Cardiac Health

Heart disease is often the killer behind diabetes


Special to the Miami Herald

It is like a dirty secret in the general community that the No. 1 cause of death among people with diabetes, type 1 or type 2, is not the incurable pancreatic illness itself but heart disease.

In fact, 80 percent of the United States’ estimated 26 million diabetics will suffer from and likely die of some sort of coronary complication — often sudden and severe heart attack or stroke.

“Coronary heart disease occurs with higher degrees of frequency and severity two to four times more in people with diabetes. It is the major killer,” said Dr. Ronald Goldberg, professor of medicine at the University of Miami’s Diabetes Research Institute.

Medical experts agree: Heart disease related to diabetes is an epidemic within an epidemic.

“If you get coronary heart disease and have diabetes, it is more likely to be severe and you are more likely to die from it sooner,” said Goldberg. “It is the most impactful and expensive problem associated with diabetes.”

Cristy Paez, a spokeswoman from the American Heart Association, said the risk of death from heart disease for diabetes patients is “probable” because diabetics, even when glucose levels are under control, are four times more likely to have conditions that lead to cardiac issues. These include high blood pressure, abnormal cholesterol and high triglycerides, obesity and lack of exercise.

Tack on poorly controlled blood-sugar levels, smoking and an unhealthy diet, and you’ve got a complete health disaster. Paez makes no apologies for scaring patients.

“I’ve heard some patients with diabetes say, ‘I’m going to die anyway, so why not enjoy life.’ They don’t understand that they could linger on needing loved ones to care for their basic functions — or they can live a long life. Why would you want to die earlier than your time or want someone to wipe you like a baby when you can prevent it?” Paez said.

Dr. Paul Jellinger, an endocrinologist at Memorial Hospital Regional and a professor of clinical medicine at University of Miami Miller School of Medicine, said controlling blood sugar, frequent health screenings and early intervention can reduce the risk of heart disease. The top eight controllable risk factors for heart disease, according to the American Heart Association, also help control diabetes, he said.

They are:

• Do not smoke.

• Maintain low LDL (bad cholesterol) and high HDL (good cholesterol).

• Keep blood pressure at the optimal 120 over 80.

• Exercise 30-35 minutes a day, five days a week.

• Eat a healthy diet to avoid obesity.

• Control blood-sugar levels.

• Reduce situations that provoke stress.

Goldberg, a member of the national Diabetes Prevention Program, said cigarette-smoking, high bad cholesterol and high blood pressure are “the big three culprits ” for the heart disease and diabetes double whammy, though cigarette smoking is decreasing overall.

“More people are learning that cigarettes and diabetes made a deadly combination. It is that critical,” Goldberg said.

Jellinger said diabetic patients, like the general public, are mostly unaware of the connection and must be told on the day of diagnosis about likely heart complications.

“They need to be educated by their physicians, read as much as they can and then ask questions,” Jellinger said.

Paez said that a report released in September by the American Heart Association stated that premenopausal women with type 2 diabetes are at high risk for heart disease.

For the study, researchers used ultrasound to measure plaque in the carotid arteries of 1,256 women with or without diabetes. Plaque buildup was more common among the nearly 300 women who had diabetes than the women who did not.

“We already knew that diabetes was an independent risk to heart disease. But now we know that we can have a 23-year-old woman with diabetes and her risk is exponentially higher,” Paez said. “The study says that we need to be screening younger populations for diabetes. If we catch it early, we can decrease risk.”

Goldberg said more aggressive blood-pressure medications to treat cholesterol and triglyceride abnormalities that cause heart disease are available. But while medications help keep cholesterol from clogging artery walls and help triglycerides store unused calories for energy, diabetics must also deal with the body’s inability to use insulin and get blood sugar into tissues. That can cause inflammation of blood vessels in fat tissue and hence tissue damage.

The bottom line for keeping heart disease and diabetes in check is diagnosis and treatment.

“The most important message of the day is: If you have diabetes, even if very mild or if you have diabetes in your family, you should already be thinking proactively for the possibility of heart disease. The sooner the better,” Goldberg said.

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