DIABETES MELLITUS Type 2 - Part VI
Protecting your heart from Diabetes
What is the No. 1 cause of death and disability among people with Type 2 Diabetes? Heart disease and stroke, of course. Here are the stats:
- At least 65 percent of people with diabetes die from some form of heart disease or stroke.
- Adults with diabetes are two to four times more likely to have heart disease or stroke than adults without diabetes.
- The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease
The diabetes-heart connection
As you know, at least 20 percent of adults over 65 have DM T2 and it is much more prevalent among Indians. The disease affects all organ systems and accelerates the entire aging process but death occurs primarily from coronary heart disease, heart failure or strokes. Atherosclerosis, manifested as increased fatty deposits on the lining of the blood vessels eventually causing occlusion of blood flow in the arteries, is the underlying cause. Many who survive acute heart attacks eventually develop chronic heart failure, a major cause for long-term disability. Sadly, one-third of America’s diabetics aren’t even aware they have the disease. And blood vessel damage may predate the actual diagnosis, so it is important to have periodic check-ups. Interestingly, even when glucose levels are under control, the risk for cardiovascular disease persists, the reason being diabetic patients often have the following significant risk factors.
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High blood pressure (BP) is quite common among the general public but more so in diabetics, especially in women. When patients have both hypertension and diabetes, their risk for cardiovascular disease doubles.
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High blood lipids: Diabetics often have higher levels of unhealthy cholesterol levels, including high LDL ("bad") and low HDL ("good") cholesterol, and high triglycerides. This triad of abnormal lipid pattern, common in patients with premature coronary heart disease, is called atherogenic dyslipidemia or diabetic dyslipidemia. Patients need to learn more about these abnormalities and take proper treatment.
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Obesity: is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. America is in the middle of an obesity epidemic and “diabesity” (the combination of diabetes and obesity) has become all too common. And metabolic syndrome -- a cluster of conditions consisting of high BP, high blood sugar level, abdominal obesity and abnormal lipid levels — is a common problem among Indians. Many of our children are becoming obese, making them prone for DM T2 as they reach adulthood.
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Lack of physical activity: This directly contributes to insulin resistance and heart disease. Regular exercise and weight reduction can prevent or delay the onset of DM T2, reduce BP and help reduce the risk for heart attack and stroke. It's likely that any type of moderate and/or vigorous aerobic physical activity — sports, household work, gardening or work-related activity — is similarly beneficial.
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Smoking: Independently one of the most important risk factors for heart disease, smoking can be deadly in diabetics. In my long experience as a cardiologist, majority of the heart attacks and strokes in the under 45 group occur in diabetics or smokers or those who have both the risk factors. So, kick the habit of smoking if you are a smoker.
Ann Albright, PhD, RD, director, Division of Diabetes Translation, Centers for Disease Control and Prevention, has this advice: “The longer you live with the disease, the more likely you are to develop complications. If you develop diabetes at a young age, the chances are greater for complications at a younger age.” Diabetes will shorten the lives of men diagnosed at age 30 by an average of 14.5 years; if diagnosed at age 20, by 17 years. For women diagnosed at 30, diabetes shortens life by an average of 16.5 years; if diagnosed at 20 by 18 years.
And now for the good news. All these can be corrected with proper control of the disease, including the risk factors as stated above. Says Albright: “You may not achieve perfect control but the better you take care of yourself, the better shot you have for a life without those serious and lethal complications.” Living with DM T2 can be challenging but help is available for proper management of the disease.
This concludes the series on Diabetes Mellitus
Dr. Ravindra Nathan is a Brooksville cardiologist and author of a new book, “Stories from My Heart.”