Diabetes and heart disease are closely related. Before discussing the heart problems in diabetes we will see what is diabetes mellitus. Diabetes mellitus is basically persistent elevation of blood sugar level due to inability to produce sufficient insulin or failure to respond appropriately to insulin. International guidelines define diabetes as fasting plasma glucose ≥ 126mg/dL or nonfasting plasma glucose ≥ 200mg/dL, or glycosylated hemoglobin ≥ 6.5%. Diabetes affects more than 200 million persons worldwide and by 2030 this figure will rise to >400 million persons.

HEART DISEASE IN DIABETES

Cardiovascular disease (CVD) remains the principal cause of suffering and death in diabetes. Diabetes causes widespread disease in heart and blood vessels like

1. Coronary artery disease- involvement of blood vessels of heart

2. Carebrovascular disease- involves the blood vessels of brain causing stroke

3. Peripheral vascular disease – involves blood vessels of limbs and aorta , may lead to loss of limbs

4. Heart failure

Coronary artery disease in diabetes:

Diabetes increases the risk of coronary artery disease manifold increasing the risk of having myocardial infarction (heart attack) and angina (chest pain). The level of increasing blood sugar directly influences the development and progression of CAD. Currently CAD is the principal cause of mortality in diabetes. People with diabetes are more likely to have severe coronary artery disease like involvement of multiple coronary arteries.

Heart failure in diabetes:

The most common causes of heart failure are coronary artery disease and hypertension which go hand in hand with diabetes. Presence of diabetes increases the risk of heart failure by 3 to 5 times and also worsens the outcome of treatment

WHAT TO DO?

Reading all these things are frightening but don’t worry there are ways to counter these problems

PREVENTING HEART DISEASE IN DIABETES

The risk of heart disease in diabetes is reduced significantly by the following measures

1. Strict control of blood sugar:

The first and foremost aspect of preventing heart disease in diabetes is control of blood sugar. Proper control is blood sugar reduces the risk of Heart disease

2. Strict control of BP:

Hypertension is present in ~70% of individuals with diabetes. Hypertension increases heart disease in diabetes. So strict control of blood pressure is mandatory. Many antihypertensives like ACE inhibitors ( ramipril, enalaprol) and ARB (losartan, telmisartan) have cardio protective and kidney protective action.

3. Treatment of coronary artery disease by medication , cardiac intervention / surgery reduces morbidity and mortality risk

4. Life style modifications like

– Cessation of smoking

– Regular brisk walking for > 40 minutes per day atleast five days in a week

– Restricting salt intake , fatty foods and increasing consumption of vegetables and fruits  reduce the risk of heart disease

You can find out about the cardiovascular effects of drugs used in diabetes under the ” medications” menu

Information about choosing between percutaneous cardiac intervention vs surgery is available under ” intervention” menu.

Thank you.

Dr. S. N. Panda