We followed until December 2007 a population-based cohort of Pima Indians who were invited every two years to participate in a research examinination. The methods for this longitudinal study are described in detail in Project Numbers Z01 DK069097 and Z01 DK069000. Electrocardiograms were obtained and serum total cholesterol, HDL cholesterol, and triglycerides were measured at each of these examinations. Participants with amputations are identified and the level of amputation was recorded. A death registry was maintained and underlying causes of death were determined by review of clinical records, autopsy reports and death certificates. Terminology and codes of the International Classification of Disease, Ninth Revision (ICD-9), were used to classify causes of death. In the past year, we found that QT prolongation and high heart rate each predict all-cause mortality and mortality from alcoholic liver disease in Pima Indians, with heart rate consistently being the stronger predictor. The effect of each variable on all-cause mortality was greater in those without diabetes. The results indicated that optimal clinical assessment of prognosis from heart rate and QT interval requires consideration of the independent effects of both variables. We also found that efforts within the Gila River Indian Community to meet American Diabetes Association treatment goals for control of glycemia, blood pressure and cholesterol were met with some success, since the prevalence of attaining these goals was over two times as high in diabetic Pima Indians as in the NHANES 1999-2003 sample. These improvements, however, were accompanied by an increase in mean body mass index. Nevertheless, improvements in the other parameters indicated that members of this community have benefitted substantially from progress in diabetes care over the last three decades. In the coming year, we will examine the relationship between total energy expenditure and natural mortality, given emerging evidence that higher metabolic rates increase aging and, in turn, mortality. We will also report on the predictive value of low estimated glomerular filtration rate and elevated albuminuria for all-cause and cardiovascular mortality, independent of other cardiovascular risk factors in an individual report and in a meta-analysis that includes nine other cohorts. Look AHEAD is a multicenter randomized clinical trial of weight loss to prevent cardiovascular disease in type 2 diabetes. We randomized 5,145 adults with type 2 diabetes to a lifestyle intervention or a diabetes support and education intervention for comparison. One-year weight losses averaged 8.6% (lifestyle) and 0.7% (diabetes education and support), meeting the goal of a difference of 5% between groups and establishing the feasibility of testing effects of weight loss. Differences were largely maintained at four years. At study entry, symptoms of depression or use of anti-depression medicines were each associated with a wide range of cardiovascular disease risk factors, indicating that depression or its treatment may be associated with higher rates of development of cardiovascular complications during the clinical trial. It will be important to determine if these factors predict complications and how they might interact with study interventions in affecting risks of complications.
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