Over 65% of all deaths in people with diabetes are caused by cardiovascular disease. Heart attacks occur at an early age in people with diabetes and often results in premature death. By proper management of diabetes, hypertension and high LDL levels and life style changes, this can be decreased to a certain extent.
- What is the relationship between diabetes and coronary heart disease? If you have diabetes you are twice at least twice as likely to heart disease or a stroke. People with diabetes also tend to develop heart disease at an age earlier than other people. If you are middle aged and have type 2 diabetes your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. People with diabetes who have already had one heart attack run an even greater risk of having a second one. Heart attacks in people with diabetes are more serious and more likely to result in death.
- What about women and heart disease ? Women who have not attained menopause usually have less risk of heart disease than men of the same age. But women of all age groups with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child bearing years.
- Why does heart disease affects diabetics more than non diabetics? Long standing diabetes leads to increased deposits of fatty material on the inside of blood vessel walls. This impairs blood flow and increases the chances of clogging and hardening of blood vessels. This results in formation of a plaque, which if ruptures leads to total occlusion of the coronary artery resulting in heart attack.
- What are the risk factors for heart disease in people with diabetes ? Diabetes itself is a risk factor for heart disease. Many with diabetes have other conditions that increase their chances of developing heart disease. These are called Risk Factors. These are family history of heart disease. Having central obesity. Having high cholesterol levels. Having high blood pressure and smoking.
- What is central obesity ? Central obesity means carrying extra weight around waist as opposed to hips. Waist circumference is a surrogate marker of visceral fat. Women with a waist circumference of more than 35 inches and men above 40 inches are at increased risk. Risk of heart disease is higher because abdominal fat increases the production of bad LDL cholesterol.
- What are the abnormal blood fat levels ? LDL Cholesterol can build up inside your blood vessels leading to narrowing and hardening of arteries. Triglycerides are another type of blood fats that can raise your risk of heart disease when the levels are high.HDL good cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal.Low levels of HDL increases your risk factors for heart disease.
- What about diabetes and high blood pressure ? If you have hypertension your heart has to work harder to pump blood. This puts a strain on the blood vessels of your heart and increases your risk of heart disease.
- What about smoking,diabetes and heart disease ? Smoking doubles your risk of getting heart disease . Stopping smoking in diabetics is specially important as both smoking and diabetes cause narrowing of blood vessels. Smoking also increases the chances of lung, stomach and throat cancer.
- What is metabolic syndrome and how is it linked to heart disease? Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and diabetes. These are elevated waist circumference, elevated levels of triglycerides, low levels of HDL, elevated blood pressure and elevated fasting blood glucose.
- What can you do to prevent or delay heart disease in diabetes? Make sure that your diet is heart healthy. Include at least 14 grams of fibre daily for every 1000 calories consumed. Cut down on saturated fats. Consume less than 300 mg cholesterol a day. Have minimum of trans fats in your diet.If you smoke then quit smoking. Your doctor may suggest aspirin to you.
- What about physical activity ? Aim for at least 30 minutes of exercise most days of the week . If you are overweight aim to loose no more than 1 to 2 pounds per week.
- How would you know that your diabetes treatment is working for you ? By knowing the ABCs in diabetes, people can reduce their risk for heart disease and stroke. A stands for A1C, B stands for blood pressure, C stands for Cholesterol. A1C should be checked at least twice a year and should be below 7 %. The blood glucose target should be before meals 90 to 130 mg % and post meal should be less than 180 mg %. The target blood pressure should be less than 130/80 mm of Hg. Target LDL to less than 100, keep HDL above 40 mg in men and 50 mg in women. Target triglycerides to less than 150 mg %.
- What are the symptoms of heart attack in diabetics ? Chest pain or discomfort, pain or discomfort in your arms , back, jaw, neck or stomach.Shortness of breathing, sweating , nausea and light headedness. Symptoms may come and go. In diabetics symptoms may be mild or absent due to nerve damage caused by diabetes. Women may not have chest pain but more likely to have shortness of breath, nausea or back and jaw pain. Treatment is most effective if given in first hour of heart attack, if delayed it can lead to permanent damage to the heart muscle.
- What are the treatment options in diabetics who have a heart disease ? Besides diet and physical activity medicines to control blood pressure, blood glucose and cholesterol are given.Blood thinners are also administered. Revacsularisation procedures like angioplasty and coronary artery bypass surgery is also a major therapy. Cardiovascular disease is a major complication in the diabetes population and poses a great challenge to the patient his family and the care providers. Successful management requires motivation, discipline and proper support and guidance from the family and medical professionals.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.