You think you’re relatively healthy: You feel fine and don’t have any serious symptoms. So when your doctor drops a diagnosis such as prediabetes or prehypertension on you, confusion and panic can set in.
Such a diagnosis means that if you continue on your current path, making the same lifestyle choices, you will likely develop the full-blown disease. When you’re in the predisease stage of a preventable condition, you need to know what you can do, when medication might be necessary and the right questions to ask your doctor.
In the case of prehypertension, your blood pressure is just shy of what’s considered “high blood pressure,” and if you are eventually diagnosed with the condition, you’re at a much greater risk of heart disease and death. For prediabetes, you have blood sugar levels that are higher than normal, but not yet high enough to be considered diabetes. You’re not sick, but you’re on your way.
Movement Toward Preventive Model
The idea of identifying and treating risk factors before they turn into diseases is not new. The ability to screen for precancerous cells on the cervix was first introduced in 1928, for instance, and screening for hypertension — a risk factor for heart disease — began with the invention of the blood pressure cuff monitor in 1896.
Now, with an increasing focus on preventive medicine and evolving medical technologies that give doctors the ability to detect the signs of a disease long before it actually strikes, diagnoses such as prediabetes and prehypertension are far more common.
“For many decades, our success with the disease-centric model has precluded the development of focused and targeted preventive interventions,” says Dr. Regina Druz, a cardiologist in Mineola, New York. Druz says developments in genetic testing and the use of both personal and wide-scale health data are “pushing for medicine to embrace the preventive approach where lifestyle, not drug, intervention will be emphasized.”
Statistics on preconditions are hard to come by. A 2004 analysis published in the Archives of Internal Medicine, using data from the 1999 to 2000 National Health and Nutrition Examination Survey, suggested approximately 27 percent of American adults are prehypertensive — 40 percent of men and 23 percent of women. The Centers for Disease Control and Prevention estimates 1 in 3 American adults has prediabetes.
Lifestyle Changes as Treatment
With prediabetes and prehypertension, it’s generally not too late to reverse your trajectory. Frequently, that can be accomplished through lifestyle changes.
A 2013 study from Johns Hopkins University researchers found that patients diagnosed with prediabetes who were able to lose 10 percent of their body weight through lifestyle changes reduced their risk of developing Type 2 diabetes by 85 percent. Even those who lost 5 to 7 percent of their body weight slashed their risk by 54 percent.
Similar findings suggest lifestyle changes can reverse the path of prehypertension. A review recently published in the journal Nature Reviews Cardiology says the relative risk of hypertension declines by approximately 20 percent with lifestyle changes, including eating healthier foods.
When Medication May Be Necessary
More controversial than lifestyle changes in the treatment of prediseases is the use of medications. Though these drugs may be effective at reversing predisease conditions, they come with financial costs, side effects and, perhaps, a loss of incentive to make healthy lifestyle changes.
In the Johns Hopkins study of prediabetes patients, participants who took the diabetes drug Metaformin saw reductions in blood sugar levels but didn’t lose weight in conjunction with the drop. In the prehypertension review, blood pressure medication was estimated to reduce high blood pressure risk by 34 to 66 percent, compared with just 20 percent from lifestyle changes alone.
But Dr. Gilbert H. Welch, professor of medicine at Dartmouth Geisel School of Medicine, writes in his new book “Less Medicine, More Health” that “too many people are being made to worry about diseases they don’t have and are at only average risk to get.” In the book, Welch suggests that “too much medical care has too little value” and that patients should adopt only those interventions that stand to make a significant difference in their health and well-being.
If you’ve been diagnosed with a predisease, or your doctor wants to prescribe a medication to lower your risk factors for a preventable condition, you should ask questions. These questions aren’t designed to second-guess your doctor’s recommendations, but to ensure you know the real risks and potential benefits of continuing as usual, making lifestyle changes or opting for a prescription drug.
1. How high are my risks? The higher your risk, the more benefit you stand to gain from an intervention, according to Welch. If your blood sugar is just slightly higher than normal, for instance, you’ll derive less benefit from a drug that lowers it.
2. Can lifestyle changes eliminate or reduce the risk? Your doctor may advise you make dietary and other lifestyle adjustments before recommending medication. If she doesn’t, ask if these changes can improve your odds.
3. How certain are the benefits of intervention? Especially useful if medicine is recommended, this question is meant to uncover what tangible results will come of the intervention. For example, you could ask, “How many points can I expect my blood pressure to drop from taking this medicine?”
4. What are the risks of intervention? Prescription drugs can have negative side effects. Talk to your doctor about whether these risks outweigh the benefits.
The term “predisease” means there is still time for prevention. You should talk with your doctor to understand the diagnosis and decide how to handle it. If you still have questions after these discussions, or if you simply want another point of view, a second opinion can provide greater clarity. Remember, identifying a problem is only the beginning. What you choose to do can have lasting effects on your health.
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Prehypertension and Prediabetes: Room for Prevention in Predisease originally appeared on usnews.com
