Heart Disease: A Major Risk For Persons With Diabetes  

Obesity Epidemic Complicates Matters

People with diabetes know all too well their disease puts them at risk for devastating health problems, including blindness, kidney failure, and amputations.

Yet too few realize heart disease is the leading cause of premature death among diabetics, claiming the lives of two out of every three people with the blood sugar disease, experts say.

"People with diabetes have a two-to-four times greater risk of heart attacks, at an earlier age, and with earlier deaths than non-diabetics," says Dr. Nathaniel G. Clark, national vice president of the American Diabetes Association. "But two-thirds of people with diabetes don't think of heart disease as a problem.

"In fact, the risk of heart disease is going down in the regular population, but is going up in the diabetic population," he adds. "People aren't aware of this. There is a serious knowledge gap between the facts and the perception of the risks of heart disease and diabetes."

Dr. Clark's comments came at a medical conference sponsored by the American Diabetes Association, the American College of Cardiology and the National Diabetes Education Program.

Experts Focus on Cause and Effect

The conference was held to spotlight the strong link between diabetes and an increased risk for heart disease, and to introduce a program to lower the incidence of heart disease among people with diabetes.

About 18.2 million Americans have diabetes, and it is the sixth leading cause of death, according to the American Diabetes Association.

More worrisome, diabetes - much of it fueled by the obesity epidemic - is rising at an alarming rate. From 1990 to 1998, the prevalence of the disease in the US rose by one-third, according to a recent study in Diabetes Care.

Currently, one out of five adults aged 65 or older have the more common type 2 diabetes, which is often caused by poor eating habits and lack of exercise, according to the Centers for Disease Control and Prevention (CDC).

"Being a diabetic is considered a risk equivalent for heart disease or a heart attack at the same risk level as someone who has already had a heart attack," says Dr. Noel Bairey Merz, director of the Preventative and Rehabilitative Cardiac Center at the Cedars-Sinai Medical Center in Los Angeles. Dr. Bairey Merz presented at the recent conference as well.

Dr. Bairey Merz conducted a recent study of 2,008 diabetics that appeared in the Journal of the American College of Cardiology.

She found 65 percent were aware that complications from diabetes could cause blindness, and 36 percent understood the link between the disease and amputation of a limb.

But only 17 percent were aware of the increased risk of heart attacks, and only 5 percent knew they were at greater risk of stroke.

The risk for women with diabetes is particularly high, five times that of women without the disease, Dr. Bairey Merz adds.

Bridging the Knowledge Gap

The key is to make people with diabetes aware they should ask their physicians to regularly test their blood pressure and cholesterol, both indicators of heart disease risk.

If the tests show they are at risk for heart disease, they should ask their physicians for help in drawing up a plan to manage their risk, including lifestyle changes - such as better nutrition and more exercise - and possibly medication.

In addition, the three groups that sponsored the conference have introduced a program called The ABCs of Diabetes, to alert diabetics to ask their physicians for three tests to assess their cardiovascular health.

"A" stands for a glucose test that is called A1C, does not require fasting, and can be done in a physician's office. "B" is a blood pressure test, and "C" is a cholesterol test.

The three groups recommend that the glucose test result be 7 percent or less; the blood pressure be no higher than 130/80 mmHg; and the combined cholesterol number not exceed 200 mg/dl.

"Patients should routinely ask, 'What are my A1C, blood pressure, and cholesterol readings?' 'What are my treatment goals?' And 'What do I do to achieve them?'" says Dr. James R. Gavin III, who presented at the conference and serves as chairman of the National Diabetes Education Program.

"This will be incredibly useful in making a better connection between risk and action and empower the patient to ask questions," he says.

Always consult your physician for more information.

Online Resources

American Diabetes Association

American Heart Association

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Diabetes Education Program

National Diabetes Information Clearinghouse

National Institute of Diabetes & Digestive & Kidney Diseases

National Insitutes of Health (NIH)

National Library of Medicine

May 2004

Heart Disease: A Major Risk For Persons With Diabetes

Experts Focus on Cause and Effect

Bridging the Knowledge Gap

Diabetes and Heart Disease

Online Resources

Other Resources:

Find a St. John's Mercy Physician

Diabetes Services at St. John's Mercy

Diabetes Health Information

St. John's Mercy Classes and Programs

Diabetes and Heart Disease

Heart and vascular disease often go hand-in-hand with diabetes.

Persons with diabetes are at a much greater risk for heart attacks, strokes, and high blood pressure.

Other vascular problems due to diabetes include poor circulation to the legs and feet. Unfortunately, many of the cardiovascular problems can start early in life and go undetected.

Serious cardiovascular disease can begin before the age of 30 in persons with diabetes. The two most common types of diabetes are type 1 and type 2.

Type 1 diabetes (also called insulin-dependent diabetes mellitus) is an autoimmune disease in which the body's immune system attacks the cells in the pancreas that produce insulin, resulting in no or a low amount of insulin.

Type 2 diabetes (also called non-insulin dependent diabetes mellitus) is the result of the body's inability to make enough, or to properly use, insulin.

According to the American Diabetes Association, damage to the coronary arteries is two to four times more likely in asymptomatic persons with type 1 diabetes than in the general population.

Because symptoms may be absent at first, the American Diabetes Association recommends early diagnosis and treatment, and management of risk factors.

Many studies demonstrate that persons with type 2 diabetes are at increased risk for heart disease.

In fact, one study found that persons with type 2 diabetes without apparent heart problems ran the same risk for heart disease as persons without diabetes who had already suffered one heart attack.

Persons with diabetes often experience changes in the blood vessels that can lead to cardiovascular disease. In persons with diabetes, the linings of the blood vessels may become thicker, making it more difficult for blood to flow through the vessels.

When blood flow is impaired, heart problems or stroke can occur. Blood vessels can also suffer damage elsewhere in the body due to diabetes, leading to eye problems, kidney problems, and poor circulation to the legs and feet.

The following are the most common symptoms of heart disease:

• chest pain
  
• shortness of breath
  
• irregular heartbeat
  
• swollen ankles

The symptoms of heart disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Even when taking proper care of yourself, heart disease may still occur.

Taking care of yourself and controlling your blood sugar can often slow down or prevent the onset of complications.

Other preventive treatment measures may include:

• See a physician regularly.
  
• Have annual electrocardiograms, or EKGs, cholesterol and blood pressure check-ups, and pulse measurement in legs and feet.
  
• Pay attention to your symptoms and report them promptly to your physician.
  
• Control your blood sugar levels.
  
• Control blood pressure levels with lifestyle and diet changes, and/or medication.
  
• Keep low-density lipoprotein (LDL) levels (the "bad" cholesterol) at less than 100 mg/dL.
  
• Control your weight.
  
• Exercise regularly.
  
• Eat a healthy and balanced diet.
  
• Do not smoke.
  
• Limit consumption of alcoholic beverages.

Always consult your physician for the most appropriate treatment plan based on your medical condition.