Diabetes and heart attack are inter related and there are chances of a CVD attack on you. Here’s your guide to prevent it!
Heart disease is twice as common in people with diabetes as compared to age and sex- matched non-diabetic population. About 65-75 per cent of people with diabetes will eventually, and often prematurely, succumb to cardiovascular disease (CVD); coronary
artery disease (CAD) being the main component of CVD. Other organ systems of the body where the impact of CVD is felt is in the brain, where it manifests as a stroke, and peripheral
vascular disease (disease of the arteries going into legs) where it can result in gangrene. Coronary Artery Disease is uncommon in pre-menopausal women as compared to age-matched men, but in the presence of diabetes, CAD occurs in equal number of men and women. A diabetic without prior heart attack carries the risk of developing a heart attack which is equal to the risk faced by a non- diabetic who has previously suffered from a heart attack. In other words a diabetic carries higher risk of a heart attack.
Heart disease in India is particularly devastating, because type 2 diabetes, as well as heart disease, affect Indians at a younger age, thus reducing their capacity to work and earn a livelihood.
Why does CVD and coronary artery disease affect young diabetics?
Diabetes accelerates atherosclerosis; a process where arterial lining is damaged and thickened and prone to occlusion. This process is accelerated because of an increasing tendency of the blood to clot and occlude vessels. Uncontrolled diabetes also sets up an inflammatory process, which injures the lining of blood vessels.
Another important cause of increased CAD in diabetes is the presence of comorbidities like
high blood pressure, high cholesterol and obesity. Consumption of tobacco can also be a potent co-conspirator in this process. Therefore, besides controlling blood sugar in diabetes, it is considered extremely important to also control comorbidities. Such holistic approach yields satisfying outcomes. Most diabetics have high LDLCholesterol (commonly known as bad cholesterol) and low HDL- cholesterol (commonly known as good cholesterol). Additionally, they also have high triglycerides, another type of blood fat. High blood pressure is seen in about 60-80 per cent of people with diabetes and is 2-3 times as common as seen in non-diabetics. Obesity is a highly prevalent comorbidity. In our series, 52 per cent of type 2
diabetics were overweight or obese. Obesity can also be a component of an interesting
syndrome – a constellation of several morbidities like increased abdominal girth (> 90
cm in man, >80 cm in women), high blood pressure and high cholesterol. This is called
metabolic syndrome which is an unholy alliance of several comorbidities.
Can we prevent CVD in diabetes?
Yes, to a great extent! A healthy lifestyle is an important requirement. Obese people must lose at least 7-10 per cent of their body weight. Diabetes must be well controlled, right at the onset of the disease. A few important studies have demonstrated that first 10 years of good glycaemic control results in significantly higher cardiovascular benefits as compared to later 10 years of control. The HbA1c, an important parameter reflecting the state of diabetes control for the previous 2-3 months should be at 6-6.5 per cent in the early phases of type 2
diabetes and 6.5-7.5 per cent in the later years.
Besides glycaemic control, the blood lipids should also be controlled. This is usually done by
using a statin. These are a lot of maligned drugs on the internet, but when tolerated, they are important in preventing vascular disease. The blood pressure must be controlled meticulously and should stay below 130/80 mm of Hg. Elderly people may be permitted to keep their blood pressure up to 150/85 mm of Hg. It is important to apply all types of tobacco cessation strategies, like use of nicotinecontaining chewing gums or patches and certain medications.
If heart disease cannot be prevented, we should try to detect it early. Therefore, a heart check-up is required in diabetics at regular intervals and early intervention is recommended if heart disease is detected.
By Dr. (Prof.) Hemraj Chandalia