The Heart & Vascular Center

Risk factors we cannot change or control are:

1.  Age (as age increases so does our chance of heart disease).
2.  Sex (males tend to have an increased risk over premenopausal women)
3.  Family history (if a sibling or parent has premature heart disease that increases your risk of developing it as well).

Risk factors we can change or control are:

1.  Smoking.
2.  Low HDL (good) cholesterol.
3.  High blood pressure.
4.  Sedentary lifestyle.
5.  Diabetes Mellitus.

     In a previous issue of the newsletter we focused on high blood pressure.  The article below will focus on diabetes and heart disease.

     Diabetes mellitus is a very complex problem, but generally, it is a disorder of carbohydrate metabolism due to an insufficiency or deficiency of insulin produced by the pancreas.   carbohydrate metabolism produces sugar, and insulin helps keep the level of sugar in our blood stream at a normal level.  It is characterized by a unique form of small vessel (capillaries) disease.  Approximately 6% of the population have some form of diabetes.

     There are two types of diabetes mellitus.  Type I usually starts before the age of 30 in non-obese individuals.  This type of diabetes almost always requires treatment with daily insulin injection.  Type II usually occurs after the age of 40 in obese individuals and can most often be managed by diet and/or medication in pill form.  Both types do tend to run in families, and both tend to increase the risk of CAD.
 

     How would someone know if they have diabetes? Many times the first indication may be an elevated fasting blood sugar found on a routine examination. An individual may also experience the classic symptoms of diabetes:  Excessive thirst, frequent urination, and weight loss.

     To diagnose diabetes a physician may order any of the following:  Fasting blood sugar and a blood sugar test following a meal, and a blood test called glucose tolerance test or a urine test to check for sugar.  A normal fasting blood sugar ranges from 80-120 mg/dl. 

     The relationship of diabetes and heart disease reveals some very sobering facts regarding the
incidence of cardiovascular disease. 

     CAD is the most common cause of death in Type II diabetics.  CAD also increases dramatically in diabetics with any of the other risk factors described earlier.  Diabetics with CAD have more blood vessels with blockages than those without diabetes, and those blockages are more complicated, calcified and hard.

     Heart attacks occur more frequently in diabetics and the size of the heart attack tends to be larger. Because diabetes effects the nerves, it is possible a diabetic would not feel the discomfort of angina (a warning sign of decreased blood flow to the heart) as intensely.  In fact, the incidence of silent heart attacks (a heart attack without pain) is higher.

      Additionally, a type of fat in the blood stream, triglycerides, tend to run high.  High triglycerides are suspected in the role of plaque build up in the arteries.  Diabetes also influence blockages of the arteries of the legs (peripheral vascular disease) and neck (carotid artery) which increases risk of stroke. 

     Diabetics are at increased risk of a small vessel disease.  This, in particular, affects the eyes (diabetes is the leading cause of blindness), and kidneys.  The nerves are also commonly affected by diabetes by unknown means, probably circulation. 

     The information may sound like the outlook for diabetics is quite bleak -- but there is good news! The good news is it has been shown that Type II diabetics under very strict control of their blood sugar levels have less of a substance circulating in their system which is known to cause the formation of clots.  These clots when lodges in a narrowed blood vessel can cause heart attacks and stroke.  Data also shows that diabetics who keep their blood sugars under control in general have less severe complications of diabetes.

     In order to keep diabetes under tight control, it is essential the patient follow their physician and dietitians guidelines without fail.  The treatment of diabetes focuses on three areas:  Diet exercise, and medication.  Diet therapy centers on weight reduction in overweight individuals, a low-fat diet (less than 20% of total calories) and a diet consistent with timing and caloric intake.  Many physicians will recommend a diet low in sugar, starch, and alcohol as a first step.  Beneficial effects of exercise for diabetics includes wight control, increased HDL (good) cholesterol, and lower blood sugar levels.  Medication therapy is started with anti-diabetic agents in pill form.  If necessary, insulin will be prescribed and is injected into the fatty layer of tissue on a daily basis.  Diabetics are usually instructed on how to take periodic test of blood and urine at home. 

     Hopefully, we can now begin to understand why diabetes is such a complex problem.  Its relationship to heart disease, America's #1 killer is very intimate.  Early diagnosis and strict compliance with physician's instructions is essential to living well with diabetes and heart disease.