Heart disease is common among diabetics. But how do diabetics get heart disease and how can the disease be treated?
About two-thirds of persons over 65 who die from diabetes have heart disease. In fact, the risk of dying from heart disease is several times higher among persons with diabetes compared to non-diabetics.
The Framingham Heart Study is a long-term continuous cardiovascular study of the residents of the Framingham, a town in Massachusetts in the USA. The study began in 1948 with 5,209 adult subjects and the grandchildren of the original subjects are now taking part.
Much of our knowledge of heart disease and how it is affected by diet, exercise and various medicines first came to light during this ground-breaking trans-generational study.
Framingham was the first study to show that diabetics are more vulnerable to heart disease than non-diabetics, and that having multiple health issues increases the likelihood of heart disease.
The health problems associated with heart disease include diabetes, being overweight, high blood pressure, high cholesterol levels, smoking, and a family history of early heart disease.
The more risks factors a person has for heart disease, the greater the chance they will develop the disease. In addition, the probability of dying from heart disease is much greater for a diabetic.
Thus while a person with one risk factor, such as high blood pressure, will have a particular chance of dying from heart disease, a person with diabetes has two to four times that risk of dying.
One medical study found that people with diabetes who had no other risk factors for heart disease were five times more likely to die of heart disease than non-diabetics. Another study indicated that diabetics were as likely to have a heart attack as non-diabetics who have already had heart attacks.
How diabetics get heart disease
The most common cause of heart disease in diabetics is atherosclerosis (hardening of the coronary arteries) due to a build-up of cholesterol in the blood vessels that supply the heart.
This build-up usually begins before blood glucose levels increase noticeably. If you have abnormally high levels of cholesterol there is an 85% chance that you also have diabetes.
Cholesterol is a microscopic ingredient found in the membranes of animal cells, including humans. It holds the thin membranes of your body cells together; without cholesterol your body would collapse into a jelly-like heap.
It also has a role in sending signals to your cells along your nerves. In addition, it is the raw material your body uses to make certain hormones, as well as vitamin D.
About 75 to 80% of your cholesterol is made by synthesising other substances inside your body. The rest comes from the animal products you eat.
If you eat too much cholesterol, your body will reduce the amount of cholesterol it makes … provided your system is working properly. If not, you will end up with too much cholesterol.
Cholesterol is transported through the blood stream to where it is needed to build cells. Because it is insoluble, it has to be carried within lipoproteins, which are soluble in blood. These can be either low-density lipoproteins (LDL) or high density lipoproteins (HDL).
The problem is LDL — when too many particles of cholesterol are being delivered by LDL, they tend to collide and become damaged.
These damaged particles cause plaques (raised bumps or small scars) to form on the walls of the arteries. These plaques are fragile. When a plaque ruptures, the blood around it starts to clot. To contain the rupture, the clot will grow. If the clot grows big enough, it will block the artery.
If an artery that carries blood to your heart becomes blocked, you’ll have a heart attack. If the blood vessels in your feet get blocked, you’ll end up with peripheral vascular disease.
Once you have too much cholesterol in your blood you are on your way to angina, heart disease and stroke, and irreversible damage to the tiny blood vessels in your eyes and kidneys.
How diabetics can be treated for heart disease
Depending on its severity, heart disease in persons with diabetes can be treated in several ways. These include:
- Aspirin therapy
- Diet
- Exercise
- Medications
- Surgery
Aspirin therapy
For type 2 diabetics who are aged over 40 and are at high-risk for heart disease and peripheral vascular disease, a daily low-dose of aspirin reduces the risks of the clots that lead to heart attacks and strokes.
Diet
A plant-focused diet such as the one that I recommend for treating diabetes will also help treat hard disease.
This easy to follow diet means that you eat food that is … natural … low in sugar … low in fat … low in salt … high in fibre … with low GI values … which is mostly plants. You also need to avoid eggs and dairy products, and drink plenty of water.
This is not a vegetarian or vegan diet as you can still eat meat provided it is ultra-lean. However, early studies do indicate that a vegan diet may have a number of benefits for persons with heart disease but more research is needed to confirm these preliminary findings.
Exercise
As well as helping you lose excess weight, regular exercise will improve your blood glucose levels, high blood pressure, cholesterol levels and to decrease abdominal fat, all of which are risk factors for heart disease.
Both aerobic and anaerobic exercises increase the mechanical efficiency of the heart. Aerobic exercise increases cardiac output (the volume of blood being pumped by the heart) and anaerobic strength training increases the thickness of your heart muscles.
The beneficial effects of exercise on the cardiovascular system have been well documented. A study that tracked physical activity among adults with type 2 diabetes over 19 years found that those who undertook at least four hours a week of moderate exercise were about 40% less likely to succumb to heart disease than sedentary people. They also cut their risk of getting a stroke.
Medications
Many medications are used to treat heart disease. Here’s a sampling:
ACE inhibitors widen or dilate blood vessels to improve the amount of blood the heart pumps and to lower blood pressure.
Angiotension II Receptor Blockers reduce chemicals that narrow the blood vessels, allowing blood to flow more easily.
Antiarrhythmics are used to treat abnormal heart rhythms resulting from irregular electrical activity of the heart.
Blood thinners or anticoagulants, such as Warfarin, help prevent clots from forming in the blood.
Antiplatelets prevent the formation of blood clots. Clot busters are used in thrombolytic therapy to break up blood clots.
Beta-blockers are one of the most widely used drugs for high blood pressure and are a mainstay in the treatment of congestive heart failure.
Calcium channel blockers relax blood vessels and increase the supply of blood and oxygen to the heart while also reducing the heart’s workload.
Digoxin helps an injured or weakened heart work more efficiently to send blood through the body.
Diuretics help get rid of unneeded water (which makes it easier for the heart to pump) and salt (a cause of high blood pressure) through the urine.
Nitrates are vasodilators used to treat angina in persons with coronary artery disease or chest pain caused by blocked blood vessels of the heart.
As you can see, most of these medications mitigate the various deleterious effects of heart disease. But they don’t actually cure the disease. Once you start taking them you have to continue for the rest of your life.
Surgery
There are many surgical techniques for treating heart disease. These range from the insertion of simple stents to heart transplants.
Stents are small expandable tubes used to reinforce weakened arteries or to open up arteries that have been narrowed by the build-up of plaque.
In heart-bypass surgery the problem of blocked coronary arteries is overcome by creating a new pathway to the heart for the blood.
Heart-valve surgery is used to repair damaged valves in the heart.
People with abnormal heart rhythms (arrhythmia) can be treated with cardioversion in which electrical signals are sent to the heart muscle to restore a normal rhythm which allows the heart to pump more effectively.
A pacemaker is a small device that sends electrical impulses to the heart muscle to maintain a suitable heart rate and rhythm.
An implantable cardioverter defibrillator (ICD) is an electronic device that constantly monitors the heart rate and rhythm and which, when it detects an abnormal rhythm, delivers energy to the heart muscle, causing the heart to beat in a normal rhythm again.
A Left Ventricular Assist Device (LVAD) is a kind of mechanical heart that is placed inside a person’s chest, where it helps the heart pump blood throughout the body.
A heart transplant is the replacement of a diseased heart with a heart from a healthy donor who has died.
In the main, the purpose of surgery for heart disease is to rectify the underlying condition.
Summary
If you are diabetic, there is a strong probability that you have or will develop heart disease also. The most common cause of heart disease in diabetics is atherosclerosis and if you have cholesterol issues there is an 85% chance that you also have diabetes.
Heart disease can be treated with a combination of aspirin therapy, a plant-focused diet and exercise. There are many medicines for ameliorating the various deleterious effects of the disease. Surgical techniques to rectify the underlying condition range from the insertion of stents to heart transplants.
When you are diagnosed with diabetes, you will probably be checked for heart disease. The diet and exercise regime that will help you beat your diabetes should also be helpful in dealing with your heart disease.
