Cardiovascular Disease Rates in Women With Diabetes
Seventy-two percent of US women with diabetes have a major form of cardiovascular disease, according to a report by researchers from the US Centers for Disease Control and Prevention (CDC) and the Agency for Health Care Research and Quality that appeared in the November 2, 2001, issue of the Morbidity and Mortality Weekly Report (2001;50: 948–954; available at http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5043a2.htm).
The most common cardiovascular disease was hypertension, which affected 64% of the women with diabetes who were surveyed, followed by other heart disease conditions (19%), coronary heart disease (12%), heart attack (11%), angina (10%), and stroke (8%). Prevalence increased with age, according to the researchers, who found that only 40.5% of women with diabetes who were between the ages of 18 and 44 had a cardiovascular disease, whereas 85.1% of those aged ≥75 years had cardiovascular disease. Age-adjusted prevalence of major cardiovascular disease among women with diabetes was twice that of women without diabetes. (The numbers of women with and without diabetes were obtained from the 1997-1999 National Health Interview Survey [NHIS].)
The age-adjusted prevalence of major cardiovascular disease was twice as high in women with diabetes as it was in women without the disease. The prevalence of cardiovascular disease in women with diabetes was higher in non-Hispanic blacks than it was in non-Hispanic whites or in Hispanics.
Hospital discharge rates for major cardiovascular disease increased with age in women with diabetes, from 22.9 per 1000 in women aged 18 to 44 years to 332.7 per 1000 in women aged ≥75 years. The age-adjusted major cardiovascular disease hospital discharge rate for women with diabetes was 3.8 times that of women who did not have the disease. In an editorial note, the Morbidity and Mortality Weekly Report authors noted that “major CVD (cardiovascular disease) prevalence is twice as common and major CVD hospitalizations are nearly four times as common among women with diabetes compared with women without diabetes. These findings are consistent with mortality studies documenting that women with diabetes are at much higher risk for death as a result of major CVD than women without diabetes. Clinical trials indicate that antihypertensive treatment, aspirin use, and lipid-lowering therapies prevent or delay cardiovascular events. Epidemiologic evidence suggests that the risk for major CVD might be reduced through glycemic control and the promotion of health lifestyles, including weight reduction/obesity prevention, smoking cessation/prevention, and improved diet.” They also noted that preventing women from progressing to type II diabetes would also reduce the risk of cardiovascular disease.
“Despite the efficacy of prevention strategies for major CVD, a large proportion of persons with diabetes have uncontrolled blood pressure, dyslipidemia, and hyperglycemia and do not take aspirin. Additional research is needed to learn how to improve the process and outcomes of care among persons with diabetes,” they advised. “The high rate of major CVD among women with diabetes of all ages indicates that strategies for CVD risk reduction should be offered to all women with diabetes. Rate differences in hospital discharges increased with age, indicating that the effects of successful CVD prevention efforts should increase with age for women with diabetes.”
Anthrax Battle Continues; Office of Public Health Preparedness Emerges
Donald A. Henderson, MD, MPH, who has long warned that the United States is ill prepared to deal with bioterrorism, has been named to head the new Office of Public Health Preparedness by Health and Human Services Secretary Tommy Thompson. The new office is charged with coordinating the national response to public health emergencies, such as the current anthrax crisis that has mystified federal and state epidemiologists.
More evidence of the bacteria’s spores turned up in post offices in Manhattan, Florida, New Jersey, and Washington, DC, in the week ending November 3, 2001, according to the November 2, 2001, edition of the Morbidity and Mortality Weekly Report (2001;50:941–948). Deepening the mystery is the death of a 61-year-old hospital stockroom worker who was not known to have contact with mail at her own institution and whose home tested negative for contamination.
In an editorial note in the Morbidity and Mortality Weekly Report, CDC officials warned, “Public health authorities must be vigilant for the appearance of new cases in previously unaffected populations. Prompt data sharing between law enforcement and public health authorities is essential.”
The CDC noted that a total of 21 cases (16 confirmed and 5 suspected) of the disease have been found in US residents since October 3, 2001. The cases reported were limited to the District of Columbia, Florida, New Jersey, and New York City.
CDC officials warned that until the source of the deliberate exposures is identified and eliminated, physicians and laboratory personnel should consider the possibility of infection with Bacillus anthracis infection. The public health agency confirmed that the cases are related to bioterrorism and noted that its personnel are continuing to search for new cases and to look for the source of the infection.
At the time of the report, the CDC had identified 10 people with confirmed or suspected inhalational anthrax. All except the hospital worker in New York City and a journalist in New York were postal workers or mail handlers who were known to have handled, processed, or received letters that contained the anthrax spores. The incubation period between exposure and onset of symptoms was between 5 and 11 days. The first symptoms included fever, sweating, and chills; severe fatigue or malaise; and minimal or nonproductive cough. Of the 10 patients, 8 reported pleuritic pain, 5 had abdominal pain or nausea, 5 reported vomiting, and 5 had chest heaviness. Other symptoms included shortness of breath, headache, myalgia, and sore throat. Not all patients had all the symptoms.
When patients first arrived for treatment, they had a normal or slightly elevated white blood cell count. However, they had an elevation in the percentage of neutrophils or band forms. None had a low white blood cell count or lymphocytosis in the beginning. Chest radiographs were abnormal in all patients, with mediastinal widening, paratracheal fullness, hilar fullness, and mediastinal lymphadenopathy. “Mediastinal widening may be subtle and careful review of the chest radiograph by a radiologist may be necessary,” the report’s authors noted. Patients often had large pleural effusions that were hemorrhagic and required repeated thoracentesis of chest tubes. Some patients had pulmonary infiltrates that were multilobar. Blood cultures from 7 treated patients grew B anthracis and B anthracis grew in all patients who had not received antibiotics. Diagnosis in patients whose cultures were negative was confirmed by bronchial or pleural biopsy and specific staining, by PCR of material from a sterile site, or by a 4-fold rise in immunoglobulin G to the protective antigen.
The authors noted that all patients whose disease was recognized early are still alive, and 2 had been discharged from the hospital at the time of the report. “Prompt recognition of the early features of inhalational anthrax is important in settings of known or suspected exposure,” they wrote.
Stem Cell Debate Takes a Back Seat
A Senate measure that would have expanded opportunities for stem cell research was dropped from the $123.1 billion fiscal year 2002 Labor–Health and Human Services Appropriations bill on November 1, 2001, in an attempt to streamline the vote on the spending measure, according to the Associated Press.
The measure would have given President Bush the option of expanding stem cell research funding to cover research done on embryos that otherwise would have been destroyed. It was a loosening of the rules the President had announced in August, which would have allowed research only on established cell lines. That decision has been criticized for being too restrictive by the scientific community, which also is concerned about the viability of the cell lines identified by the National Institutes of Health. Senators feared that debate over the measure would have slowed approval of the critical funding measures.