study looked at vigorous activities like running, swimming and biking, but researchers didn't find a link between those vigorous activities and a reduced stroke risk. The researcher said there may not have been enough women in that group to show a difference. It's also possible, they said, that moderate activity is better at lowering blood pressure, a strong risk factor for stroke.

The researchers took into account age, aspirin use, smoking and other things that could influence stroke risk.

"I think what's encouraging is that moderate activities are powerfully effective in reducing the risks of stroke," said Dr. Anand Rohatgi, a cardiologist at the University of Texas Southwestern Medical Center in Dallas.

In addition to high blood pressure, risk factors for stroke include heart disease, Type 2 diabetes and obesity.

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"The things that directly correlate with stroke are improved with physical activity," Rohatgi said. "They all line up."

Dr. Tracy Stevens, director of Saint Luke's Muriel I. Kauffman Women's Heart Center in Kansas City, Mo., said people can see the benefits of exercise by taking their blood pressure after exercising to see how much lower it is.

"It takes hard work," she said, adding, "It doesn't have to be anything fancy."

The American Heart Association recommends that adults do 2½ hours a week of moderate-intensity or 75 minutes a week of vigorous aerobic activity or a combination.

 

Artificial pancreas hope for children with diabetes

Scientists in Cambridge have shown that an "artificial pancreas" can be used to regulate blood sugar in children with Type 1 diabetes.

A trial found that combining a "real time" sensor measuring glucose levels with a pump that delivers insulin can boost overnight blood sugar control.

The Lancet study showed the device significantly cut the risk of blood sugar levels dropping dangerously low.

Experts said the results were an important "step forward".

Type 1 diabetes is a chronic, life threatening condition, in which the pancreas does not produce insulin - the hormone that regulates blood sugar levels.

In total, 17 children and teenagers with Type 1 diabetes took part in the study over 54 nights in hospital.

Individually, the glucose monitoring system and the insulin pump used in the study are both already widely used and commercially available.

But in order to turn them into a "closed loop" system which monitors the patient's condition and delivers treatment accordingly, the researchers developed a sophisticated algorithm to calculate the appropriate amount of insulin to deliver based on the real-time glucose readings.

They then measured how well the artificial pancreas system controlled glucose levels compared with the children's regular continuous pump, which delivers insulin at preselected rates.

Low blood sugar

Testing was done in different circumstances - for example on nights when the children went to bed after eating a large evening meal, which can lead to 'insulin stacking' or having done early evening exercise - both of which can increase the risk of low blood sugar episodes known as hypoglycaemic attacks or "hypos".

1 - Continuous glucose sensor monitors blood sugar level 2 - Data transmitted for the computer programme to work out insulin dose 3 - Insulin pump delivers the dose

Overall, the results showed the artificial pancreas kept blood glucose levels in the normal range for 60% of the time, compared with 40% for the continuous pump.

And the artificial pancreas halved the time that blood glucose levels fell below 3.9mmol/l - the level considered as mild hypoglycaemia.

It also prevented blood glucose falling below 3.0mmol/l, which is defined as significant hypoglycaemia, compared with nine hypoglycaemia events in the control groups.

Study leader Dr Roman Hovorka said: "This is the first randomised study showing the potential benefit of the artificial pancreas system overnight using commercially-available sensors and pumps.

"Our study provides a stepping stone for testing the system at home."

Karen Addington, chief executive of Juvenile Diabetes Research Foundation, who funded the research said the study provided "proof of principle" of an artificial pancreas.

"We need to redouble our efforts to move the artificial pancreas from a concept in the clinic to a reality in the home of children and adults with type 1 diabetes."

Dr Victoria King, research manager at leading health charity Diabetes UK, said: "This is an important step forward in managing overnight blood glucose levels as well as in the eventual development of a full 'artificial pancreas' which could vastly improve the quality of life for people with type 1 diabetes and reduce the risk of the associated complications."

Diabetes sugar 'can go too low'

Intense treatment to lower blood sugar in patients with diabetes could prove nearly as harmful as allowing glucose levels to remain high, a study says.

Cardiff researchers looked at nearly 50,000 patients with type 2 diabetes and found the lowest glucose levels linked to a heightened risk of death.

Significant differences in death rates between patients on insulin and those taking tablets are also flagged up.

But there could be various explanations for this, experts noted.

Patients taking insulin-based treatments have been urged not to stop taking their medication as a result of the Cardiff University study, which is published in The Lancet.

Changing treatments

Using data from GPs, the team identified 27,965 patients with type 2 diabetes whose treatment had been intensified to include two oral blood glucose lowering agents - metformin and sulphonylurea.

A further 20,005 patients who had been moved on to treatment which included insulin were added to the study.

Patients whose HbA1c levels - the proportion of red blood cells with glucose attached to them - were around 7.5%, ran the lowest risk of dying from any cause.

For both groups this risk went up by more than half if levels dropped to 6.4%, the lowest levels recorded. For those with the highest levels the risk of death increased by nearly 80%.

But the risks appeared to be particularly pronounced among those on the insulin-based regimen than those on the combined treatment.

Irrespective of whether their HbA1c levels were low or high, there were 2,834 deaths in the insulin-taking group between 1986 and 2008, nearly 50% more than in the combined group.

'Don't stop'

The authors acknowledged there could be various factors associated with this, such as these being older patients with more health problems, who perhaps had had diabetes for a longer period of time. They also make reference to a possible link between use of insulin and cancer progression that had been reported in a different study.

"Whether intensification of glucose control with insulin therapy alone further heightens risk of death in patients with diabetes needs further investigation and assessment of the overall risk balance," wrote lead author Dr Craig Currie.

"Low and high mean HbA1c values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA1c value."

Dr Iain Frame, head of research at Diabetes UK, described the study as "potentially important" but stressed it had limitations.

"It is not clear what the causes of death were from the results reported. Furthermore, when it comes to the suggestion made in this research that insulin could increase the risk of death, we must consider important factors such as age, the duration of their diabetes and how the participants managed their condition.

"It is crucial to remember that blood glucose targets should always be agreed by the person with diabetes and their healthcare team according to individual needs and not according to a blanket set of rules."

While people would be able to manage their condition for a period with diet, exercise and even tablets, many would eventually have to move on to insulin, he noted.

"We would advise people with type 2 diabetes who use insulin not to stop taking their medication. However, if they are worried about blood glucose targets, they should discuss this with their healthcare team."

Having a big bum, hips and thighs 'is healthy'

Carrying extra weight on your hips, bum and thighs is good for your health, protecting against heart and metabolic problems, UK experts have said.

Hip fat mops up harmful fatty acids and contains an anti-inflammatory agent that stops arteries clogging, they say.                                                              

Big behinds are preferable to extra fat around the waistline, which gives no such protection, the Oxford team said.

Science could look to deliberately increase hip fat, they told the International Journal of Obesity.

And in the future, doctors might prescribe ways to redistribute body fat to the hips to protect against cardiovascular and metabolic diseases such as diabetes.

The researchers said having too little fat around the hips can lead to serious metabolic problems, as occurs in Cushing's syndrome.

Shape not weight

Evidence shows that fat around the thighs and backside is harder to shift than fat around the waist.                                                                                                                                                                                       

Although this may sound undesirable, it is actually beneficial because when fat is broken down quickly it releases a lot of cytokines which trigger inflammation in the body, say experts.

These cytokines have been linked to cardiovascular disease, insulin resistance and diabetes.

The slower burning hip fat also makes more of the hormone adiponectin that protects the arteries and promotes better blood sugar control and fat burning.

In comparison, carrying excess fat around the stomach, being "apple shaped", raises the risk of diabetes and heart disease.

Lead researcher Dr Konstantinos Manolopoulos, of Oxford University, said: "It is shape that matters and where the fat gathers.

"Fat around the hips and thighs is good for you but around the tummy is bad."

He said in an ideal world, the more fat around the thighs the better - as long as the tummy stays slim.

"Unfortunately, you tend not to get one without the other," he said.

Fotini Rozakeas of the British Heart Foundation said: "This research helps us better to understand how fat acts in the body in order to develop new approaches in reducing heart and circulatory disease.

"If you are overweight, obese, or if you have a waist size that is increased, it is important to make changes to your lifestyle, such as eating a healthy diet and doing regular physical activity, to reduce your risk of heart health problems."

Giving up smoking 'raises diabetes risk'

Giving up smoking sharply increases the risk of developing type-two diabetes, a US study suggests.

Researchers found quitters had a 70% increased risk of developing type-two diabetes in the first six years without cigarettes compared with non-smokers.

This is because they tend to put on weight.

However, the Annals of Internal Medicine study stressed that this should not be used as an excuse to carry on smoking.

The Johns Hopkins team also stress that smoking is a well known risk factor for type-two diabetes - as well as many other health problems, such as heart disease, stroke and cancer.

Researcher Dr Jessica Yeh said: "If you smoke, give it up. That's the right thing to do.

"But people have to also watch their weight."

The study, based on 10,892 middle aged adults who were followed for up to 17 years, found the risk of developing type-two diabetes was highest in the first three years after giving up smoking.

Around 1.8% of people giving up smoking developed type 2 diabetes each year during that period.

If quitters avoided developing the condition for 10 years, then their long-term risk returned to normal.

People who made no effort to give up smoking had a constant 30% increased risk of type-two diabetes compared with non-smokers.

Blood sugar

Type-two diabetes means the body either fails to make enough of the hormone insulin, or cannot make proper use of it, leading to uncontrolled blood sugar levels.

Untreated this can cause serious disease, and complications such as blindness, kidney failure and nerve damage.

One of the major risk factors for the condition is being overweight, and the rise in obesity across the developed world has been blamed for a big increase in type-two diabetes.

The researchers found those who smoked the most and those who gained the most weight had the highest likelihood for developing diabetes after they quit.

On average, during the first three years of the study, quitters gained about 8.4lb (3.8kg).

The researchers said doctors should keep in mind the importance of weight control when counselling people about giving up smoking.

Quitters tend to put on weight because smoking acts to suppress appetite.

The use of nicotine replacement therapy has been shown to blunt the weight gain associated with giving up smoking.

Martin Dockrell, of the anti-smoking charity Ash, said: "The researchers are clear that smokers should quit but - especially if you are a heavy smoker or are already overweight - you might want to gently increase your exercise when you quit.

"If you are a smoker who is also overweight you should talk to your doctor about how to get the best from quitting.

"A little more exercise could help improve your sense of well being, reduce weight gain and undo some of the harm done by smoking leading to a healthier, happier you."

Natasha Marsland, of the charity Diabetes UK, said: "On no account should people use the theoretical results of this study as an excuse not to give up smoking.

"The health benefits of giving up smoking far outweigh the risk of developing type-two diabetes from modest, short-term weight gain."