Lowering Numbers Too Far May Backfire

Numbers are seductive. Credit scores are a way of measuring your fiscal responsibility. That’s why some people work very hard to get their numbers up, not because they want to borrow money but just on principle.
Golfers also get obsessed with numbers. The lower their handicap, the happier they are.
Both golf handicaps and credit scores are calculated using complicated equations. The numbers that measure our health are just as tricky.
Physicians use many numbers to assess risk. Blood pressure, cholesterol and blood sugar are among the most important. When these numbers get too high, they indicate that the individual is more likely to experience serious complications.
High fasting blood sugar is the marker for diabetes, a disease that increases a person’s likelihood of developing neuropathy, blindness, kidney failure and most significantly, heart attacks. High blood pressure and cholesterol also boost the chance of a stroke or heart attack.
To save their patients’ lives, doctors focus on getting these numbers (among others) under control. People whose blood pressure is too high are told to lose weight and given a prescription for a blood pressure pill. If one drug doesn’t do the job, another will be added, and then another. It’s not unusual for a person to be taking three or four different medicines to normalize blood pressure.
People with diabetes are also admonished to watch what they eat and prescribed drugs to control their blood sugar. In diabetes as in hypertension, several medications may be needed to reach the target.
The same pattern holds for cholesterol: the patient is told to clean up his diet and given a prescription for a cholesterol-lowering drug like Crestor, Lipitor or simvastatin.
There is no such thing as too low a golf score, but the human body is a lot more complicated than the game of golf. Moderation may be a better strategy. Getting too caught up in lowering numbers might be counterproductive.
Physicians were shocked earlier this year when the results of a few large long-term studies on diabetes showed that aggressive control of blood sugar, blood pressure and blood fats did not keep people from dying prematurely of heart attacks and strokes (New England Journal of Medicine, April 29, 2010; JAMA, July 7, 2010).
In fact, those under intensive treatment to lower blood sugar actually fared worse (Lancet, Feb. 6, 2010). In one study people with type 2 diabetes who received both insulin and oral medicines to get blood sugar close to normal had a 49 percent higher risk of dying during the study than those who lowered blood sugar with oral medicine alone.
In a new study of people with chronic kidney disease, getting blood pressure down to the target of 130/80 did not keep their condition from worsening (New England Journal of Medicine, Sept. 2, 2010).
No one would ever suggest that risk factors like hypertension, diabetes or elevated cholesterol should go untreated. But aggressive treatment can result in serious side effects and may not yield the anticipated benefits.
Both patients and physicians should stay focused on the goal of improving quality of life as well as longevity, rather than being seduced by numbers. If the recent diabetes trials are any indication, the best results may be achieved through moderation.