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July 2006

Prehypertension Greatly Increases Cardiovascular Risk

Prehypertension, or blood pressure levels at the upper end of the normal range, can increase the risk of cardiovascular disease by up to threefold, according to a recent study published in the American Journal of Medicine.*

Prehypertension is defined as blood pressure between 120/80 and 139/89 mmHg. Levels of 140/90 mmHg and above are considered high blood pressure, which is a known risk factor for heart disease and stroke. Until recently, however, data on the health risks associated with prehypertension have been incomplete.

Dr. Abhijit V. Kshirsagar and his colleagues at the University of North Carolina conducted a prospective study of 8,960 middle-aged adults, aged 45-64, who were enrolled in the Atherosclerosis Risk in Communities study. The researchers monitored the relationship between the participants’ blood pressure values and cardiovascular events for an average of 11.6 years.

During this follow-up period, 772 new cardiovascular disease events were observed within the group. These included documented or suspected myocardial infarction, ischemic stroke, and various cardiac procedures, including coronary artery bypass graft, angioplasty, and stenting.

Prehypertension was associated with a 233% greater risk of cardiovascular events, and was especially dangerous in blacks, diabetics, and obese individuals, increasing risk in these groups by 329%, 410%, and 356%, respectively. Maintaining optimal blood pressure levels below 120/80 mmHg could prevent nearly 30% of new cardiovascular events in the study participants, according to the research team.

Many patients with prehypertension may be able to improve their blood pressure using lifestyle changes such as weight loss and dietary modification, thus improving their cardiovascular risk profiles while avoiding the undesirable side effects associated with prescription hypertension medications.

—John Otrompke


* Kshirsagar AV, Carpenter M, Bang H, Wyatt SB, Colindres RE. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006 Feb;119(2):133-41.

Early Diagnosis Critical for Surviving Prostate Cancer

Early diagnosis of prostate cancer is necessary to allow curative surgery, according to a study from Italy.*

New research findings show that when it is detected early, localized cancer is curable by surgery alone, and even cancer that has spread beyond the prostate gland may be cured by surgery. When cancer recurs or lymph node biopsies are positive, early treatment with hormonal therapy is beneficial.

The Italian researchers studied 729 patients with prostate cancer who had previously undergone radical prostate removal and pelvic lymph node removal. The patients without lymph node involvement underwent surgery alone, while those with positive lymph nodes received hormonal therapy along with surgery. A subgroup of 116 had a high level of cancer aggressiveness (as determined by a Gleason score of 8-10, a system of grading prostate cancer cells based on their microscopic appearance), and this group was monitored for an average of four years to determine outcomes.

Long-term results varied significantly depending on the cancer’s severity. Five-year survival rates were 100%, 65%, and 11% for increasingly severe tumor stages (pT2, pT3a, and pT3b, respectively). Likewise, survival at five years declined dramatically, from 72% for men with a Gleason score of 8 to 38% for men with a Gleason score of 9. Patients with positive lymph nodes had a five-year survival of 61%. In statistical analysis, the only factor that predicted cancer recurrence was the extent of the tumor expressed as disease stage, with worse outcomes as cancer invaded the seminal vesicles, the glands on either side of the bladder.

Screening of prostate-specific antigen (PSA) is generally recommended to help detect prostate cancer at an early stage, thus decreasing the likelihood of positive lymph nodes and allowing for early surgical intervention. The results of this study strongly confirm the value of routine prostate screening and demonstrate that men whose prostate cancer is detected early have a significantly greater likelihood of survival.

—Laura J. Ninger, ELS


* Serni S, Masieri L, Minervini A, Lapini A, Nesi G, Carini M. Cancer progression after anterograde radical prostatectomy for pathologic Gleason score 8 to 10 and influence of concomitant variables. Urology. 2006 Feb;67(2):373-8.

Vitamin D and Calcium Reduce Diabetes Risk

High intake of vitamin D and calcium may reduce the risk of type II diabetes in women, according to a large long-term study.*

A total of 83,779 healthy women, with an average age of 46, were monitored for 20 years. Consumption of vitamin D and calcium were calculated separately for dietary intake, supplement use, and total intake from all sources. During the study, 4,843 new cases of type II diabetes were recorded.

Women who took the highest amount of vitamin D in the form of supplements had a 13% reduction in their risk for type II diabetes compared to women who took the least vitamin D. Women who had the highest intake of calcium from supplements had an 18% reduction in their risk of diabetes compared to those with the lowest calcium intake. Likewise, the risk of diabetes was 21% lower for women who took the highest amount of total calcium (from all sources) as opposed to the lowest amount.

For vitamin D plus calcium together, those women with the highest combined intake (greater than 800 IU of vitamin D and 1200 mg of calcium daily) had the lowest risk of diabetes—a 33% reduction compared to women with the lowest intake of these nutrients.

No significant effects on diabetes risk were found for dietary vitamin D intake or dietary calcium intake; in other words, the beneficial effects of vitamin D and calcium were greatest for supplementation rather than intake from food sources.

If future studies confirm the findings in this report, women will have another good reason to supplement with vitamin D and calcium—as an easy, inexpensive way to lower their risk for type II diabetes.

—Laura J. Ninger, ELS


* Pittas AG, Dawson-Hughes B, Li T, et al. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care. 2006 Mar;29(3):650-6.