Gut Checks Carry More Weight

When big-bellied patients come through the door of George Griffing's medical office in Brentwood, Mo., he pulls out a measuring stick.

Griffing, a professor of internal medicine at Saint Louis University School of Medicine, has those patients lie flat on their backs on an exam table. Then he measures the height of their bulging midsection from table top to tummy top.

"I'd like to use a ruler, but with a lot of patients I have to use a yardstick," he says. "What we're really looking for is how much fat is in the abdomen and the liver. It's simple and accurate and reveals a lot of information."

Medical experts have long suspected that people with excess deep-belly fat are at an increased risk for cardiovascular disease and Type 2 diabetes, and ongoing research bolsters that belief.

Griffing believes that measuring abdominal height is more efficient and accurate at predicting the risks of diabetes and cardiovascular disease than more commonly used methods such as calculating body mass indexes or waist-to-hip ratios, or measuring the circumferences of patients' waists. Those all factor in subcutaneous fat on arms, legs and hips, which is not as bad for you as fat in the gut, Griffing says. Griffing says most studies have found that abdominal heights that measure more than 10 inches in women and more than 12 inches in men triple the chance of cardiovascular disease.

The American Diabetes Association and the American Heart Association endorse using the midsection measuring technique. On its Web site, the American Diabetes Association calls it a simple, cheap and noninvasive tool but added that more research is needed.

Heart doctor named president of cardiovascular society

San Antonio cardiologist Steven R. Bailey has accepted a one-year term as president of the Society for Cardiovascular Angiography and Interventions, the primary professional organization for more than 4,000 invasive and interventional cardiologists.

Dr. Bailey is chief of the Janey and Dolph Briscoe Division of Cardiology at the University of Texas Health Science Center at San Antonio. He is also a professor of medicine and radiology in the School of Medicine and sees patients at UT Medicine San Antonio.

Invasive and interventional cardiologists perform a range of heart procedures, including the placement of coronary artery stents, cardiac catheterization and diagnostic angiography. Bailey teaches students, residents and fellows and conducts research on a number of topics, including the development of next-generation stents. Stents are small wire-mesh tubes that hold arteries open.

The Health Science Center is South Texas’ leading health research institution. It has six campuses in San Antonio, Laredo, Harlingen and Edinburg and trains physicians, dentists, nurses, scientists and allied health professionals.

Extreme Glucose Levels In Diabetic Patients With Heart Failure Linked To Increase Risk Of Deaths

Compared with patients with moderately controlled glucose levels, diabetic patients who have heart failure and either too high or too low glucose levels may be at increased risk of death, said researchers at Baylor College of Medicine in a report published in the current issue of Journal of the American College of Cardiology.

To determine average glucose levels in the blood over a two to three month period, doctors measure glycosylated hemoglobin (the oxygen-carrying protein in the blood that is bound to the sugar glucose). In general, higher levels have been associated with increased risk of heart disease, said Dr. David Aguilar, assistant professor of medicine – cardiology at BCM.

"Most doctors try to keep glucose levels of those with diabetes as low as they can to lower the risk of complications such as eye problems, kidney disease or the development of heart disease," said Aguilar, senior author of the study. "However, we found that in diabetic patients with heart failure, glucose levels slightly higher than what are normally recommended had the lowest risk of death."

Researchers at BCM and the Michael E. DeBakey Veterans Affairs Medical Center in Houston identified 5,815 veterans with heart failure and diabetes who were receiving treatment at VA medical centers across the nation. They followed the patients for two years, dividing them into five categories based on their glycosylated hemoglobin levels.

Most medical professionals recommend levels at 7 and below as the target for optimal health for diabetic patients. However, the results of the study of diabetic patients with heart failure showed that those with levels 7.1 to 7.8 had the lowest rate of death. Those patients at both ends of the spectrum had the higher death risks.

"This doesn't mean that diabetic patients with heart failure should change their target goal for glucose levels," Aguilar said. "The results could simply be telling us that the glycosylated hemoglobin levels are a marker for other risks that are contributing to increased risk of death, but not necessarily the cause of the problem."

Aguilar said the correlation needs to be further investigated to confirm the findings and see what other factors could be contributing to the mortality rate.

The research is supported by a V.A. Health Services Research and Development Service grants and a National Institutes of Health Mentored Career Development Award.

Other researchers who took part in this study include, Drs. Biykem Bozkurt, Kumudha Ramasubbu and Anita Deswal, all from the Winters Center for Heart Failure Research and Section of Cardiology, and the Department of Medicine at BCM. Deswal is also at the Houston Center for Quality of Care and Utilization Studies at the Michael E. DeBakey V. A. Medical Center in Houston.