Diabetes and heart disease are both global epidemics. People with diabetes tend to develop heart disease at a younger age than people without diabetes. It is more common in patients with Type 2 diabetes and is currently among the leading causes of morbidity and mortality worldwide. The negative effects of these conditions are accelerated by globalisation, rapid unplanned urbanisation and increasingly sedentary lifestyles.
The Framingham Study was the first research study to provide evidence that people with diabetes are more prone to heart disease than those who did not have diabetes. Glucose is the energy source for body tissues. It is stored in the liver in the form of glycogen. If high blood glucose levels remain in the bloodstream for a long period of time, it can damage blood vessels and the nerves that control them leading to heart disease.
By heart disease, we refer to coronary artery disease, the disease of the blood vessels supplying oxygen and blood to the heart muscle. Hardening of vessels due to deposition of cholesterol plaques (atherosclerosis) in the walls of these coronary arteries causes sluggish blood flow or complete blockage of blood flow leading to a heart attack, stroke due to the stiffening/atherosclerosis of blood vessels of the brain, Peripheral Arterial Disease or PAD: Atherosclerosis or hardening of arteries of legs/feet. PAD can be a first pointer that a person with diabetes has cardiovascular disease.
Diabetics are more likely to have certain risk factors that increase their chances of having heart disease. Risk factors for developing heart disease are smoking, high blood pressure, abnormal cholesterol — high triglycerides and low-density lipoprotein/LDL (bad cholesterol), low high-density lipoprotein/HDL (good cholesterol), obesity and belly fat, sedentary lifestyle, consuming an excess of alcohol, a diet rich in saturated fat, trans fat, less fibre, excess salt, and a family history of heart disease.
Symptoms of heart disease are chest pain or pressure in the chest that is persistent or intermittent, pain or discomfort radiating to the left or both arms, shoulders, or back, neck, or jaw, shortness of breath, light-headedness, excessive sweating, nausea, fatigue, and a racing heartbeat. Heart failure is a complication of heart disease where the heart is unable to pump blood effectively to other parts of the body leading to swelling in the legs, and fluid build-up in the lungs making it hard to breathe.
Symptoms of stroke could be variable, including weakness or numbness of the face, arm, or leg on one side of the body, slurred speech, confusion, irrelevant talking, dizziness, imbalance, visual disturbances, abnormal sensation and sudden, severe headache. The peripheral vascular disease presents as leg pain or cramps while walking (intermittent claudication) or hips or buttocks pain, cold feet, decreased or absent pulses in the feet or legs, loss of hair on the lower parts of the legs.
Testing for heart disease in people with diabetes includes:
HbA1c: Glycosylated haemoglobin which gives the average blood glucose control over the past 3 months.
Blood cholesterol levels.
ECG: Electrocardiogram that measures the electrical activity of the heart.
An echocardiogram to measure the thickness and pumping capacity of the heart.
Exercise Stress Test helps determine how well your heart responds during times when it’s working its hardest.
Heart disease can be prevented by controlling the risk factors:
Strict control of diabetes (target HbA1C below 7%).
Strict control of blood pressure (BP goal for most people with diabetes is below 130/80 mm Hg).
Control the levels of cholesterol (LDL cholesterol less than 100mg/dl, in patients with heart disease it is targeted to less than 70mg/dl). Total cholesterol between 100-199mg/dl. Triglycerides less than 150mg/dl. HDL was greater than 45mg/dl.
Cessation of smoking and abstinence from alcohol.
Eating healthy — a diet rich in fibre, a salt-restricted, low-fat diet.
Physical activity like brisk walking for 45 minutes a day for at least 5 days a week.
Maintaining an ideal body weight.
Getting adequate good
quality sleep.
Managing stress by indulging in activities like yoga, meditation, deep breathing, working on hobbies etc. Having diabetes does not mean that heart disease is the norm.
Managing one’s own risk factors and working to improve heart health through lifestyle changes along with a doctor’s treatment plan can prevent heart-related complications.
(The author is a senior
consultant in internal medicine.)