Diabetes can harm your heart

Type 2 diabetes mellitus is associated with a marked increase in the risk of atherosclerotic disease, including coronary artery disease (CAD) or narrowing of arteries supplying blood to the heart leading to heart attacks, peripheral arterial disease leading to amputations and cerebrovascular disease leading to stroke. Not surprisingly, diabetes is now considered a cardiovascular risk equivalent. Type 2 diabetes is associated with a two to three-fold higher risk of CAD compared to non-diabetics and they occur at a younger age too.

The diabetes risk factor
In diabetic patients, there is a deficiency either in the production of insulin or in its action, which affects the body’s ability to utilise blood sugar. Excess blood sugar gets converted to fat, leading to increased fat levels in the blood, enhancing the risk of thickening of arteries. Consequently the blood vessels to the heart get blocked by these deposits also called plaques, which reduce blood supply to the heart. The sudden rupture of the plaque leads to a heart attack.

Symptoms
Symptoms which invariably occur, if one develops a heart attack include chest pain, pain in the arms, back, jaw, or neck, indigestion, shortness of breath, sweating, nausea and light-headedness. However, in diabetic individuals, heart disease can present itself without any symptoms. Some patients show evidence of a recent heart attack only when they go for a regular diabetes check-up and an ECG. This is called ‘silent ischemia’ or a ‘silent heart attack’. The lack of symptoms may give a false sense of good health until more serious complications set in.

Added risk factors
Diabetes itself is a risk factor for heart disease. Many people with diabetes have other conditions that increase their chance of developing heart disease and stroke-like physical inactivity, obesity, smoking, stress, increased low-density cholesterol, decreased high-density lipoprotein (HDL) levels, high triglyceride levels, high blood pressure, family history of heart disease etc. These are common preventable risk factors for both diabetes and heart disease, which if corrected, can not only help prevent heart attacks but can prevent diabetes itself.

Precautions
The first step is to detect diabetes early. Unfortunately, nearly half of those with diabetes in India are not even aware of it. Diabetic individuals can take steps to lower their risk of heart disease and stroke by emphasising the “ABCs” where, A stands for A1C or haemoglobin A1C test, which measures average blood glucose over the past three months, B for Blood pressure and C for Cholesterol.
Prevention of diabetes and heart disease is a societal problem. The emphasis should be on changes in lifestyle — stressing optimal caloric intake, increasing physical activity, weight reduction and cessation of smoking. Individuals who have an increased waist measurement are also at a very high risk of developing diabetes and heart disease. The bottom line for prevention is to follow a diabetes-free, heart-healthy lifestyle.

— The writer is chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai and Hyderabad.

Commandments
* Detect diabetes early and control blood sugars well.
* Healthy diet — decrease fat, sugar and calorie intake.
* Exercise regularly.
* Maintain ideal body weight.
* Keep blood pressure under control.
* Lower blood lipid levels aggressively.
* Quit smoking or use of tobacco in any form.
* Use alcohol, if at all, only in moderation.
* Take prescribed medications regularly.
* Reduce stress through relaxation techniques.