A review of the international health literature has shown nutritional supplements and herbal medicines are the most commonly used complementary and alternative therapies in diabetes.

Annie Chang, a PhD candidate in Griffith ™s School of Nursing, said while some products may have benefits for patients, they can also have side effects in their own right or interact with conventional medications.

Fenugreek for example, used as a supplement, may affect blood sugar levels but patients are already on other blood sugar lowering medications as well.

While the prevalence of use varies widely between different countries (17-72%), her review suggests nearly half of people living with diabetes supplement their conventional medicines with some form of alternative therapy.

Women, over 65-year-olds, those who had been living with diabetes for longer, and people interested in self management of their condition were the most likely to use alternative therapies.

People will tell their alternative practitioners that they are using Western medicines but the vast majority will not discuss their alternative therapies with a doctor or other healthcare professional, she said.

Ms Chang, who has also surveyed more than 300 diabetics in Taiwan, said people feared their doctor would not be interested in discussing alternative medicines or that they might get into trouble ™ for taking them.

The evidence is that patients are using these products and may even reduce their conventional medicine doses and modify the timing of doses so they aren ™t taking both together.

While it might be impossible for Western medicine to learn all about complementary and alternative therapies, healthcare professionals do need to be included in discussions about them so we can document their use and be aware of any potential problems for our patients.

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Another interesting aspect of MPO is that it may be a marker for unstable plaque. Even more than the number or severity of coronary plaques, we want to know the risk of plaque rupture, and this evolving new marker may help in that regard. More study is needed, but among the hundreds of markers tested to date, MPO looks like a keeper that will one day become part of clinical care, Dr. Cannon said.

Researchers are continuing to assess the value of MPO in different patient groups as well as in relation to other biomarkers, Dr. Boekholdt said. Key questions include whether, and under what circumstances, MPO should be added to the laboratory tests used to screen for cardiovascular disease, and whether blocking MPO could prevent cardiovascular disease.

The EPIC-Norfolk study is supported by program grants from the Medical Research Council UK and Cancer Research UK, with additional support from the European Union, Stroke Association, British Heart Foundation, and the Wellcome Trust. Some of the measurements in this study were supported by Wyeth. One of the study's authors, Stanley L. Hazen, M.D., Ph.D., is named as a co-inventor on pending patents filed by the Cleveland Clinic Foundation relating to the use of myeloperoxidase as a biomarker for cardiovascular disease.

The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 34,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.acc .

The American College of Cardiology (ACC) provides these news reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.

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