Diabetes and Heart Disease: A Common Association

Maturity onset Diabetes also called Type II diabetes is a common medical problem seen with an estimated prevalence of 11.4% as per the recent ICMR-INDIAB-17 study published in the Lancet in 2023. The figures are not very different in the population of Jammu and Kashmir. India has an estimated 100 million people formally diagnosed with diabetes, which makes it the second most affected in the world, after China. Furthermore, 700,000 Indians died of diabetes, high blood pressure, kidney disease and other complications of diabetes in 2020.

Diabetes and heart disease: Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. Patients with diabetes face a high risk of heart disease especially a heart attack. Ten years’ risk of getting a heart attack in a patient with uncomplicated diabetes is 20 per cent. “Silent heart attack” is another peculiarity seen in diabetics. This is because of involvement of pain transmitting nerves due to uncontrolled diabetes. These people will not feel many sensations of touch, vibration, heat, cold or pain, and this may also include the expected pain of a heart attack. Diabetics are often complicated by associations like high blood pressure (Hypertension), high cholesterol and triglyceride levels

High blood pressure (Hypertension)

Hypertension is a major risk factor for heart disease and stroke. Studies have shown a link between high blood pressure and insulin resistance a common cause of diabetes. When people have both hypertension and diabetes, which is a common combination, their risk for cardio-vascular disease increases even more.

Abnormal cholesterol and high triglycerides

People with diabetes often have unhealthy cholesterol levels including high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol and high triglycerides. This often occurs in people who get heart attacks at younger ages. It’s also typical of a lipid disorder linked with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in people with diabetes.

Obesity
Obesity is a major risk factor for CVD and has been strongly linked with insulin resistance. Losing weight can improve CVD risk, decrease insulin concentration and increase insulin sensitivity. Obesity and insulin resistance also have been linked to other risk factors, including high blood pressure.

Sedentary Life Style

Physical inactivity and lack of exercise is another modifiable risk factor for insulin resistance and CVD. Exercising and losing weight can prevent or delay the onset of Type 2 diabetes, reduce blood pressure and help reduce the risk for heart attack and stroke. Any type of moderate to vigorous physical activity is beneficial, such as sports, house work, gardening or work-related physical activity. A minimum of 8000 steps per day at least 5 days a week is also a recommendation.

Poor control of blood sugar (out of range)
Diabetes can cause blood sugar to rise to dangerous levels which are toxic to the blood vessels and the heart.

Smoking
Smoking puts people at higher risk for heart disease and stroke, whether they have diabetes or not. Diabetics who are already more prone to heart attacks get even more vulnerable.

People with diabetes and even pre-diabetes (a term used for the population whose blood sugar is high but not high enough to be Type 2 diabetes. It is diagnosed when the Hb A1c is between 5.7 -6.4 %) and one or more of the risk factors enumerated above are at even greater risk of heart disease or stroke. People with diabetes may avoid or delay heart and blood vessel disease by managing their risk factors. Your treating physician needs to do periodic testing to assess whether you have developed any of these risk factors for CVD.

An early diagnosis and effective treatment of diabetes and its associations like hypertension, high bad cholesterol and obesity goes a long way in preventing heart attacks, strokes, chronic kidney disease and heart failure which can be present even without a heart attack by damaging the heart muscle by several indirect methods.

“A stitch in time saves nine”.

The author is Founder Director Gauri Kaul Foundation