You do everything you can to manage diabetes: you check your blood sugar, take medication as directed, visit your doctor regularly, take good care of your feet, eat right, and exercise. But have you discussed your heart health with your physician recently?
Diabetes is a risk factor for heart disease, and in combination the two can increase the likelihood of heart attack, stroke, and circulation problems affecting your kidneys, eyes, and feet. When considering your risk of heart disease, long-term diabetes is practically equivalent to having heart disease. This is because adults with diabetes are at a similar risk of having a heart attack within the next five years as someone who has already had a heart attack. According to the American Diabetes Association, death rates from heart disease are about two to four times higher in adults with diabetes. The risk of stroke is similarly higher in people with diabetes.
Read on to learn more about the relationship between diabetes and heart disease, including how you can improve your heart health, identify important symptoms, and evaluate treatment options.
The Link Between Diabetes and Cardiovascular Disease
When we talk about heart disease, we are really talking about a disease process that extends beyond your heart and takes place throughout the blood vessels of your cardiovascular system. These blood vessels supply your heart, brain, and other organs and tissues with oxygen-rich blood. If you have diabetes, high levels of blood sugar (glucose) can damage these blood vessels throughout the body over time. When the lining of blood vessels becomes damaged, plaque—a substance made up of fat, cholesterol, and other materials—can begin to build up in the blood vessel walls. This is what is called atherosclerosis, or “hardening of the arteries.” Plaque build-up can ultimately cause a heart attack or stroke, or it can reduce blood flow to the extremities (peripheral artery disease) or kidneys (renal artery disease).
Glucose alone does not account for all of the damage to blood vessels. People with diabetes also have low levels of inflammation that can damage blood vessel walls. Additionally, blood clots form more easily in people with diabetes, raising the risk of heart attack or stroke.
What Does Having Diabetes Mean for Diagnosis and Treatment of Cardiovascular Disease?
Heart disease can be symptomless, and diabetes can mask some symptoms. For example, nerve damage from diabetes can make it less likely that you will experience chest pain during a heart attack. Instead, someone with diabetes who is having a heart attack may experience chest pressure, shortness of breath, sweating, or a sudden change in glucose levels. Because of this, it is important that you have your physician evaluate you for cardiovascular disease. This evaluation may include the following tests, among others, in conjunction with consideration of your individual and family medical history:
- Blood tests to measure cholesterol, blood glucose, inflammation and other factors
- Diagnostic tests such as a treadmill stress test to gauge blood flow to the heart, imaging tests to look for blockages in arteries (large blood vessels), or a simple blood pressure cuff test called the ankle-brachial index (ABI) to check for reduced blood flow to the legs
Depending on test results, treatment may consist of a combination of several options:
- Lifestyle changes to improve diet, increase exercise, and quit smoking
- Medicationadjustments or the addition of new medications
- An interventional procedureto reopen blockages in a blood vessel by inserting a thin tube called a catheter into an artery (large blood vessel) and feeding it to the site of the blockage where a tiny balloon can be opened to push the blockage aside
- Surgery to remove blockages in the arteries that supply the brain with blood or bypass surgery to reroute blood around blockages in the arteries that supply the heart or legs with blood
New Research on Treating Severe Heart Disease in People with Diabetes
A recent study offered helpful information about treating severe heart disease – blockages in three or more heart arteries – in people who also have diabetes. Study participants received either coronary bypass graft surgery (open-heart surgery) or an interventional procedure with an angioplasty balloon to reopen an artery and place a tiny metal cage called a stent to permanently prop the artery open.
The patients with diabetes and multiple, severe blockages who had bypass surgery were less likely to die or have another nonfatal heart attack within five years. However, these patients were somewhat more likely to have a stroke.
This new research can help influence treatment decisions made by cardiologists and other healthcare providers.
Questions to Ask Your Doctor About Diabetes and Your Heart Health
- How high is my risk for cardiovascular disease, based on diabetes and my other risk factors?
- What risk factors do I have (high blood pressure, cholesterol, obesity, etc.), and how can I reduce my risk?
- What dietary choices should I be making to manage both diabetes and my cardiovascular health?
- What level of exercise is safe for me and will also have cardiovascular benefits?
- Are there lab tests or diagnostic tests that you would recommend based on my risk factors?
Questions to Ask If You Have Been Diagnosed with Cardiovascular Disease and Diabetes
- Which medical professionals should I be seeing and how often?
- What are my treatment options? What combination of lifestyle, medication, and in-hospital treatments/surgery may be necessary to combat cardiovascular disease and diabetes?
- Do any blood vessels to my heart have serious blockages? If so, how many? Am I a better candidate for bypass surgery or for angioplasty and stenting?
- What is my prognosis? What are the likely outcomes?
- Will I be able to have my desired quality of life? What can I do to improve the odds of this?
What Should I Do If I Have More Questions?
Ask them. Remember that though the risks are substantially higher that someone with diabetes will also have heart disease, each individual is different. The key is to establish with your physician what your baseline cardiovascular health is now. Then, periodically ask your physician, "Have we checked my heart health recently?" Identifying and treating cardiovascular disease sooner rather than later will increase the odds of being able to work with your physician to slow or reverse the disease process.
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