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Item
#15
Delaying Disability in the
Elderly with Diabetes
Ace inhibitors can delay aging by affecting muscle function
A group of commonly prescribed hypertension drugs shows promise
for delaying muscle loss and disability in older adults, report
researchers from Wake Forest University Baptist Medical Center in
the March 14, 2002 issue of The Lancet.
"This is one of the first studies to suggest that a drug treatment
could delay a decline in physical function," said lead researcher
Graziano Onder, M.D. "Our results indicate that ACE inhibitor
drugs could slow the process that leads to disability."
In a study of 641 older women with hypertension, those who
regularly took ACE inhibitors had slower declines in walking speed
and muscle strength than those taking other types of hypertension
drugs, or taking no hypertension drugs. Declines in walking speed
and muscle strength have been shown to predict the onset of
disability, mortality, and nursing home and hospital admission in
older adults. "If additional research confirms our hypothesis that
ACE inhibitors have a positive effect on muscle function, they
could become an important treatment for delaying the loss of
physical function in older adults," said Onder.
ACE inhibitors had previously been shown to improve exercise
tolerance in people with heart failure. Researchers thought this
effect was related to the drug's positive action on the
cardiovascular system.
To test a theory that the drugs can affect muscle function, Onder
and colleagues analyzed data from the Women's Health and Aging
Study (WHAS), started in 1991 by the National Institute on Aging
(NIA) through a contract with Johns Hopkins University School of
Medicine.
"The finding that medication use is associated with maintenance of
walking ability in a group of partially disabled women is
exciting," said Dr. Richard Havlik, M.D., MPH, Chief of NIA's
Laboratory of Epidemiology, Demography, and Biometry. "If the
result is replicated in further research it could lead to a
valuable intervention."
For the study, muscle strength and walking speed were measured
over a three-year period in older women with hypertension. While
seated in a chair, participants extended their knees, pushing as
hard as they could against a device to measure the force. Walking
speed was evaluated by walking for four meters.
Participants who continuously took ACE inhibitors had a
significantly lower average decline in muscle strength (-2.2 lb)
over the three years, as compared to continued/intermittent users
of other antihypertensive drugs (-8.2 lb) and to never users of
antihypertensive drugs (-8.6 lb). The average three-year decline
in walking speed among ACE inhibitor users was 10 times lower than
among the other groups.
"The effect needs to be confirmed by additional research," said
Onder. "But it points to the possibility of ACE inhibitors being
used as a first-line therapy for hypertension in older adults.
Currently, these drugs are recommended only in certain
situations."
Onder and colleagues plan to extend their research to include
older men.
ACE (angiotensin converting enzyme) inhibitors include such drugs
as Accupril, Captopril and Vasotec. They help reduce hypertension
by blocking a protein that constricts blood vessels. Theories for
how they could also impact muscle include the possibility that
they can improve muscle efficiency, change a protein in muscle
cells that makes them more resistant to fatigue, increase blood
flow to muscles, and reduce inflammation that results in muscle
wasting.
WHAS was initiated by NIA to better understand the causes and
course of disability in older women. It was a prospective,
observational study of 1,002 women age 65 years and older who were
moderately to severely disabled, but not severely cognitively
impaired, at study entry. These women represented the
approximately one-third most disabled older women living in the
community. These data were obtained from November 1992 to February
1995.
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Fact:
For every
one-percentage point drop in the Hemoglobin A1c diabetes
complication rates drop by more than 25%.
Source: Diabetes 2001: Vital Stats.
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