Diabetic Heart Disease
Linking Diabetes and Heart Disease
There is a clear link between diabetes and heart disease. In fact, the most common long-term complication of diabetes is heart disease.
Diabetes is now regarded as one of the strongest risk factors for heart disease. This risk burden is particularly worsened when combined with other common risk factors including high blood pressure, high cholesterol and smoking.
- Cardiovascular diseases, including heart attack and stroke, account for two-thirds to three-quarters of all diabetes-related deaths.
- Heart disease strikes people with diabetes two to three times as often as people without diabetes.
- Deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years, compared to a 27 percent decrease in women without diabetes.
- Deaths from heart disease in men with diabetes have decreased by only 13 percent compared to a 36 percent decrease in men without diabetes.
- People with diabetes are as likely to have a heart attack as people without diabetes who have already had a heart attack.
- People with diabetes are also at increased risk for heart failure, a condition in which the heart is unable to pump blood adequately. This can lead to fluid buildup in the lungs, which causes difficulty breathing, as well as fluid retention in other parts of the body, particularly the legs.
Why the Increased Risk?
People with diabetes are at higher risk of cardiovascular disease because elevations in blood sugar (glucose) can lead to damage inside blood vessel walls. This makes it easier for fatty deposits known as plaque to build up in artery walls, narrowing the passageways and causing blockages that can lead to heart attack or stroke. Diabetes also increases the likelihood of clot formation, which can further block blood flow in the artery.
The risk also increases due to other factors that interact with diabetes. For example, the blood vessels in patients with diabetes are more susceptible to injury from other risk factors such as smoking, high cholesterol and high blood pressure. More than 90 percent of diabetes patients have one or more of these additional risk factors.
There is also some evidence that those with diabetes have an increased level of low-grade inflammation in the linings of their arteries, a process that starts blood vessel changes that lead to heart disease.
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Heart disease is not inevitable among people with diabetes. The best way to prevent or delay the development of significant cardiovascular disease is to prevent diabetes itself.
Weight Reduction and Exercise
Modest weight reduction and 30 minutes of exercise five days per week can reduce the development of type 2 diabetes over three years by 50 percent.
Blood Glucose, Blood Pressure and Cholesterol Control
Those with diabetes can still treat abnormalities in blood pressure and cholesterol levels in order to prevent cardiovascular disease. Controlling blood glucose levels is of paramount importance for preventing many complications of diabetes.
- Blood Glucose: Blood glucose levels are measured at home to provide information regarding daily diabetic control and to guide the health care provider with medication adjustment. Generally, glucose levels should range from 80 to 120 mg/dl prior to meals; however, these values may vary among individual patients.
- A1C test: This test is the best way to measure blood glucose levels over time. The test reflects average blood glucose levels over three months. The goal is to maintain an average level of less than 7 percent. The test should be given twice a year once adequate control is achieved. The combination of A1C and home glucose level testing provides the most accurate information to reduce the long term complications of diabetes.
- Blood Pressure: For people with diabetes, the goal is a blood pressure reading of less than 130/80 mmHg.
- Cholesterol: The target is less than 100 milligrams per deciliter of blood (mg/dL) for LDL or "bad" cholesterol for people with diabetes. For those who already have heart disease or are at higher risk, the goal is less than 70 mg/dL.
Your doctor can help you devise a plan to meet these guidelines. It will likely include:
- A healthy diet
- Regular physical activity
- Weight loss
- Quitting smoking
- Use of one or more blood pressure or cholesterol medications.
- Research shows that most adults with high blood pressure and diabetes need multiple medications to reach their blood pressure goals.
Less than 30 percent of people with diabetes are achieving the recommended blood pressure and cholesterol goals and fewer than 50 percent are meeting the A1C goal of 7. It is important to work with your physician to set up a program aimed at meeting these goals.
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Treatment for Heart Disease in Diabetic Patients
Treatment of heart disease in those with diabetes ranges from lifestyle changes to medications to revascularization, depending on the severity of the heart disease. Treatments may include:
- Aspirin therapy to reduce the risk of blood clots and strokes.
- Changes in diet, including more fruits, vegetables, fiber and fish.
- Exercise and weight loss to improve blood glucose, blood pressure and cholesterol levels.
- Medications, including those for blood pressure and cholesterol.
- Revascularization (re-establishment of adequate blood flow within the artery), including angioplasty to open clogged arteries with a balloon or stent or coronary artery bypass surgery (CABG) based on individual patient characteristics.