Diabetes and heart disease often go hand in hand. If one has diabetes, he or she is twice as likely to have heart disease or a stroke as someone who doesn’t have diabetes and also at a much younger age. The longer you have diabetes, the more likely you are to have heart disease.

But the good news is that you can lower your risk for heart disease and improve your heart health by changing certain lifestyle habits. Those changes will help you manage diabetes better too.

What are the heart problems in diabetes? Heart disease or the term “cardiovascular disease” includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.

Coronary artery disease is caused by the build-up of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause chest pain or angina and can lead to a heart attack. Decreased blood flow to the brain can cause a stroke.

Hardening of the arteries can happen in other parts of the body too. In the legs and feet, it’s called peripheral arterial disease, or PAD which manifests as pain in the legs while walking forcing you to reduce the speed of walking or stop and take rest for a while. PAD is often the first sign that a person with diabetes has cardiovascular disease.

How diabetes affects the heart? Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease, such as

1. High blood pressure or Hypertension which increases the force of blood through your arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease.

2. Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls.

3. High triglycerides (a type of fat in your blood) and low HDL (“good”) cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.

The most important aspect is that none of these conditions produce symptoms. Only a routine health check-up often leads to detection of high bloodpressure, diabetes and high cholesterol levels. More important coronary artery disease in diabetes is often “silent” and often patients are surprised to know that they have already sustained a heart attack in the past which they were not aware of. This is because typical symptoms of chest pain may not occur even if someone with diabetes gets a heart attack.

The following factors can also raise your risk for heart disease:

• Smoking
• Being overweight or having obesity
• Not getting enough physical activity
• Eating a diet high in saturated fat, trans fat, cholesterol, and sodium
• Drinking too much alcohol

People with diabetes are also more likely to have heart failure. Heart failure is a serious condition, but it doesn’t mean the heart has stopped beating; it means your heart can’t pump blood well. This can lead to swelling in your legs and fluid building up in your lungs, making it hard to breathe. Heart failure tends to get worse over time, but early diagnosis and treatment can help relieve symptoms and stop or delay the condition getting worse.

Testing for heart disease in diabetes

The blood pressure, cholesterol levels, sugar levels including Hba1c and weight will help the doctor understand the overall risk for heart disease in a patient. Your doctor may also recommend other tests to check your heart health, which could include:

1. An electrocardiogram (ECG or EKG) to measure your heart’s electrical activity. Your heartbeat is the result of an electrical impulse traveling through your heart.
2. An echocardiogram (echo) to examine how thick your heart muscle is and how well your heart pumps.
3. An exercise stress test (treadmill test) to see how well your heart functions when it’s working hard.

Take care of your heart

These lifestyle changes can help lower your risk for heart disease or keep it from getting worse, as well as help you manage diabetes:

1. Follow a healthy diet. Eat more fresh fruits and vegetables, lean protein, and whole grains. Eat fewer processed foods (such as chips, sweets, fast food) and avoid trans-fat. Drink more water, fewer sugary drinks, and less alcohol.
2. Aim for a healthy weight. If you’re overweight, losing even a modest amount of weight can lower your triglycerides and blood sugar. Modest weight loss means 5% to 7% of body weight, just 5 to 6 kilograms for a 90 kg person.
3. Get active. Being physically active makes your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), which helps manage your diabetes. Physical activity also helps control blood sugar levels and lowers your risk of heart disease. Try to get at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.

Manage your ABCs

A: Get a regular A1C test to measure your average blood sugar over three months; aim to stay close to 7 as much as possible.

B: Aim to keep your blood pressure below 130/80 mm Hg.

C: Manage your cholesterol levels – LDL <100mg/dl

s: Stop smoking or don’t start.

Along with the above manage your stress levels. Stress can raise your blood pressure and can also lead to unhealthy behaviours, such as drinking too much alcohol or overeating. Instead, visit a mental health counsellor, try meditation or deep breathing, get some physical activity, or get support from friends and family.

Your doctor may also prescribe medicines that can help keep your blood sugar, blood pressure, cholesterol, and triglycerides close to your target levels.

Dr Ramesh Natarajan

Senior Consultant

Department of Cardiology

KIMSHEALTH