Word: cholesterol
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Lynne Newhouse Segal was the picture of robustness. At 59, the slim former lawyer was an avid runner, golfer and yoga practitioner. Segal, who lives in San Francisco, was healthy by nearly every measure - except her cholesterol level, which a routine test four years ago revealed was high. High cholesterol is a key risk factor for heart disease, especially in a patient Segal's age and with her family history (several close relatives had had heart attacks), so her doctor put her on a cholesterol-lowering statin drug as a preventive measure...
Segal was one of 24 million people taking drugs to lower cholesterol in the U.S. that year. The workhorse of American medicine, statins - first sold in the U.S. in 1987 and marketed under brand names like Lipitor, Zocor and Crestor - are designed to clear away LDL cholesterol, the waxy buildup that can clog arteries and trigger heart attacks and strokes. Doctors say the majority of current statin users are healthy people who don't have heart disease but who, like Segal, simply have high cholesterol. Use among this group, known as the primary prevention population, has made these drugs...
...prescribed to women at moderately high risk for heart disease. Grundy says the underrepresentation of women in drug trials does not discount statins' benefit; it results only in a failure to show a statistically significant effect. Grundy was one of the authors of the 2001 national guidelines for lowering cholesterol and the 2004 revisions that greatly expanded the use of statins - and were criticized because of his and other authors' ties to the drug industry...
That's a pattern that many diabetes experts expect to emerge more robustly as researchers dig deeper into the data. It's possible, for instance, that younger, newly diagnosed patients with diabetes may actually benefit from aggressively lowering their blood pressure, cholesterol and blood sugar levels - a trend that may have been lost in the noise of the current studies, which included patients who were up to 79 years old. "I tend to be far more tuned in to getting normal targets in my younger patients," says Dr. Daniel Einhorn, medical director of the Scripps Whittier Diabetes Institute...
...primary lesson that clinicians can take away from the new findings is that the blind push to lower all risk factors such as blood pressure or cholesterol isn't necessarily healthy, says Dr. Christopher Saudek, director of the diabetes center at Johns Hopkins University. That may even mean resisting the commonsense urge to reduce these measures to recommended or normal range in diabetics patients. "To me, it's a matter of having reasonable and patient-oriented individual targets," he says, "rather than trying to push and push and push just to get lower and lower glucose or blood pressure...