Diabetes is on the rise globally. While many individuals may not realize it, having type 2 diabetes mellitus (DM) is accompanied by an increased risk of cardiovascular disorders.
Recent research has shown an up to four-fold higher risk of heart disease among individuals with type 2 DM compared to the general non-diabetic population, since diabetes can damage the blood vasculature and increase the stiffness of the heart, potentially leading to fluid retention and/or cardiovascular failure.
In addition, diabetics also have an increased risk of developing premature (and accelerated) coronary artery disease (CAD), which means that the coronary arterial walls of diabetics have higher fat deposition and harden (referred to as atherosclerosis) earlier among diabetics often without warning signs (commonly referred to as ‘silent heart attacks’), making diagnosis and treatment difficult and presentation of the patient to healthcare professionals at advanced stages of the disease.
The build-up of cholesterol and atherosclerotic plaques in blood vessels responsible for providing nutrition and oxygen to the heart leads to atherosclerosis causing narrowing of blood vessels and reduced blood flow, which could lead to serious complications. Reduced blood flow to the heart could cause heart attacks and reduced blood flow to the brain could lead to stroke.
People with type 2 diabetes have a higher risk of recurring myocardial infarction (heart attack) and scarring of the cardiovascular (heart) musculature, increasing the risk of sudden heart failure (and death). Furthermore, due to neural (nerve) damage by diabetes, patients may not even feel pain/discomfort in the chest which may be indicative of a potential pathological change within the heart, and so cardiovascular diseases may be neglected by patients in the initial stages.
Hypertension (high blood pressure) increases the force of blood through the arteries and therefore, could potentially damage arterial walls. Having both diabetes and hypertension could greatly elevate the risk for cardiovascular disorders due to their synergistic effects.
Elevated low-density lipoprotein (LDL) (commonly referred to bad cholesterol) in the blood could form atherosclerotic plaques on damaged walls of arteries. Elevated triglycerides (TGs, a type of fat) and reduced high-density lipoprotein (HDL) (commonly referred to as good cholesterol) could contribute to the hardening of arteries.
Ongoing research has shown that weight loss could reverse diabetes in a few patients and that good blood pressure (BP) control with medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) could decrease the risk of diabetic complications. This is especially important for patients with comorbidities along with diabetes and for those who already have diabetic complications.
Positive lifestyle habits, including smoking cessation, weight management, regular exercise, a balanced diet, and blood pressure management, all could contribute to improved diabetes control and cardiovascular health. Working on such cardiovascular risk factors and enhanced self-care could substantially improve the quality of life of diabetics and prolong their lives by a mean of 8 years.
Cardiac imaging modalities such as electrocardiograms (ECG), advanced echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance imaging (MRI) coupled with artificial intelligence (AI) and treadmill exercise stress test/treadmill test bring the hope of detecting cardiovascular abnormalities by healthcare professionals in the initial stages and thereby preventing serious consequences.
Tips for a healthy heart
- Follow a healthy and balanced diet: Consume more fresh fruits and vegetables, whole grains, and lean protein. Restrict consumption of processed foods (such as sweets, fast food, and chips,) and avoid trans fats. Drink more water and limit alcohol consumption.
- Weight management: If you are obese, losing even a modest amount of body weight (5% to 7% of body weight) could reduce blood sugars and triglycerides.
- Stay active. Being physically active increases the sensitivity of body cells to the insulin hormone (the hormone that regulates blood sugars), which helps manage diabetes. A minimum of 150 minutes every week of moderate-intensity exercise such as brisk walking is recommended.
Manage the ABCs:
- A: Get a regular HbA1C test to measure the average blood sugar level in the previous three months and aim to obtain good results.
- B: Try to maintain your blood pressure (BP) under 140/90 mm Hg.
- C: Manage and regularly monitor blood cholesterol levels.
- s: Stop (or don’t start) smoking.
Stress management: Stress could elevate blood pressure and potentially lead to unhealthy practices such as alcohol abuse or binge eating. Instead, try meditation, deep breathing, physical activity, or get support from family, friends, and/or healthcare providers.