Diabetes and Your Heart

There are approximately 2 million people in the UK diagnosed with diabetes, plus a further 750,000 still undiagnosed. Current trends suggest that by 2010 these figures will double.

Statistically, if you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke. This means that 80% of diabetics will develop heart disease, and, due to their condition, are less likely to suffer any symptoms until the condition has worsened.

That’s why it is so important for diabetics to regularly monitor the rhythms of their own heart so that appropriate action can be taken quickly!

Heart conditions are by far the most dangerous complications associated with diabetes but their risk can often be reduced. Diabetes is a disorder in the body's ability to break down glucose (blood sugar). It is one of the four major risk factors – along with high blood pressure, smoking and abnormal cholesterol levels – for heart attack.

Diabetes and the heart

The heart is a muscular pump that transports blood throughout the body. Together, the heart and blood vessels compose the cardiovascular system. In general terms, the risk of disorders affecting the heart and cardiovascular system increases with age.

This process, which naturally involves the buildup of plaque (atherosclerosis) within artery walls, occurs at a faster rate in diabetics. High levels of glucose (blood sugar) damage the arteries, making them lose their elasticity and causing them to narrow. As a result, blood pressure increases, placing further strain on blood vessels and organs throughout the body.

Increased Risks

Diabetes increases the risk of developing blood vessel disease throughout the body. Typically, blood vessel disease involves damage or weakening of the blood vessel walls, which can make them vulnerable to a buildup of plaque. When this buildup occurs within the coronary arteries, which feed the heart muscle, the condition is called coronary artery disease (CAD).

Diabetics are two to four times more likely to develop CAD than non-diabetics. Furthermore, the type of plaque that develops in people with diabetes may be more dangerous.

Plaque is a mixture of fats (called lipids) and other substances covered by a calcified cap. In diabetics, this cap is thin and vulnerable to rupture by the rushing blood, particularly if they have high blood pressure. If this cap is shorn off, the fatty core within is exposed to the bloodstream, which can cause it to clot over again and further obstruct the blood vessel. In addition, pieces of plaque can travel to other vulnerable arteries, blocking them as well.

A heart attack occurs when a coronary artery becomes blocked and heart tissue dies from lack of blood. Depending on the severity of the attack, the heart muscle may become seriously weakened (a condition called cardiomyopathy) and may eventually begin to fail, a condition called heart failure.

Heart and cardiovascular diseases are the primary cause of premature death in diabetics. Statistically at least 65 percent of people with diabetes die from heart disease or stroke. The impact of diabetes on the heart has been compared to surviving a first heart attack among non-diabetics, because the risk of a second, possibly fatal, heart attack is that much greater.

These risks exist for people with either Type 1 or Type 2 diabetes. However, many of the risk factors for developing Type 2 diabetes and related complications (e.g., obesity, high blood pressure and high cholesterol) are also the same for heart disease. Although Type 1 diabetes cannot be prevented, sufferers who have elevated glucose levels but not yet Type 2 diabetes may be able to prevent or delay diabetes as well as heart disease.

Types and differences of heart conditions

Coronary artery disease (CAD) is the most common type of heart condition, and it can impede blood flow to the heart muscle. Inadequate blood flow can cause a number of conditions, including:

Angina. A type of temporary chest pain, pressure or discomfort that occurs when the heart is not getting enough oxygen.
Heart attack. Occurs when vessel blockages reduce or stop blood flow to the heart. The affected area stops working, thus weakening the heart. People with diabetes tend to have heart attacks that are more severe and occur earlier in life than non-diabetics.
Heart failure. Over time, the heart may begin to struggle to supply the body with the blood it requires. Heart failure is a term used when the heart cannot meet the body's needs. It is a chronic disease that is the result of other heart-related conditions, such as high blood pressure and cardiomyopathy (weakened heart muscle). Among women with coronary heart disease, diabetes has been shown to be the strongest risk factor for heart failure.

High blood pressure is often referred to as a heart condition but it is actually a cardiovascular condition and is prevalent among diabetics. It occurs when the force of blood against artery walls becomes excessive, which can affect entire body. In the heart, it is both a cause and a consequence of a buildup of plaque (atherosclerosis) within artery walls.

Blood vessel disease, such as diabetic angiopathy, can occur in other areas of the body. When it occurs in the peripheral arteries, the condition is called peripheral arterial disease (PAD). Diabetes and smoking are particularly strong risk factors for PAD.

Symptoms and diagnosis of heart conditions

Heart conditions related to diabetes can cause a number of symptoms. These include:

Chest pain due to reduced blood flow (angina)
Shortness of breath
Dizziness
Sudden loss of vision
Slurred speech
Numbness or weakness in arms and legs
Pain or cramping in buttocks, thighs or calves during exertion
Swollen ankles
Abnormal heartbeat

A physician is likely to assess the medical history and perform a medical examination when diagnosing heart conditions. If a heart condition is suspected, they may perform additional tests such as an ECG (electrocardiogram).

Treatment options for heart conditions

In some cases, the risk of heart ailments related to diabetes can be significantly reduced through lifestyle modifications including:

Taking regular exercise
Eating a healthy diet
Quitting smoking
Losing weight
Avoiding excessive alcohol consumption

For many people with diabetes, lifestyle modifications alone are not enough to reduce the risk of heart conditions. There are many medications used to treat heart conditions related to diabetes, including:

Aspirin. It is generally recommended by health professionals that daily intake of low-dose aspirin is useful for diabetes that are at high risk for cardiovascular disease. However, some diabetics, such as those with stomach problems, may not be able to take aspirin and they should always consult their physician about the benefits and risks associated with aspirin medication.
Alpha blockers. These work by reducing the workload of the heart. They are often prescribed as initial treatments for diabetics, and may have the added benefit of positively affecting cholesterol levels.
Vasodilators. These work by expanding or widening blood vessels, thus reducing blood pressure. This allows blood to flow more freely and the heart to pump more efficiently.
Diuretics. These work by promoting the formation of urine in the kidneys, causing the body to flush out fluids and minerals including sodium.
Medications that lower the levels of fats (lipids) in the blood, which include cholesterol.
Other oral medications prescribed for people with Type 2 diabetes have recently been found to have heart benefits such as protection against heart attack and stroke.

In some instances, lifestyle modifications along with medication still may not adequately treat heart conditions related to diabetes, in which case surgical procedures to open or bypass blocked blood vessels may be necessary.

Prevention methods for heart conditions

The good news is that diabetics can take many steps to decrease the likelihood of developing heart conditions. The most important measures include controlling glucose (blood sugar), blood pressure and cholesterol levels.

Keeping these factors within healthy ranges can dramatically lower the risk of developing diabetes-related heart conditions. It is widely recommended that the following readings should be worked towards for diabetics:

Glucose measurement (Hemoglobin A1C level): Less than 7 percent
Blood pressure: Less than 130/80 millimeters of mercury (mm/Hg)
LDL (“bad”) cholesterol: Less than 100 milligrams per deciliter (mg/dL)

Maintaining healthy levels of these factors also reduces the risk of other common diabetic complications, such as diseases affecting the kidneys and eyes. For example, for every 1 percent reduction in glucose, the risk for complications within smaller blood vessels, such as capillaries, decreases by 37 percent. For every 10 mm/Hg reduction in blood pressure, diabetes–related deaths decrease by 15 percent.

Other steps that can be taken include:

Scheduling regular checkups. Heart conditions can usually be treated far more effectively when they are caught early.
Losing excess weight. Those who are overweight should shed pounds to reduce stress on the heart, lower blood pressure and LDL (“bad”) cholesterol levels.
Regular physical exercise can help people lose weight, improve glucose control, and improve cholesterol levels.
Eating healthy and nutritious meals is essential to preventing heart conditions. A dietician specialising in diabetes can help develop a lifetime eating plan that will work for them.
Quitting smoking. Smoking doubles the risk of cardiovascular disease for diabetics.
Taking medications as prescribed by a physician.

Questions for diabetics to ask their doctor

Preparing questions in advance can help diabetics to have more meaningful discussions with their doctors regarding their conditions. Such questions may include the following:

What condition are my heart and blood vessels in?
Do I need any tests to determine my cardiovascular fitness? If so, what will these tests involve?
Do I have any cardiovascular problems? If not, what is my risk of developing them?
How can I reduce my risk?
What types of exercise should I do?
Where should my cholesterol and glucose levels be?
What is the difference between the types of cholesterol?
What are the good fats and oils to eat and the bad fats to avoid?
Do I need any cardiovascular treatments in addition to improvements in diet and exercise?
Can any diabetes drugs benefit my heart?
How do I know if a chest pain is angina?
When should I seek medical help if I feel chest pain, dizziness, slurred speech or other possible symptoms of a cardiovascular problem?

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