Here’s How Diabetes Can Affect Your Heart (And What You Can Do To Protect It)

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During a conversation with friends or family members, you may have heard about someone with diabetes who suffered a heart attack. In fact, many people who hear such news seek medical attention immediately to get their heart and sugar levels tested.

Diabetes is highly prevalent in India, with over 65 million people suffering from this condition. The number is steadily rising, and it should come as no surprise that India is now the world’s capital when it comes to diabetes.

The problem with diabetes is not just limited to high sugar levels. Diabetes can also affect many vital organs, one of which is the heart.

In this article, we will take a look at how diabetes affects your heart. But first, let’s quickly look at diabetes in brief.

What is Diabetes?

Diabetes is a clinical condition where the level of glucose (sometimes referred to as sugar) in the blood is elevated.  It is a genetically inherited condition where the pancreas fails to produce sufficient amount of insulin to control blood glucose levels. It also occurs when the tissues of the body stop responding to the insulin being produced by the pancreas.

There are 2 types of diabetes – type 1 and type 2. In type 1 diabetes, the pancreas does not produce insulin. It is commonly seen in children.

In type 2 diabetes, the cells and tissues in the body do not respond to insulin. In other words, the body is resistant to the effects of insulin. This is called insulin resistance, and this is the basic underlying process that leads to all the complications of diabetes. Type 2 diabetes is commonly seen in adults.

How Does Diabetes Affect the Heart?

Heart-ProblemsHere, we will deal with type 2 diabetes alone.

Diabetes is notorious in causing complications that affect the heart, kidney, eyes and brain. This is because the high blood sugar levels damage the single layer of cells that line the blood vessels called endothelial cells. Endothelial cells are protective cells that release certain chemicals that prevent clogging up of arteries by fat and cholesterol. In addition, these chemicals also keep the arteries wide and patent, allowing extra blood flow to the vital organs in times of need.

The vessels that supply blood to the heart (i.e. heart arteries) are lined by endothelial cells. These cells are damaged by the high levels of blood glucose in diabetes. This triggers a series of reactions that leads to deposition of fat and smooth muscle tissues along with platelets (blood cells that help clotting) onto these damaged areas. This phenomenon is called atherosclerosis.

Atherosclerosis begins at a very young age in all of us, and progresses at a gradual rate as we get older. However, in diabetes, the high glucose levels speed up the process of atherosclerosis.

Atherosclerosis leads to narrowing of the heart arteries. This means that when the heart needs extra blood and oxygen, the narrowed arteries do not allow that to happen. The reduced oxygen and nutrients in times of need is what leads to chest pain and a heart attack.

A heart attack is a serious condition that requires urgent treatment and intervention. In India, one person dies every 33 seconds from a heart attack, and a large proportion of these individuals suffer from diabetes.

But it is not just heart attacks that are caused by diabetes.

Diabetes can also lead to ‘diffuse coronary artery disease’. This is a condition where all the arteries that supply blood to the heart are narrowed. Over time, the reduced circulation of blood can lead to weakening of the heart muscle, making it an inefficient pump. This is called heart failure, or diabetic cardiomyopathy.

Those individuals with diabetes who develop a weak heart can experience symptoms such as breathlessness, difficulty walking, poor sleep and fatigue all the time. It greatly affects quality of life.

Diabetic cardiomyopathy can be detected through an echocardiogram test.

Preventing Diabetes Related Heart Disease

If you have diabetes and are worried about developing heart disease, then it is important to take the right steps to prevent this from occurring.

Many a time, diabetes is accompanied by high blood pressure, high cholesterol level and a family history of heart disease. If any of these risk factors are present, the risk of having a heart attack or heart failure increases manifold. Targeting all these is essential as a part of the preventative strategy.

Here are some simple ways to prevent diabetes related heart disease.

1. Follow a healthy diet

oatsThe first and most important step in preventing heart disease is following a healthy diet. This includes consuming foods that are high in protein and low in fats. Consume complex carbohydrates such as oats and millets and avoid simple carbohydrates such as unpolished rice and potatoes.

Make sure your diet includes plenty of fresh vegetables and fruits. A high fibre diet can not only reduce your risk of heart disease; it can also help you gain control of your blood sugar levels. Avoid sugary drinks and bakery items.

Keep your salt intake to a minimum. Excess salt intake can raise your blood pressure and further increase your risk of heart disease.

Avoid oily and fried foods as these can increase your bad cholesterol levels. Processed foods are equally bad, so avoid them at all costs.

If you are struggling with your diet and are not sure what to do, make an appointment with a dietician. They will be able to guide you.

2. Perform regular exercise and lose weight

The American Heart Association recommends at least 150 minutes of moderate intensity aerobic exercise every week – that is 30 minutes a day 5 days a week. Performing more exercise and combining it with a strength training routine can increase your exercise related gains. Always speak to your doctor before you embark on an exercise program.

You could take up sporty activities such as swimming, football, basketball or tennis if you wished to. A brisk walk, a short jog and cycling also help you stay fit.

The whole point of exercise is to reduce blood glucose levels, increase stamina, burn fat, lose weight and improve your overall cardiac fitness. Over time, this will help you manage your diabetes better and even reduce your chances of developing a heart attack or a weak heart.

3. Take your medicines

Your doctor has prescribed your medicines for a reason – to get your blood glucose levels under control. Scientific studies have shown that keeping your blood sugar levels under control and your HbA1c levels below 7% improves long term survival and reduces cardiac disease.

Make sure you take your medicines as prescribed. While it might seem like a nuisance sometime, it is doing you a world of good in keeping you free from diabetes related complications. Avoid stopping your medicines without taking your doctor’s advice first.

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4. Watch your blood pressure

A high blood pressure combined with diabetes staggeringly increases your risk of a heart attack. Make sure you keep an eye on your blood pressure. You can do this by visiting your doctor or by checking it using a blood pressure apparatus at home.

It is currently recommended that people with diabetes have a blood pressure of around 130/80 mmHg.

5. Stop smoking

Smoking kills. We all know that. If you are a smoker, then do your best to quit smoking as soon as you can. If you have diabetes and you smoke, then you almost certainly will have heart disease.

Stopping smoking can be hard, and must be done gradually. Talk to your doctor on how you can stop smoking.

6. Maintain a low cholesterol level

Individuals with diabetes often have high cholesterol levels. In particular, the levels of bad cholesterol i.e. LDL and triglyceride levels are elevated. High cholesterol levels have been linked to heart attacks and strokes.

Currently, the Lipid Association of India recommends that all individuals with diabetes maintain an LDL level below 70 mg/dL. However, this is hard to achieve, so doctors sometimes recommend a level below 100 mg/dL. This can be achieved through diet, exercise and medications called statins.

Closing Remarks

Having diabetes is now considered to be the same as having heart disease. Simple measures can help you reduce your blood sugar levels and consequently reduce your risk of developing a heart attack or heart failure.

References:

  1. Iyengar, S., Raman Puri, and S. Narasingan. “Lipid association of India expert consensus statement on management of dyslipidemia in Indians 2016-part 1.” Journal of the Practice of Cardiovascular Sciences 2.2 (2016): 134-134.
  2. World Health Day 2016 – Diabetes http://www.searo.who.int/india/mediacentre/events/2016/en/
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Dr Vivek Baliga
Dr Vivek Baliga is a consultant cardiologist and physician practicing at Baliga Diagnostics, Bangalore. He is the director of HeartSense (http://heartsense.in), an online patient education initiative. He has a special interest in diabetes and cardiovascular disease, and is an expert in the management of lipid disorders and heart failure. In his spare time, he enjoys running and spending time with his wife and son.

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