Having Diabetes means there is an increased likelihood of having a heart attack and stroke. Long Standing Diabetes damages the blood vessels and nerves in the heart. The longer the duration of diagnosis of Diabetes, greater are the chances of having a heart attack. Studies have shown that people who have Diabetes are more likely to have an early heart attack than those who don’t. People who have other cardiovascular conditions in particular such as metabolic syndrome and a multitude of other heart conditions are at a high risk of a heart disease. There is also probably a genetic predisposition to heart problems. Obesity, sedentary lifestyle, unhealthy food habits and impaired metabolism are the major causes of heart disease in Diabetes.

The link explained

There are several reasons responsible for the high rate of deaths caused by heart-related complications. For example, people with Diabetes often have other cardiovascular risk factors such as high blood pressure and high cholesterol levels which increase the risk of having cardiovascular disease. It might also be that Diabetes in itself causes heart disease. The exact mechanism is still unknown, it might be high blood sugar levels or it might be oxidative stress but the exact cause is unknown.

High blood sugar levels associated with Diabetes damage the arteries by making them stiff and hard. Atherosclerosis results when plaque (fat, cholesterol, calcium deposits) builds up inside your arteries which carry blood to the heart and other parts of the body. These deposits reduce the blood flow to the heart or brain as it blocks the arteries. Reduced blood flow leads to heart attack and stroke.

The most commonly seen heart condition in people with Diabetes is myocardial infarction or a heart attack. Along with this, angina, heart failure and arrhythmic problems are linked to Diabetes. People with Diabetes have more often been diagnosed with hypertension and hypertension is one of the major causes of heart failure.

Adults with Type 1 

A Swedish study published in Lancet Diabetes and Endocrinology looked specifically at the likelihood of heart failure in people with Type 1 Diabetes as compared with the general population. The research study found that people with Type 1 Diabetes had four times the risk of heart failure over an average of 8 years, compared with people without Type 1 Diabetes from the general population. The study has also found that women with Type 1 Diabetes have a higher risk of heart failure than men with Type 1 Diabetes.

Poor glycaemic control can increase the risk of heart failure by 10 times. People with Type 1 Diabetes and with albuminuria have 18 times greater risk of heart failure. These risks increase as glycaemic control and renal function continue to worsen. People with well controlled Type 1 Diabetes and normal renal function also have an increased risk of heart failure. This risk is still more than double with well-controlled Diabetes and three times greater with normal renal function.

Children and adolescents with Type 1

Heart attacks and stroke are not generally expected to occur during childhood, even in children and adolescents with Type 1 Diabetes. However, the atherosclerotic process begins during childhood. Children and adolescents with Type 1 Diabetes have displayed heart-related abnormalities even within the first decade of diagnosis of Diabetes.

The Diabetes Control and Complications Trial (DCCT) has studied the effects of glycaemic control during childhood on heart related events. The study has shown that good glycaemic control during adolescence delayed the onset and progression of retinopathy (eye problems) and nephropathy (kidney problems) but not a cardiovascular disease (heart-related problems).

Adults with Type 2 

The link between Type 2 Diabetes and heart disease has been firmly established by extensive research studies. The American Diabetes Association (ADA) considers Diabetes as one of the seven major controllable risk factors for cardiovascular disease. The ADA states that people with Diabetes have two to four times increased the risk of death by heart disease than adults without Diabetes. More than 68 per cent of people aged 65 or above and with Diabetes have an increased risk of death due to some form of heart disease and more than 16 per cent die of stroke.

Heart problems – can they be avoided?

When I see my patients in the ward, of all the patients with myocardial infarction, 20 percent of them have chronic Diabetes. Of the other 80 per cent, only one-third have normal glucose tolerance. Of the rest, only one-third have Diabetes and only one-third have prediabetes. It is more common to have abnormal blood sugar readings in people who have had a heart attack.

It is important to take action today to avoid heart related complications tomorrow. There is no sure shot way to avoid heart disease and circulation problems. But the risk can be lowered by if you:

• Keep your blood sugar levels under control,
• Stop smoking,
• Lose weight if you are overweight,
• Keep your blood pressure in the proper range,
• Get regular physical activity and
• Keep your blood fats and cholesterol levels in a healthy range.

Carefully noting the early symptoms and timely medical intervention can help prevent further complications of heart, in Diabetes. Regular consultations, lifestyle intervention and regular blood sugar monitoring can help to keep the heart healthy for a longer time.