AACE: Insulin Not Sodium May Be Hypertension's Bad Actor

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AACE: Insulin Not Sodium May Be Hypertension's Bad Actor

http://www.medpagetoday.com/Endocrinology/Diabetes/dh/3196

By Peggy Peck, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of

Pennsylvania School of Medicine.

April 28, 2006

MedPage Today Action Points

* Explain to patients who ask that weight loss in obese patients

reduces cardiovascular risk factors including hypertension.

* This study was published as an abstract and presented at a

conference. These data and conclusions should be considered to be

preliminary as they have not yet been reviewed and published in a

peer-reviewed publication.

Review

H. Hays M.D. Christiana Care

CHICAGO-Insulin rather than salt is the major driver of hypertension,

according to an analysis of data from a prospective study of 23 patients

with confirmed atherosclerotic cardiovascular disease.

In the study, obese patients consuming a high saturated fat diet

increased daily sodium intake from less than 2 grams a day to more than

20 grams a day. But they also lost an average of 5.5 kg-or about 5% of

their total body weight-in six weeks.

" At the same time there were dramatic and significant reductions in

fasting insulin and in mean arterial pressure, " reported H. Hays,

M.D., of the Christiana Care Health Services in Newark, Del., at the

American Association of Clinical Endocrinologists meeting here today.

Dr. Hays said the finding strongly suggests that " we need to stop paying

so much attention to sodium and pay much more attention to fasting insulin. "

The patients in the trial were all put on a very high fat diet-50% of

calories consumed came from saturated fat sources " mostly flesh of

mammals, " he said. And were told to avoid starch. There was, however, no

caloric restriction. " These were free range humans who could consume as

much as they liked, " he said.

Dr. Hays and colleagues previously reported in the Mayo Clinic

Proceedings that the patients achieved significant improvements in a

number of cardiovascular risk factors, including reductions in total

triglycerides, triglycerides, very low density lipoprotein (vLDL), and

vLDL particle size. Additionally, while LDL and HDL concentrations were

unchanged, there were significant increases in HDL and LDL particle size.

Among the findings reported today:

* After six weeks, average fasting blood glucose was 98.3 mg/dL

±9.3 mg/dL down from 106.1 mg/dL ±9.3 17.7 mg/dL (P<0.05).

* At baseline, average fasting insulin was 21.3± 12.2

microunits/ml, after six weeks it declined to 14.8 mu/ml± 5.7 mu/ml

(P<0.05).

* Mean arterial pressure decreased by an average of 5.5 mm Hg from

96 mm Hg at baseline to 88.5 mm Hg after six weeks of the high fat diet

(P<0.05).

The patients in the study " were all very high risk at baseline and were

all taking a number of medications including a number of

antihypertensive drugs, " he said. " By the end of the study some patients

were able to stop drug therapy and others were able to reduce their doses. "

The study was limited by its post-hoc design and by the fact that sodium

intake is based on dietary recall. But Dr. Hays said he is confident

that patients significantly increased sodium consumption because

" despite the fact that we discouraged them from eating processed meats,

many of them were eating a half pound of bacon and six eggs for breakfast. "

Dr. Hays said it is also possible that the real key to the success of

these patients is the rapid weight loss. " It all comes back to obesity, "

he said. Asked whether a similar weight loss achieved with a restricted

calorie diet or a low fat diet could produce the same results, he agreed

that it could.

" We are testing that hypothesis with a new study that will begin

enrollment this summer, " he said. " We will be comparing the high fat,

no-calorie-restriction diet, to a low fat diet plus Xenical (orlistat). "

Asked to explain the rapid weight loss observed in the high fat study,

he said that satiety is a factor. " Steak at every meal sounds good, but

it gets old. "

He said, however, that although he was once " pretty close to a

vegetarian, I do believe in this diet (high fat, red meat) and I do

follow it myself. "

Primary source: American Association of Clinical Endocrinologists

Endocrine Practice

Source reference:

Abdul-Rahman, M et al " A High-Fat Diet in Obese Patients Induces

WeightLoss, Leads to Improved Insulin Resistance, and Lowers Systolic

Blood Pressure Despite Marked Increase in Dietary Sodium Intake "

Abstract 201 Endocr Pract 2006 12 (Suppl2) 50

Additional source: Mayo Clinic Proceedings

Source reference:

Hays JH et al " Effect of a High Saturated Fat and No-Starch Diet on

Serum Lipid Subfractions in Patients with Documented Atherosclerotic

Cardiovascular Disease " Mayo Clin Proc 2003:78;1331-1336).

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