DIABETES

Intensive treatment appears to halve the risk of heart disease.

* THE QUESTION Can diabetics reduce their risk of heart attack and stroke through intensive blood pressure and cholesterol treatment?

* PAST STUDIES have shown that type 2 diabetes raises a person's risk of dying from heart disease by two to three times.

* THIS STUDY compared 160 people with type 2 diabetes who were randomly assigned to receive either conventional treatment for diabetes through a general practitioner or intensive treatment for eight years. The intensive treatment, which was supervised by dietitians, included lowering saturated fat intake, increasing physical activity, quitting smoking, taking drugs to lower blood pressure, cholesterol and glucose levels and using multivitamins and aspirin.

At the end of the study, those who received intensive therapy -- a large majority of whom had managed to cut their blood pressure, cholesterol and glucose levels -- had about half the risk of cardiac events as those who received conventional therapy.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with type 2 diabetes.

* CAVEATS The researchers had received funds from manufacturers of the drugs used in this study. Also, more than half the people in the conventional-therapy group were referred to diabetes specialists during the study.

* BOTTOM LINE Many diabetics may be able to reduce their risk of heart disease through intensive, supervised therapy. They may wish to consult their physician about making lifestyle changes and taking drugs to control blood pressure, glucose and cholesterol.

* FIND THIS STUDY Jan. 30 issue of the New England Journal of Medicine; abstract online at www.nejm.org.

HEART DISEASE

Too little or too much sleep may damage cardiovascular health.

* THE QUESTION Does the amount of sleep a person gets affect the likelihood of developing heart disease?

* PAST STUDIES have shown that short-term sleep deprivation may interfere with blood pressure, heart rate, glucose metabolism and cortisol ("stress hormone") levels.

* THIS STUDY examined the effects of long-term sleep patterns on 71,617 female nurses aged 45 to 65 who were free of heart disease. Over a 10-year period these women experienced 934 coronary events. Those who were sleeping five hours or less each night at the beginning of the study (5 percent of the overall sample) had a 39 percent higher risk of heart disease than women who slept eight hours, and those who slept six hours (26 percent of the total) had an 18 percent higher risk. In addition, in a finding for which the researchers had no likely explanation, women who slept nine hours or more (5 percent of the participants) had a 37 percent higher risk of heart disease than those who slept eight hours. The eight-hour group, which contained 24 percent of all those studied, had the lowest rate of heart disease.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People who routinely sleep more or less than eight hours nightly.

* CAVEATS The results are not based on a randomized trial and may not apply to men. Also, sleep time was self-reported by the participants. Finally, different reasons behind sleep deprivation, such as insomnia and work or family responsibilities, may have different effects on heart disease.

* BOTTOM LINE Adequate daily sleep should be considered a major contributor to cardiovascular health.

* FIND THIS STUDY Jan. 27 issue of the Archives of Internal Medicine; abstract online at http://archinte.ama-assn.org/.

ASTHMA

Inhaled corticosteroids do not seem to affect bone density.

* THE QUESTION Do inhaled corticosteroids lead to reduced bone density?

* PAST STUDIES have shown that long-term use of oral corticosteroids, taken in pill form, may have adverse effects, including osteoporosis. Little such research has been done on the inhaled form of the drug.

* THIS STUDY examined the effects of sustained corticosteroid use on the bone mineral density (BMD) of post-menopausal women who were being treated for asthma and other respiratory problems; some took the drug in inhalant form only, while others used both inhaled and oral formulations. Regardless of the type of drug taken, the women in both groups had used similar amounts of corticosteroids each day for eight years. The 106 women who used only inhaled corticosteroids had BMD levels similar to those of a matched group of healthy women who did not use any corticosteroids. The 49 women who used a combination of oral and inhaled corticosteroids, however, had substantially lower BMD than non-users.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Women with asthma or other breathing disorders.

* CAVEATS The results are not based on a randomized trial. In addition, the findings may not apply to men. Finally, different inhaled corticosteoids may not have the same effects on BMD.

* BOTTOM LINE Women with breathing disorders may wish to consult their physician about using inhaled, rather than oral, corticosteroids.

* FIND THIS STUDY January issue of the Journal of Allergy and Clinical Immunology; abstract online at www1.mosby.com/scripts/om.dll/serve?action=searchDB&searchdbfor=home&id=ai.

-- Haleh V. Samiei