Ignoring a troubling sign, such as rising blood pressure, can be dangerous. But treatment — especially if your numbers are borderline — can come with risks that outweigh the benefits.
“There’s a very large pool of people that fit in these pre-disease ranges who quite likely will never go on to have any serious health consequences at all,” says Jenny Doust, a professor of clinical epidemiology at Bond University in Queensland, Australia.
Here’s what you need to know about these pre-diseases — and what you can do about them.
What is it? Pre-diabetes means your blood sugar levels are higher than normal but not as high as in full-blown Type 2 diabetes.
How serious is it? The Centers for Disease Control and Prevention says that about 84 million Americans have pre-diabetes, about a third of the country. But studies vary widely on how many go on to develop diabetes and how quickly it happens. A 2016 analysis published in the journal Diabetes Care estimated that only about 2 percent of people with pre-diabetes develop diabetes each year. And a comprehensive evidence review found that over a period of up to 11 years, 17 to 59 percent of people with pre-diabetes reverted to normal blood sugar levels.
What should you do? Although the American Diabetes Association says medications can be an option for people with pre-diabetes, don’t jump to them, says Michael Hochman, director of the Gehr Family Center for Health Systems Science at the Keck School of Medicine at USC. They’re not harmless. In a major clinical trial, scientists found that aggressive treatment for diabetes resulted in a higher death rate than standard care.
Instead, opt for lifestyle changes. Increase your exercise and try to lose weight if you need to. Consider checking your blood sugar levels regularly.
What is it? Although the American Heart Association doesn’t use the term anymore, prehypertension used to be defined as systolic blood pressure (the top number) of 120 to 139 mm Hg and diastolic (the bottom number) of 80 to 89 mm Hg. Guidelines from the AHA, updated in 2017, have reclassified blood pressure of 120 to 129 over 80 mm Hg as “elevated” and 130 to 139 over 80 to 89 mm Hg as “Stage 1 hypertension.”
How serious is it? According to the CDC, 1 in 3 Americans could be classified as having elevated or Stage 1 hypertension. For older adults in that category, the rate of progression to Stage 2 hypertension (140/90 mm Hg or greater) may be as high as 50 percent over four years.
What should you do? Measuring blood pressure outside a doctor’s office is a key step to confirm your reading, says Anthony Viera, chairman of the department of community and family medicine at the Duke University School of Medicine.
Whether your blood pressure is elevated or at Stage 1, making lifestyle changes is the first step. Regular exercise, losing weight, quitting smoking, drinking less alcohol and following a diet called DASH (Dietary Approaches to Stop Hypertension) — which calls for fruit, veggies and whole grains, and less saturated fat and sodium — can help.
The new guidelines recommend considering medications for Stage 1 hypertension only if a person is at high risk for a heart attack or stroke because of other factors. And the American College of Physicians recommends blood pressure meds for people 60 and older only if their systolic pressure is 150 mm Hg or higher.
What is it? Osteopenia is defined as bone density below normal but above the threshold for osteoporosis, a condition in which bones become weaker and are at greater risk of breaking.
How serious is it? More than 43 million adults may have osteopenia. But a 2012 analysis of 4,957 older women found that after 15 years, only 5 percent of those with mild osteopenia developed osteoporosis. Also note that bone density is a relatively weak risk factor for fractures, says Teppo Jarvinen, a professor of orthopedics at the University of Helsinki.
What should you do? The U.S. Preventive Services Task Force recommends a baseline bone density scan for women 65 and older (and for young women at increased risk). Whatever the results, you can build bone mass without meds. Weight-bearing physical activity — including walking, jogging and strength training — encourages bone growth, while smoking depletes bone. Get plenty of vitamin D and calcium in your diet from foods such as fatty fish, fortified dairy and dark, leafy greens.
What about pre-cancer?
If you’ve ever had a cervical lesion or colon polyp removed or destroyed as a result of a routine cervical or colon cancer screening, then you’ve been treated for a potential pre-cancer. For those two diseases, robust evidence shows that treating the pre-disease has substantial benefits. But with other cancers, the benefit of catching lesions while they’re still very small isn’t as clear. Research suggests, for example, that ductal carcinoma in situ, or pre-cancer of the breast, progresses to invasive cancer in only about 20 to 25 percent of cases.
Scientists often can’t predict which early stage cancers or pre-cancers will go on to cause harm. But more screening can increase your chances of being treated for a pre-cancer that ultimately won’t hurt you. Talk with your doctor about your risk factors and what kind of screening regimen makes sense for you.
Dyslipidemia: If your LDL (or bad) cholesterol is 130 or higher, that’s called dyslipidemia, an abnormal amount of fats in blood. And although cholesterol-lowering drugs can help reduce your risk of heart disease, your LDL level on its own isn’t the only consideration. Instead, says Douglas DeLong, chair of the Board of Regents of the American College of Physicians, your doctor should calculate your overall risk of having a heart attack or stroke in the next 10 years. If your risk is low, then exercise, weight loss and an improved diet are your best bet.
Pre-dementia: Mild cognitive impairment (MCI) can sometimes signal the beginning stages of dementia. Screening is covered by Medicare on the theory that being forewarned could help people prepare. But many people with MCI never develop dementia and may even revert to normal cognition. There’s also no known treatment that can stop cognitive decline. That means a diagnosis could simply cause you anxiety in exchange for no benefit.
Copyright 2019, Consumer Reports Inc.
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