Statin use tied to more diabetes in women

NEW YORK (Reuters Health) - Cholesterol-lowering drugs may be linked to an increased risk of diabetes, according to a new study of middle-aged and older women.

But researchers said that shouldn't dissuade people with heart disease -- or at risk of it -- from taking so-called statins.

Instead, statin users should try to reduce their risk of diabetes in other ways, such as by losing weight, and should have their blood sugar regularly monitored, they said.

"The conclusion still stands that overall, those people who've got existing heart disease or have had previous strokes, they still would get vast benefits from statins," as would those at high risk for heart disease, said Naveed Sattar, a metabolism and diabetes researcher at the University of Glasgow, UK.

Instead, the finding "may make us a bit more cautious about putting statins in the water, for example," Sattar, who wasn't involved in the new study, told Reuters Health.

In other words, not all people with few heart risks should be taking the drugs, as some researchers have suggested, because they aren't side effect-free.

For their report, Dr. Yunsheng Ma of the University of Massachusetts Medical School in Worchester and his colleagues used data from the Women's Health Initiative, including more than 150,000 diabetes-free women in their 50s, 60s and 70s.

As part of that larger trial, some of the women were prescribed diet changes or took daily hormone therapy or vitamins, while others weren't told to change their diet or lifestyle.

At the start of the study in the mid-1990s, women filled out health questionnaires that included whether or not they were taking statins, as well as information on other diabetes risks, such as weight and activity levels. The researchers then followed participants for six to seven years, on average, and tracked how many of them were diagnosed with diabetes.

In total, just over 10,200 women developed diabetes. Ma's team found that the women who reported using any kind of statin at the start of the study -- about one in 14 of the participants -- were 48 percent more likely to be diagnosed with diabetes than those not taking statins.

That was after considering other known diabetes risks, the researchers reported Monday in the Archives of Internal Medicine.About one-quarter of adults age 45 and older in the United States now take statins -- which run anywhere from $11 to over $200 per month -- to lower their cholesterol and heart disease risks.

Previous studies, mostly in men, have suggested a smaller, 10-to-12-percent increase in diabetes among statin users, according to Sattar.

Those numbers may be more accurate because they come from trials in which participants were randomly assigned to take a statin or not, which can better account for possible differences in groups of patients, he added.

What's more, this type of "observational" study can't prove cause-and-effect.

Still, "broadly speaking, this kind of confirms that stains may well increase diabetes risk," Sattar said. Why that's the case isn't totally clear, he said, but statins' effects on the muscles and liver may lead the body to make slightly more sugar than it normally would, or cause users to exercise a bit less.

'A VERY FAIR TRADE-OFF'

Dr. David Jenkins, a nutrition and chronic disease researcher from the University of Toronto, said the medical community has accepted an increased risk of diabetes with statins as "a very fair trade-off," since statins lower the risk of heart disease, the primary concern related to diabetes.

Still, the findings highlight the importance of monitoring risks for diabetes, including blood sugar levels, and encouraging patients who are on the drugs to try to eat better and be physically active, researchers said.

"Statins will always be with us, they will always be valuable, and we will always prescribe them," Jenkins, who wasn't tied to the new research, told Reuters Health. But, "Statins, brilliant as they are, haven't actually completely precluded the use of changing one's diet and one's lifestyle."

Ma told Reuters Health that there's a need for future studies to evaluate both the risks and benefits of statins for people of different ages and genders, with and without heart disease. For some with high cholesterol, he said, a smart choice may be starting out with changes in diet and lifestyle, before going straight to a statin.

"Each person deserves a careful risk versus benefit assessment," agreed his co-author, Annie Culver, from the Mayo Clinic in Rochester, Minnesota.

Then, she told Reuters Health, "Once (you) receive the statins, don't abandon the idea of making lifestyle changes."

SOURCE: http://bit.ly/fO01ME Archives of Internal Medicine, online.

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Acupuncture little better than 'sham' for migraine

NEW YORK (Reuters Health) - Traditional Chinese acupuncture seems little better than a "sham" version of the procedure when it comes to preventing migraines, a study published Monday suggests.

The findings, reported in the Canadian Medical Association Journal, add to a pattern commonly seen in studies on acupuncture and migraines.

Many have found that people with migraines can get relief from acupuncture. But often, "true" acupuncture has worked no better than "sham" acupuncture -- where the needles are inserted only to a superficial depth in the skin, or into sites that are not considered acupuncture points in traditional medicine.

That raises the question of whether acupuncture works by "non-specific" effects, according to the researchers on the new study, led by Dr. Ying Li of Chengdu University of Traditional Chinese Medicine in China.

That is, some people might feel better because they expect to, or because of the personal attention from the acupuncturist.

But other experts said that the findings do not mean that acupuncture offers nothing more than a "placebo effect" for migraine sufferers.

For the study, Li's team recruited 480 adults who had migraines at least twice a month.

They randomly assigned people to one of four groups: In three, patients were given one of three different types of acupuncture that focused on traditional points, with electrical stimulation added to the needling; the fourth group received a sham version.

In the sham group, needles were inserted in the skin at non-traditional sites, with electrical stimulation. But the needles were not manipulated to create a so-called "de qi" sensation.

Patients in all four groups were offered 20 acupuncture sessions over four weeks.

In the month after treatment ended, migraine sufferers in all four groups were reporting fewer headache days, Li's team found.

On average, they had migraine pain on about three days out of the month -- down from around six days at the study's start.

In the third month after treatment, the "real" acupuncture groups were doing slightly better, while the sham group held steady at around three headache days. But the advantage was "clinically minor," according to Li's team, who did not respond to requests for comment.

'SHAM' MAY HAVE REAL EFFECTS

So does that mean acupuncture's benefits are all in your head?

No, according to Dr. Albrecht Molsberger, of Ruhr University Bochum in Germany, who wrote an editorial published with the study.

The problem, he told Reuters Health by email, is that sham acupuncture is not a true placebo -- and may have real physiological effects.

According to traditional Chinese medicine, acupuncture eases pain by stimulating certain points on the skin believed to affect the flow of energy, or "qi" (pronounced "chee"), through the body.

But some modern research suggests that the needle stimulation triggers the release of pain- and inflammation-fighting chemicals in the body, even if it doesn't strictly follow traditional principles.

"The sham acupuncture effect is so strong and long lasting, that this suggests that other factors, like the stimulation of cytokines or endorphins, are important too," Molsberger said.

And even though real acupuncture has not clearly beaten the sham version, it has outperformed standard migraine treatments in some studies.

A recent research review looked at four clinical trials that tested acupuncture against medications proven to prevent migraine attacks. Overall, acupuncture patients reported somewhat fewer migraines in the couple months after treatment, with fewer side effects.

Dr. Jongbae J. Park, who directs Asian Medicine & Acupuncture Research at the University of North Carolina at Chapel Hill School of Medicine, agreed that the sham in this study was not a true placebo.

"In my mind, it's far from being a true 'control,'" Park said in an interview.

In fact, Park said, the issue with acupuncture research in general is that sham procedures vary from study to study.

Researchers need to settle on a form of true placebo that is used consistently, according to Park -- who acknowledged that questions about acupuncture's effectiveness remain, and further studies are needed.

But based on research overall, acupuncture "should be an option" for treating migraines, said Molsberger, who is also president of Forschungsgruppe Akupunktur, which profits by offering acupuncture training.

Acupuncture is considered a generally low-risk procedure, with side effects like bruising at the needle site. The cost can vary widely -- and may or may not be covered by insurance -- but a session would typically start around $100.

At his center, Park said a typical migraine patient might start with six weekly sessions, and then come monthly, tapering down to once every six months. But the acupuncture sessions would also involve "whole-person" care, with advice on diet, sleep and other lifestyle habits.

There are, of course, other ways to tackle migraines. Several types of medications can prevent attacks, including a group of drugs known as triptans, certain antidepressants, high blood pressure drugs and anti-seizure medications.

Another non-drug option is biofeedback, in which people learn to control the physical responses to stress, like muscle tension -- which may help head off or ease migraine pain.

SOURCE: http://bit.ly/wdot9I Canadian Medical Association Journal, online.

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Give slim kids higher marks, says French diet guru

PARIS (Reuters) - Pierre Dukan, the nutritionist behind the popular but controversial Dukan diet, has suggested that France tackle child obesity by giving extra exam marks for slimness.

Dukan, who has sold 8 million copies of his diet book worldwide, made the proposal in a 250-page book called 'An Open Letter to the Future President', which he sent out on Tuesday to 16 candidates for France's presidential election.

The plan calls for high school students to be allowed to take a so-called "ideal weight" option in their final year exams, the "baccalaureat," under which they would earn extra points if they kept a body mass index (BMI) of between 18 and 25.

Those already overweight at the start of the two-year course would score double points if they managed to slim down over a period of two years.

"It's a fantastic motivator," Dukan told Reuters.

"The baccalaureat is really important in France. Kids want to get it, their parents want them to even more, so why not get them to work together on nutrition?"

Weight gain is becoming an increasing problem in France and experts say sedentary lifestyles and poor nutrition are to blame.World Health Organisation (WHO) figures show 50.7 percent of the population were overweight in 2010, including 18.2 percent classed as obese.

"There's a real problem. Since the 1960s the number of overweight people in France has risen from 500,000 to 22 million and it's going up every year," Dukan said.

"When you reach those levels, it's no longer a health problem, it becomes a political problem, and the leaders of the nation need to worry about it."

As well as the suggestion for students, Dukan's book, which will hit French bookshops on Thursday, contains a further 119 suggestions for the future president on ways to fight obesity.

One idea is the creation of a French fast-food restaurant serving more nutritional versions of the ubiquitous burgers and fries.

Dukan has earned an international reputation as diet guru to the stars, although his methods have drawn criticism from some health experts and weightwatchers who say his high-protein meal plan causes fatigue, bad breath and dizziness. But he is also a committed campaigner for the promotion of healthier lifestyles.

He recently met executives from McDonald's France with a suggestion for a healthy "McDukan" burger, made with low-fat meat and with oatmeal bread instead of the usual white bun. Unfortunately, the giant food chain turned him down.

"They were interested, but they said the public wasn't quite ready for it yet," he said.

The BMI, obtained by dividing a person's weight by the square of their height, is used as an indicator of the proportion of body fat. The WHO defines a BMI of 18.5 to 25 as normal, 25 to 30 as overweight, and over 30 as obese.

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