Diabetes and Heart Diseases

Heart failure (reduced pump function of heart), coronary artery disease (obstruction of the vessels supplying blood to heart) and peripheral artery diseases (obstruction of vessels supplying blood to extremities and brain) are more commonly observed in diabetic patients rather than non-diabetic patients.

Moreover, risk of mortality and myocardial infarction is similar in healthy subjects with diabetes and other non-diabetic subjects, who has history of myocardial infarction. In this end, diabetes is, now, recognized as equivalent to heart disease. In addition to increased prevalence of heart diseases, diabetes is also leading to onset of heart diseases at earlier age.

Cholesterol is a constituent, which is required for metabolic processes under normal conditions. However, cholesterol adheres to and accumulate in walls of vessels, if patient is hypercholesterolemic. Secondary to this accumulation, lumen of major vessels is narrowed or occluded. Diabetes accelerated this process. Secondarily, coagulation disorders are more frequently seen in diabetic patients, resulting with occlusion of vessels. Hypertension further aggravate vascular damage and occlusion risk in diabetic patients. Presence of particular risks, including but not limited to smoking, overweight and obesity and hypercholesterolemia, further increases risk of above specified conditions.

Patient will feel a chest pain, if occlusion occurs in coronary artery disease, which refers occlusion of vessels supplying blood to heart. The medical term is angina pectoris for this condition. Chest pain is typically triggered by exercise and alleviates with resting. Pain may radiate to back, arm and jaw and sometimes to neck. Patient feels sensation of pressure, and the pain is characterized with compression. In addition, patient may also complain about exercise-induced dyspnea, which is not associated with pain. The pain is, in fact, a sign for heart attack. When such complaints emerge, you should immediately consult your cardiologist. Unfortunately, diabetic patients may not feel the pain, since there is damage in nervous system, which conduct the sensation of pain. Patient may not even notice heart attack. This condition is also known as silent coronary heart disease, which is characterized with absence of symptom. Patients with diabetes require special attention for this condition.

Similarly, pain is felt in legs, while walking and doing exercise, if leg vessels are occluded. Numbness or delayed wound healing can be the case, if the occlusion is severe.

ECG, recording electrical activity of heart, is the first-line modality in diagnosis of coronary artery disease. Treadmill test or scintigraphy can be ordered in the light of exercise capacity and various findings of ECG. If occlusion is found in the light of those tests, patient will have coronary angiography, and treatment will be started. Color Doppler or vascular angiography can be performed, if occlusion of vessels, supplying blood to arm, leg and brain, is investigated. Diagnostic test will be decided according to clinical findings of patient.

Treatment modality will be determined depending on severity of occlusion in coronary artery(ies) and findings of patient. Medical therapy will be selected, if severe occlusion is not found on diagnostic tests. Dose and number of medications should be adjusted according to risk group. Balloon dilatation/stent implantation or bypass surgery are options available, if severe stenosis is found. Patient will be maintained on medication (medical) therapy, after stent is implanted or patient undergoes surgery. Risk of re-occlusion is higher in diabetic patients, even after stent is implanted or patient undergoes surgery. Patient should be very careful especially about relapsed (relapse) of old complaint. You should immediately get in contact with your doctor, if you have any complaint. In addition to heart medications, other risk factors should be also efficiently manages (managed), including but not limited to diabetes, hyperlipidemia and hypertension. Medication (medical) therapies should be adjusted in the light of guidelines, which are updated at regular intervals in the light of scientific data. Although sensational arguments are made about medications via media, scientific data-based guidelines will be more instructive for patient. Therefore, if you have any question about your medication or any other issue, you should better consult your physician. Self discontinuation of medication may lead to irreversible diseases in future. Sedentary lifestyle and unhealthy nutrition have, recently, increased prevalence of diabetes. Patient will need not only medications, but also some lifestyle modifications. These include:

> Consume more vegetable and fruit.

> Limit salt intake.

> Lose weight.

> Do exercise regularly (do exercise for minimum 30 minutes 5 days a week, after you consult your physician)

> Increase your physical activity (ascend stairs rather than taking the elevator, prefer walk for close distances, and getting off the bus one stop before)

> Do not smoke

> Do not drink or drink at very small amount of alcohol

What should a diabetic patient without a heart disease take into account?

They should be very cautious especially for cardiovascular diseases, and they should need cardiac examinations at regular intervals, even if patient has no complaint. Following suggestions can be also made:

1. Monitor your blood glucose level

You can learn whether your diabetes is controlled by having HbA1c analyses at regular intervals. This test indicates mean of quarterly glucose monitoring. Target value is not same for each patient, or in other words, there is inter-patient variability. You should ask your patient your specific target value.

2. Restore your blood glucose level to normal ranges

Make your blood pressure measured at each doctor visit. Measure your blood pressure at home, whenever it is possible, and consult readings with your physician. Your active precipitation will probably increase success of treatment

3. Keep your blood lipid levels controlled

You should have blood lipid levels analyzed minimum once a year. You should ask your physician whether you need medication therapy. Compare recent readings with old blood cholesterol levels, if you are using medications. Thus, you will also monitor efficiency of drug.

4. Increase your physical activity:

Do exercise regularly (do exercise for minimum 30 minutes 5 days a week) after you consult your physician. Increase your physical activity (ascend stairs rather than taking the elevator, prefer walk for close distances, and getting off the bus one stop before)

5. Be careful for healthy nutrition:

Try to consume heart-friendly foods, such as oat, cereals, fruits and vegetables. Be careful to consume meat, butter and whole milk rich in fat and cholesterol as little as possible. You should avoid consuming convenient (convenience) foods and fast-foods, which include trans-fats.

6. Lose weight.

Increase your exercise level, if you are overweight. Under guidance of dietician,

start a nutrition program, which is poor in calorie and fat.

7- Quit smoking

Always remember that each cigarette you smoke implies a further step towards heart failure (disease). If required, ask for professional advice to quit smoking.

8. Use your drugs as advised by your physician.

You should necessarily consult your doctor in case of any side effect. Do not modify dose of drug(s) on your own discretion or as advised by your friends and relatives.

Do you know that

> Diabetes and cardiovascular disease imply an equivalent condition.

> Prevalence of cardiovascular disease is 2 to 4 folds in diabetic patients.

> Risk of cardiovascular disease decreases by 15 percent in response to each one unit decrease in HbA1c level.

> Cardiovascular diseases account for mortality in 65% of patients with diabetes.

> Of all diabetic patients, 17-56% have senile (silent) heart disease.