Dr Sujeet Jha, Director - Endocrinology, Diabetes & Obesity, Max Super Specialty Hospital | Updated: May 23, 2017 16:27 IST
diabetes in the country, India is the diabetic capital of the world. Diabetes mellitus is a chronic condition that can lead to complications over time. These complications can include coronary heart disease which may lead to a heart attack, cerebro-vascular disease which may lead to stroke, retinopathy (disease of the eye) which may cause blindness, nephropathy (disease of the kidney) that can lead to kidney failure and frequent need for dialysis, and neuropathy (disease of the nerves) which can lead to ulceration of the foot that might require amputation. Many of these complications produce no symptoms in the early stages, and most can be prevented or minimised with a combination of regular medical care and blood sugar monitoring.
Heart disease, particularly coronary heart disease (CHD) is a major complication of patients with Diabetes Mellitus. A large number of the patients may not even know that they have a heart disease – a condition called silent emyocardial ischmia. Also, Type 2 Diabetes is considered to be an equivalent to coronary artery diseases as its adverse effects are as bad as of heart diseases. One of the largest studies for heart, The Framingham Heart Study, states that the presence of diabetes increases the risk of heart disease twice in men and thrice in women.Diabetes remains a major cardiovascular risk factor even when compared to factors like advancing age, hypertension, smoking, hypercholesterolemia, and enlarged heart. This is because patients suffering from Diabetes have significantly higher incidence of complex blockages in the vessel, which makes them vulnerable to cardiac risks.
What are diabetes-induced complications that make people vulnerable to heart disease?
A person suffering from diabetes needs to manage his/her blood sugar and lipids in order to control the risk of heart disease. Here are some tips-
- High levels of sugar in vessels and elevated blood glucose: Sugar tends to damage the inner lining of vessels and makes the blood thicker, which in turn makes patients more prone to heart disease or stroke.
- Abdominal Obesity: Excessive fat build-up around the stomach area can lead to cardiovascular disease risk factors such as high blood pressure and diabetes. It also can harm the heart muscle more directly.
- Uncontrolled Blood Pressure: Left uncontrolled or undetected blood pressure can lead to heart attack or stroke. It can also lead to the thickening of the arteries, creating high risk of cardiovascular complications in the long term.
- Dyslipidemia: Dyslipidemia refers to rise of plasma cholesterol, triglycerides (TGs), or both.Patients with an extensive family history of heart disease need to be screened by measuring their lipid levels for any abnormality.
- Smoking: Smoking damages the lining of your arteries. Thus, should be avoided.
- Micro Albuminuria: It is an earlier sign of vascular damage. It is referred to as a small or moderate increase of albumin xceretion in the urine.
Diabetes, the Silent Killer
Diabetes also tends to affect the nerves. Some diabetic patients have a blunted appreciation of pain due to heart diseases (ischemic pain), which may result in unusual symptoms and sometime no symptoms at all. A large number of studies have shown that almost 40% of patients with no symptoms but long standing diabetes have significant heart disease on Coronary Angiogram (a dye test for heart vessels).
Most patients who have unexplained sweating or even upper abdomen discomfort must meet their doctor and get the ECG done and should not let it pass as just “gastric symptoms”.
In the West, the incidence of cardiovascular disease has declined substantially over the last 50 years, however in India, masses have not yet focused on prevention of heart complications occurring due to diabetes. Also, the patients who have had poor control at the time of detection of heart problems like heart attacks or angina should not have sudden strict control, as this may increase the risk of heart related problem. You are advised to consult your Physician or Endocrinologist if you have already suffered heart disease.
How Can We Prevent Diabetes?
- Quit smoking: Lifestyles changes are most important. One needs to quit smoking. It is the single most important aspect in preventing heart disease for patients with diabetes.
- Regular exercise is recommended: It is important to identify which type of exercises should be done. It is well-proven that starting aggressive exercises suddenly for someone who has been sedentary for long can provoke heart attacks.
- Hypertension (High Blood pressure) must be controlled: With lifestyle modifications or medication(s), it can be controlled. A large number of blood pressure medicines are available but a certain class of drugs has more beneficial effect in patients with diabetes. Contact your endocrinologist for the same.
- Bad Cholesterol makes you more prone to heart problem: Blood fat (cholesterol) is at times abnormal in patients with diabetes. It is very important to have a blood test done to measure cholesterol and triglyceride levels (fasting lipid profile), and modify the diets if needed.
Heart disease, particularly coronary heart disease (CHD) is a major complication of patients with diabetes mellitus. Blood sugars levels if maintained close to normal ranges in patients with diabetes can help prevent long-term complications. Additional steps like lifestyle changes (from exercising regularly to quitting smoking), monitoring and controlling blood pressure through various means will help prevent heart disease in high risk individuals.
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With an estimated 50 million people suffering from