Consumer Reports: Pre-disease diagnosis is warning to act but no reason to panic

It’s important to act — but not overreact — if your doctor says you’re at the “pre-disease” stage for hypertension, osteoporosis or another condition. While the news is certainly a warning, it doesn’t mean you have to succumb to a cycle of worry and rush to get additional tests and treatment.

After all, diagnosing some conditions is somewhat arbitrary because the risk is evaluated on a continuum. And some of the interest in defining a pre-disease comes from testing or drug companies motivated to sell more products to more people.

A preemptive strategy, such as adopting healthful habits to fend off heart disease and stroke, clearly saves lives. But critics worry that the “pre” label will turn healthy people into patients. Generally, the best approach is to make lifestyle changes, control other risk factors and then focus on enjoying your good health.

Pre-hypertension

Hypertension is not a disease per se but a serious condition that can trigger a heart attack or stroke. And the risks begin to rise with even moderately elevated blood pressure. But should drugs be used to treat it? The risks and benefits of using medication in people with pre-hypertension are still largely unknown.

Who has it? People with blood pressure levels of 120 to 139 millimeters of mercury (the systolic, or upper number) and/or 80 to 89 mmHg (the diastolic, or lower number). Risk factors include being overweight or sedentary and having a family history (involving a parent or sibling) of hypertension.

How serious is it? Nineteen percent of the people with pre-hypertension develop hypertension over four years. The progression is more likely in older people and those at the high end of the pre-hypertension levels.

How to reduce your risk: Lose excess weight; consume a diet rich in fruit, vegetables and low-fat dairy products; limit your intake of saturated fat and trans fat; cut back on sodium; exercise regularly; and drink moderately, if at all.

How to avoid over-treatment: It’s sufficient to have your blood pressure checked on a yearly basis, with a goal of keeping it below 140/90 mmHg, the cutoff for hypertension. If you also have diabetes or kidney disease, aim for 130/80 mmHg or lower, and consider adding medication if lifestyle measures aren’t enough.

Pre-obesity

Being overweight is now categorized as pre-obesity, but some researchers point out that unlike obesity, being overweight doesn’t clearly increase the risk of death. And the body mass index (BMI), a standard measure for excess weight, doesn’t always reflect health. But the term pre-obesity has relevance because many people who are overweight continue to gain weight.

Who has it? People with BMIs of 25 to 29.9 are considered overweight, although the index might not be valid for very muscular or very short people. To determine your BMI, multiply your weight in pounds by 703, then divide by your height, in inches, squared. Or use the free online calculator at www.consumerreportshealth.­org.

How serious is it? The rate of progression to obesity hasn’t been pinned down, but clearly all obese people were once overweight. And being overweight increases the risk of having high cholesterol levels, hypertension and Type 2 diabetes.

How to reduce your risk: Prevent additional weight gain. If you have risk factors for obesity-related diseases, try to lose 5 to 10 percent of your body weight through moderate diet and exercise.

How to avoid over-treatment: Weight-loss drugs are approved only for obese or very overweight people with a related medical condition. Weight-loss surgery is an option for severe obesity.

Pre-diabetes

Soon after the term pre-diabetes was coined — with lifestyle interventions the only recommended treatment — the maker of rosiglitazone (Avandia), a medication for Type 2 diabetes, partly funded a trial in which the drug was found to reduce the risk of the disease in people with borderline blood sugar levels. That prompted aggressive marketing of the drug for prevention.

Who has it? People with a fasting blood sugar level of 100 to 125 milligrams per deciliter. Risk factors include being 45 or older, being overweight or physically inactive, and having a family history of diabetes.

How serious is it? Most people with pre-diabetes develop the full-blown disease within 10 years.

How to reduce your risk: Lose 5 to 10 percent of your body weight through diet and moderate aerobic exercise such as brisk walking 30 minutes a day, five days a week.

How to avoid over-treatment: If you have pre-diabetes, you should be checked for diabetes every one to two years, according to the American Diabetes Association. Aim for a fasting blood glucose level close to 110 mg/dL or lower. No drug is approved by the Food and Drug Administration to treat pre-diabetes or prevent Type 2 diabetes.

Copyright 2011. Consumers Union of United States Inc.

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