Heart disease

Diabetes takes a major toll on heart disease

 

Cardiovascular disease is the No. 1 cause of death for diabetics. Prevention and treatment are key.

icordle@MiamiHerald.com

Diabetes touches nearly every aspect of a person’s health, but none as devastating as the heart.

To put it plainly: “Heart disease is the No. 1 cause of death, No. 1 cause of disability, No. 1 cause of admission to hospitals and the No. 1 healthcare cost in caring for people with diabetes,” said Dr. Ronald Goldberg, an endocrinologist and professor of medicine at the University of Miami’s Diabetes Research Institute.

The general consensus among doctors, he said, is that the risk for cardiovascular disease doubles for patients who have diabetes. Doctors are not sure of all of the reasons for the link to heart disease, but high blood pressure and lipid or blood fat disorders are very common in diabetics, and are among the factors.

“Prevention is critical,” Goldberg said. “Once you have heart disease, your prognosis is worse — you are more likely to have shortened life, heart failure, be hospitalized. It makes it much more complicated.”

Treatments have advanced in the last decade, however. The biggest help: Statin drugs, to ward off the first heart attack or stroke, as well as recurrences, he said. (Statins lower cholesterol levels and include drugs like Lipitor, Crestor, and Zocor.)

Preventing diabetes in the first place is key, through lifestyle factors like exercising and eating well, as well as by starting medications early. It is also important to check for other risk factors, like high blood pressure.

“Knowing that someone is prone to diabetes, it becomes increasingly important to make sure they don’t have any other risk factors,” Goldberg said. “If they do, those factors should be treated early on.”

Smoking is particularly dangerous.

“Smoking and having diabetes is like holding a loaded gun to your head,” Goldberg said. “They are two very serious cardiovascular risks.”

Diabetes is linked to cardiovascular disease because the insulin-resistant state is associated with inflammation, which is what causes arterial disease. The result can be heart attack, stroke, heart failure or life-threatening arrhythmias, said Dr. Jonathan Fialkow, a preventative cardiologist, certified lipidologist, and medical director of EKG, Stress Lab, Clinical Cardiology and Cardiac Rehabilitation at Baptist Cardiac & Vascular Institute.

“When they have diabetes, they are immediately considered high risk and treated as if they have coronary disease,” Fialkow said.

So preventing cardiovascular disease is vital for diabetics.

“If you are diabetic, the way to prevent cardiovascular disease is to aggressively control your lipids, maintain a well-controlled blood pressure, take a baby aspirin a day, exercise, and keep weight down,” he said. “Control of the blood sugar is not as important for cardiovascular risk reduction as the other things, though it is important to prevent other problems.”

In fact, the American Diabetes Association and the American Heart Association say that every Type 2 diabetic over the age of 40 should be on a statin — a cholesterol-lowering agent, regardless of their cholesterol level.

“Cardiovascular disease is the most common cause of death and greatest risk of all for people who have diabetes,” said Fialkow, who is focused on prevention. He said he sees more and more people in their 30s and 40s with diabetes or diabetic precursors.

Doctors say that the vast majority of diabetic patients today have Type 2 diabetes, which is tied to obesity. The incidence has risen to epidemic proportions, they say, and the link to the heart can be disastrous.

“Cardiovascular disease is the inevitable death of people who have Type 2 diabetes, which at this point in our country is the fastest-growing disease, more than AIDs or cancer,” said Dr. Joseph Gutman, an endocrinologist and director of diabetes services at Mount Sinai Medical Center in Miami Beach.

In fact, Gutman said, having diabetes is statistically the same thing as already having had a heart attack. And those who have had one heart attack are much more likely to have a second, he said.

Moreover, diabetic patients have a 25-fold higher risk of having a heart attack or a stroke than the general population, Gutman said.

“I see obese patients, 27 and 30 years old, and they discover that they have diabetes after having a heart attack,” he said. “I would say that probably in excess of 50 percent or better of my patients who have diabetes have some form of heart disease.”

But if patients control their diabetes, lose weight and control their cholesterol, their chances of having another heart attack can be reduced by 40, 50, sometimes 60 percent, he said.

“Those who have had a first heart attack tend to cooperate more,” he said. “Those that have not, but are at the same risk, tend to roll the dice — until they or a relative has a heart attack, and then they panic.”

Gutman said that anyone who has had diabetes 10 years or longer, or is over the age of 40, should visit a cardiologist.

“I am not about to sit quietly and watch my patients die without having prevented their death,” he said. “If you catch coronary artery disease early, you can do so much.”

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