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How diabetes is linked to heart health

Diabetes is a chronic metabolic disease that occurs when blood sugar can’t be regulated; this is either because the pancreas doesn’t produce enough insulin (type 1 diabetes) or because the body can’t effectively use the insulin it produces (type 2 diabetes). Yet, while diabetes can be life threatening if it’s not treated properly, the greatest threat to a diabetic patient is actually the risk of heart disease, since the two conditions tend to go hand in hand.

“Around 75 to 80 percent of all deaths in diabetic patients are related to cardiovascular disease (CVD),” says DR RAMASAMI NANDAKUMAR (known as Dr Kumar to his patients), cardiologist at Arden Cardio-Metabolic Clinic H2H.

In fact, it’s the main cause of death in both types of diabetes, with the risk being slightly higher for women.

Dr Kumar says 30 to 40 percent of his patients with heart disease who have been referred to him for coronary angiograms (a test to look at the blood vessels in the heart) tend to have diabetes. This is because high blood glucose in diabetics, or even pre-diabetics, can damage the blood vessels, which, in turn, damages the heart.

Unsurprisingly, diabetics tend to develop heart disease at a younger age and have more severe cases, as progression is faster, explains Dr Kumar.

But, if diabetes is a controllable risk factor for cardiovascular disease, why are so many diabetics dying from CVD?

Even if blood glucose is under control, someone with diabetes likely has other conditions that contribute to their risk of CVD such as high blood pressure and high cholesterol, which can both lead to heart blockage, the doctor says.

Are you at risk?

Even if you haven’t been diagnosed with diabetes or heart disease, you could be on the threshold of “the big two”, according to Dr Kumar. If you’ve got excess body fat around the waist, in combination with two other risk factors such as elevated blood pressure, high cholesterol, high glucose, excess body weight or an increased BMI (body

mass index), you may have what’s known as metabolic syndrome. This is a cluster of conditions that occur together, increasing your chances of CVD and type 2 diabetes, as well as stroke.

“Metabolic syndrome is part of the continuum that stretches long before the diagnosis of diabetes and heart disease is made. It can be present in up to 25 percent of adults – this rises with age – and comprises a constellation of risk factors including central obesity, which is defined by waist circumference,” he says. “Those with metabolic syndrome are twice as likely to have heart disease and five times more likely to develop or have diabetes than those people without metabolic syndrome.”

Screening

So, should screening be done for diabetes and heart disease at the same time?

“Ideally, yes,” says Dr Kumar, “because by the time diabetes has been diagnosed, most patients would have been in the pre-diabetic stage for quite some time (or even diabetic already). In general, once they’ve been exposed to the higher glucose conditions for a few years, the heart damage has started, though the rate of progression can vary.”

It’s for this reason that Dr Kumar offers assessments for both diabetes and heart disease in one clinic, thus bridging the gap between the interrelated conditions. This integrated approach, he says, means a holistic treatment plan can be put into action, together with the clinic’s endocrinologist, if necessary.

Even if patients don’t present any symptoms, it’s certainly worth getting checked – particularly people who have had diabetes for more than five years. “We tend to do an extended and comprehensive cardiac examination and blood profile, as the disease is more aggressive. We don’t rely on the development of symptoms, as the classic ‘chest pain on exertion’ symptom isn’t always present in many patients. Most will have minimal or no symptoms and may present more often with breathlessness, vague discomfort or palpitations.”

In general, Dr Kumar says simple screening tests like bodyweight, blood pressure and waist circumference should be taken during routine medical appointments from the age of 20. He also advises having a cholesterol test every five years from the age of 18, just to be safe.

Other preventative steps

Regardless of your risk factors, it’s always important to adopt healthier lifestyle behaviours, says Dr Kumar. These include increasing physical activity, reducing stress, getting more sleep, eating a healthier diet, reducing weight and waist circumference, and controlling blood pressure and cholesterol levels. Avoiding tobacco is also key to reducing your chances of CVD and diabetes.

If you already have diabetes, Dr Kumar says you can protect your heart by managing your blood glucose, also called blood sugar. It’s especially vital to make sure your HbA1C (a form of haemoglobin found in glucose) is close to or below 6.5.

Arden Cardio-Metabolic Clinic H2H, #05-31 Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road 6262 3616 | h2h.com.sg

The classic ‘chest pain on exertion’ symptom isn’t always present in patients