By Julian Booker, MD
When I am in clinic, there are very few things that drive me crazier than trying to impress upon a patient the importance of managing their cardiovascular risk. Once a patient has a heart attack or heart failure, they tend to become more receptive to my rambling. The problem comes when counseling patients without known heart disease but have conditions that place them at risk. There are a number of conditions that predispose one to cardiovascular disease including:
3. High cholesterol
4. Family history of atherosclerotic disease
5. Physical inactivity
Some risk factors like family history and your genetic predisposition can’t be changed so we won’t go into too much detail about these things. I would like you to follow along with us at MyHeartWordpress.com over the coming weeks to months as we will discuss the risk factors and how they can affect your heart. Today we will focus upon diabetes and what impact it can have on your heart.
Adult onset diabetes, specifically type 2 diabetes (sometimes called non-insulin dependent diabetes), is an increasingly common disorder. There are over 25 million cases currently in the US accounting for about 8% of the US population. This represents roughly 90% of all cases of diabetes. Diabetes results in an inability of the body to metabolize glucose. Glucose, or blood sugar, is the main source of energy for our body’s cells.
But what does high blood sugar have to do with heart disease? The association between blood sugar and coronary artery disease has been well documented. Fasting blood glucose has been shown to increase the risk of cardiovascular disease regardless of whether a person has diabetes or not.
As an aside, diabetes is a leading cause of blindness, kidney failure, heart disease and nontraumatic limb amputations. These are largely related to cardiovascular complications
But specifically, what does diabetes mean for my heart. Diabetics are more likely to develop heart failure. Diabetes increases your risk of heart attack as much as four-fold. For those of you that aren’t math whizzes (I have documented proof that I am not) that means you are four times more likely than a similar person without diabetes. As an example, if you take a person with a prior history of heart attack but no diabetes, their risk for heart attack is the same as yours just because you are a diabetic. More than half of diabetics will have significant coronary artery disease with 10-20% being completely asymptomatic. For diabetics diagnosed with coronary artery disease, the severity of their heart disease tends to be more severe. If you have a heart attack, the heart attack tends to be larger and your are more likely to die from your heart attack. Unfortunately, diabetic patients are less likely to have chest pain. Chest pain is our body’s way to warn us that there is a problem. You could be having a heart attack and not even know it. For me these are amazing statistics. If you have diabetes then you need to take it seriously.
If you are diagnosed with diabetes then your doctor is probably going to give you a long list of recommendations for what you should be doing. Now you know why you should treat your diabetes. The next step is to know what you should do to treat your diabetes. I am not an endocrinologist so I will not go into great detail about how best to manage your type 2 diabetes. There are so many ways that one can approach management that it is well beyond the scope of this post to discuss them all. What I can say is that there are many ways to skin a cat and you and your personal physician can find a path that is best for you. Whatever you do, get this disease under control.
1. The first and most important thing you can do is take command of your diet and lifestyle. You should adhere to a heart-healthy diet that is in compliance with the American Diabetes Association.
2. GET ACTIVE!!! These are the recommendations by the American Heart Association regarding physical activity:
• At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150
• At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75; or a combination of the two
• Moderate to high intensity muscle-strengthening activity at least 2 or more days per week for additional health benefits.
3. LOSE WEIGHT if you are currently overweight. The Centers for Disease Control recommend the use of BMI to identify possible weight problems. Granted this tool is not perfect but it is a great starting point. I have included the table from the CDC website that discusses what your BMI means for you.
BMI Weight Status
Below 18.5 Underweight
18.5 – 24.9 Normal
25.0 – 29.9 Overweight
30.0 and Above Obese
The BMI calculation requires your height and weight. If you do not have a BMI calculator you can visit MyHeart.net or the CDC.
Our own Dr. Murtaza Ahmed is a fantastic resource for how to get active and lose weight. Visit his blog posts on MyHeart
4. LDL cholesterol is not your friend. I want that value at least less than 100 mg/dl (2.6 mmol/l) but I would prefer that value to be less than 70 mg/dl (1.8 mmol/l). Please refer to my earlier post on statins for more details.
5. CHECK YOUR FEET. Although not specifically a heart related recommendation it is important nonetheless.
The important thing to remember is that diabetes management is more than pills and shots, it is a lifestyle change.