Diabetes and heart disease: what you need to know

Diabetes and heart disease: what you need to know


Diabetes can affect the heart in a number
of different ways. The most common thing that we think about when we think about diabetes
is narrowing of the blood vessels over time where fat lines the blood vessels increasingly
with duration of diabetes. And that increases the risk
of heart disease and strokes. In addition to that, the effect of diabetes on the heart
can affect the heart muscle directly whereby the heart muscle becomes stiff, it doesn’t
relax as well leading to heart failure. So, the complications of diabetes
are potentially heart attacks, potentially strokes obviously
affecting the brain, and heart failure. Well one of the challenges in people with
diabetes is that the pain threshold is a lot different in people with diabetes. So often
typically when somebody’s having a heart attack, they express chest pain, sweating, discomfort,
and if you’ve had diabetes for a long time, patients actually don’t get the same feelings
of pain. So often heart disease is more silent. So you need to have a high threshold for
diagnosis. And if people with diabetes have slightly atypical symptoms, maybe start to
get breathless on walking, that could be a sign that there’s a problem
with the blood supply to the heart or it could be a sign that the heart muscle
is not pumping adequately. One of the challenges is the people
with diabetes often have heart failure where the heart is not pumping properly. And it’s undiagnosed in about 25% of people. So, there are a couple
of ways of thinking about diagnosing this. One is with scans of the heart, two is basically
blood tests that show that the heart is being overworked and is being stressed. And the
third thing is in in people with slightly atypical symptoms whereby maybe they’re getting
a little bit of breathlessness on walking, it’s what’s called a stress test either on
a treadmill, a bicycle, or doing what’s called a stress echocardiogram of the heart; whereby
increase the heart rate and you just take images of the heart muscle to see if it’s
pumping properly in response to exercise. Heart problems in patients with diabetes are
treated with the same medications as in people without diabetes. So that basically means people
with diabetes need cholesterol-lowering medications. And we know that for one unit
lowering in so-called bad cholesterol or LDL, the patients with diabetes get about a 22%
reduction in risk, but often even when you’ve lowered blood pressure, you’ve lowered cholesterol,
you might often use things like aspirin. And this is obviously on top of things like lifestyle. Having diabetes, per se, gives you the so called
“high-residual risk”. So, blood pressure, cholesterol and lifestyle factors
become more important. And often you have to treat those much, much more aggressively
in people with diabetes. The other problem that often need
we find with diabetes is kidney problems. And once kidney problems start, that often
increases the likelihood of heart failure and so that means that kidney disease needs
to be treated much more early, particularly when detected early. The issue with diabetes is that
on average if you have diabetes you double the risk of heart disease
throughout your life. And the earlier somebody develops diabetes
the more life years you lose. So on average, a 40-year-old with diabetes
loses about 6 years of life; half of those are going to be
from heart disease or strokes. So in order, if you like, to claw back those six years,
you have to basically modify lifestyle and think about medications that traditionally reduce
the risk of diabetes progression or complications. So that basically means cholesterol lowering, it means controlling blood sugars, blood glucose levels, it meanscontrolling blood pressure and doing that early before complications develop. So, prevention really starts early. And if somebody’s unfortunate enough
to have diabetes and heart disease, they need to be treated even more aggressively. So, if you’re age 16, you’ve already got diabetes
and have had heart disease, on average the number of
life years lost is about 12. So, the main take-home message for people with diabetes is prevention long-term – starting early – and aggressive control of risk factors early and maintaining that throughout life.

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