The majority of people living with diabetes understand that they have an increased risk of cardiovascular disease. But the following statistics show clearly that there is a strong link between heart disease and diabetes.
- As many as 68 percent of people age 65 and older with diabetes die from some form of heart disease. Approximately 16 percent will die of a stroke.
- Adults who have diabetes have twice the chance of developing heart disease as people who don’t have diabetes.
- The American Heart Association considers diabetes to be one of the seven main controllable risk factors for cardiovascular disease.
The link between diabetes and heart disease begins with high blood sugar levels. Over time, the high glucose in the bloodstream injures the arteries, making them become stiff and hard.
The fatty material that builds up on the inside of these blood vessels can obstruct blood flow to the heart or brain and potentially cause a heart attack or stroke. Your risk of heart disease with diabetes is even higher if you also have a family history of cardiovascular disease or stroke.
Diabetes can also affect many major organs in your body, which can lead to an assortment of dangerous complications when left untreated. These medical problems include:
- Cardiovascular disease including peripheral artery disease (PAD) and stroke;
- Kidney disease;
- Harmful cholesterol levels, which can cause atherosclerosis;
- Damage to one’s eyesight;
- Nerve damage and numbness in your extremities which can result in amputation;
- Metabolic syndrome;
Healthy Lifestyle Habits
It’s important to have healthy lifestyle habits that can help you control your diabetes and prevent heart disease.
- Follow a healthy eating plan.
- Physical activity should be a part of your daily routine.
- Stay at or get to a healthy weight.
- Work with your health care team to manage your disease, which may include the use of medications.
- Know your health numbers. – blood pressure and diabetes.
Managing your Diabetes
Understanding your diabetes numbers will reduce your risk for heart disease.
- The A1C test reveals your average blood sugar level over the past three months. High blood sugar levels can damage your heart, blood vessels, kidneys, feet, and eyes.
- High blood pressure makes your heart to work too hard. It can cause a heart attack, stroke and kidney disease.
- There are two types of cholesterol LDL and HDL. LDL is often referred to as the bad cholesterol. It can build up and clog your blood vessels and can trigger a heart attack or stroke. Talk with your health care provider about your cholesterol numbers. Sometimes you may need to take medications to lower your cholesterol and protect your heart.
- Don’t smoke and quit if you do. It is particularly important for people with diabetes since both smoking and diabetes narrow the blood vessels, so your heart has to work even harder.
According to the Centers for Disease Control and Prevention (CDC), 60% of Americans are not meeting the recommended levels of physical activity. Fully 16% of Americans are not active at all. Overall, women tend to be less active than men, and older people are less likely to get regular physical activity than younger individuals.
In a recent article published in Circulation: Journal of the American Heart Association, researchers from the Harvard Medical School released data from the 10-year Women’s Health study that showed moderate exercise reduced the risk of heart disease by 27% to 41%. the study was performed on 27,055 participants.
The mechanism of benefit was shown to be largely due to the reduction of LDL (bad cholesterol), raising HDL (good cholesterol) and reducing inflammation.
It is well-known that inflammation leads to the release of molecules called cytokines that can cause damage to the blood vessels in the heart and throughout the body. Cholesterol tends to deposit at these damaged sites, leading to plaque. the damaged vessels containing increased cholesterol deposits are the sites where platelets attach to blood vessels. These clumps of platelets can break off and completely block the blood vessel as it narrows downstream. In the coronary arteries, this leads to an acute heart attack; in the brain, it causes either a major or a minor stroke.
As little as two hours of brisk walking every week was sufficient to lower the risk of major cardiac events dramatically. Can you imagine that if all you do is walk briskly for 17 minutes daily, your risk of heart disease will go down by 40%? Regular physical activity is defined as about 30 minutes of moderate activity (preferably all days of the week) can reduce the risk of heart disease. One can lower your chances of having a stroke, colon cancer, high blood pressure, diabetes and other medical problems.
If you’re also trying to manage your weight and prevent gradual, unhealthy weight gain, try to get 60 minutes of moderate to vigorous-intensity activity on most days of the week. At the same time, watch your calorie intake. Take in only enough calories to maintain your weight. I often counsel my patients to eat no more than 350 calories a meal four to six times a day. Most of our bodies cannot metabolize more than this amount so large meals that many of us are used to will cause us to store weight and develop fatty tissue.
I often share the following scenario with my patients:
Patient A – Eats two large meals daily of 750 calories each – totalling 1500 calories.
Patient B – Eats five small meals of 300 calories each about 2-3 hours apart – totalling 1500 calories.
Q: Who will lose weight?
A: Patient B
By eating only the calories the body can burn, patient B will likely lose weight coupled with regular physical activity. Unfortunately, Patient A is unable to burn the extra 450 calories they eat at each meal and that totals 900 extra calories daily. 1 pound is about 3500 calories. In about 4 days, a person can gain an unwanted pound of weight eating this way and it can be exacerbated if they are physically inactive.
Another example: A 200 pound person who keeps on eating the same amount of calories, but walks briskly each day for 1.5 miles, will lose about 14 pounds in one year. Staying active will also help to keep the weight off. Second, you can eat fewer calories and be more active. This is the best way to lose weight, since you’re more likely to be successful by combining a healthful, lower-calorie diet with physical activity.
For example, a 200 pound person who consumes 250 fewer calories per day, and begins to walk briskly for 1.5 miles each day will lose about 40 pounds in one year.
As you can see, about 2/3 of weight loss is attributed to diet, but we need physical activity to help us stave off medical problems including heart disease.
Heart disease occurs when the arteries that supply blood to the heart muscle become hardened and narrowed, due to a buildup of plaque on the arteries’ inner walls. Plaque is the accumulation of fat, cholesterol and other substances. As plaque continues to build up in the arteries, blood flow to the heart is reduced. Heart disease can lead to a heart attack. A heart attack happens when a cholesterol-rich plaque bursts and releases its contents into the bloodstream. This causes a blood clot to form over the plaque, totally blocking blood flow through the artery and preventing vital oxygen and nutrients from getting to the heart. A heart attack can cause permanent damage to the heart muscle. Some people aren’t too concerned about heart disease because they think it can be cured with surgery.
This is a myth. Heart disease is a lifelong condition. It’s true that certain procedures can help blood and oxygen flow more easily to the heart. But the arteries remain damaged, which means you are still more likely to have a heart attack. What’s more, the condition of you blood vessels will steadily worsen unless you make changes in your daily habits and control other factors that increase risk.
You have control.
Physical inactivity is one of several major risk factors for heart disease that you can do something about. The others are:
- Smoking. People who smoke are up to six times more likely to suffer a heart attack than non-smokers, and the risk increases with the number of cigarettes smoked each day.
- High Blood Pressure. Also known as hypertension, high blood pressure increases your risk of heart disease, stroke, kidney disease, and congestive heart failure.
- High Blood Cholesterol. High Blood Cholesterol can lead to the buildup of plaque in your arteries, which raises the risk of a heart attack. Starting at age 20, everyone should have their cholesterol levels checked by means of a blood test called a “lipoprotein profile”. You can lower high blood cholesterol by getting regular physical activity, eating less saturated fat and trans fat, and managing your weight. In some cases, medication is also needed.
- Overweight. If you are overweight or obese, you are more likely to develop heart disease even if you have no other risk factors. Ask your doctor to help you determine whether you need to lose weight for your health. The good news: Losing just 5-10% of your current weight will help to lower your risk of heart disease and many other medical disorders.
- Diabetes greatly increases your risk for heart disease, stroke, and other serious diseases. Ask your doctor whether you should be tested for it. Many people at high risk for diabetes can prevent or delay the disease by reducing calories as part of a healthy eating plan, and by becoming more physically active.
Some people should get medical advice before starting, or significantly increasing physical activity. Check with your doctor first if you:
- Are over 40 years old and not used to moderately energetic activity.
- Currently have a heart condition, have developed chest pain within the last month, or have had a heart attack. (Also see the section, “After a Heart Attack”)
- Have a parent or sibling who developed heart disease at an early age.
- Have any other chronic health problem or risk factors for a chronic disease.
- Tend to easily lose your balance or become dizzy.
- Feel extremely breathless after mild exertion.
- Are on any type of medication.
While physical activity can strengthen the heart, some types of activity may worsen existing heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting, extreme breathlessness, or pain or pressure in your upper body. These symptoms may occur during, or just after, an activity. Ignoring these signals and continuing your activity may lead to serious heart problems. Instead, call your doctor right away.
Overall, it is best to get regular comprehensive evaluations to help understand how best to incorporate the right type of exercies in your life to help reduce your risk of heart disease and other illnesses.
Vincent Caracciolo, MD, FACC
First Coast Heart & Vascular Center, PA