Diabetes Greatly Increases Risk Of Heart Attack
Diabetics Urged to Screen For Heart Disease. Obesity Major Factor.
Nov 12, 2009
Diabetics may have more to worry about than their glucose levels.
It turns out many of the metabolic factors involved in diabetes are correlated to heart disease, and obesity remains at the center of the issue.
Doctors Warn Diabetic Patients of Serious Heart Risks
Dr. Jorge Pluty, director of the vascular disease program at Brigham and Women's Hospital in Boston, warns doctors of the serious implications of the relationship between patients with diabetes and heart disease. "You should conceivably treat every patient with diabetes as aggressively as a heart attack survivor," he said in an article for Tribune Newspapers.
John McMurray, professor of cardiology at the Western Infirmary, Glasgow, and President of the Heart Failure Association, reported that around one-third of patients with heart failure show evidence of diabetes. A session at Heart Failure 2009 pointed out that obesity isn't just associated with an increased risk of heart attack, but also with (and especially) an increased risk of heart failure. "Obesity is at least as great a risk factor for heart failure as it is for heart attack or stroke," says Professor McMurray, "Obesity more than doubles the risk."
But whether people with diabetes have a higher risk of heart failure or people with heart failure have a higher risk of diabetes is less important than the fact that a strong association exists. "Whichever is the causative factor," McMurry notes, "it's very bad news for those with both conditions."
Factors Associated with Diabetes and Heart Disease
Researchers believe that fat cells may have a harmful effect on heart tissue and blood vessels. Diabetes can have a serious cascading affect on a person's health. Scientists believe the following factors contribute to an increased risk for heart disease in diabetic patients:
- Increased Fatty Acids: Excess fat triggers the production of fatty acids that overflow into the muscles and liver rather than staying in fat cells and cholesterol molecules where they belong. While still not entirely understood, scientists believe these fatty acids make the muscle cells insulin-resistant, which makes them less able to absorb glucose, which means blood sugar levels shoot up.
- Higher LDL cholesterol: Fatty acids in the body trigger the liver to make too much LDL, the body's "bad" cholesterol. In addition, the LDL particles in most people are large and buoyant, but in diabetics, they're small, dense and harder to clear from the body. These particles attach more easily in the fatty arterial plaque and irritate the heart. Despite having "normal" LDL levels, people with this type of small, dense LDL are more at risk for heart disease.
- Lower HDL cholesterol: Diabetics have lower HDL, the "good" cholesterol molecules that remove cholesterol from the fatty plaques in the arteries that can rupture and cause heart attacks or strokes. Low HDL levels in diabetics allow these risky plaques to build.
- Inflammation: Inflammation is a key contributor to heart disease because it leads to the formation of fatty plaques which contain immune cells called macrophages. Macrophages spew out inflammatory molecules in the body that hinder insulin's ability to work in other cells. Researchers believe these inflammatory molecules harm the arteries. Fat tissue itself can become inflamed, which could explain why obesity triggers both diabetes and heart disease.
Screening for Heart Disease
Although researchers aren't entirely clear about inflammation's role in diabetes, there is an intervention that could help solve the mystery. Salsalate, an inexpensive anti-inflammatory drug approved for rheumatoid arthritis (and is similar to aspirin except that it doesn't cause stomach bleeding), was once used as a treatment for diabetes 140 years ago.
People with diabetes may want to consider the following preventative measures:
- Minimize risks closely associated with diabetes and heart disease by making lifestyle changes (diet, exercise and stress reduction), take heart-friendly supplements and/or drug therapy, lose weight, reduce blood pressure and lower cholesterol.
- Ask your doctor to order a C-reactive protein (CRP) test. CRP is an inflammatory marker produced by macrophages and a measure for heart disease risk.
- If you or someone in your family has diabetes or heart disease, ask your doctor to run a VAP cholesterol test, even if their cholesterol numbers are "normal." The VAP is an advanced lipid test and is more accurate than a routine cholesterol screen. This test measures, among a number of factors, the size and pattern of the LDL cholesterol.
As scientists continue to research the relationship between diabetes, heart disease and heart failure, diabetics should be aware of their risks and talk to their doctor about heart disease prevention.
Further Reading:
Bulging Belly and Fatty Liver Disease Linked to Diabetes, Heart Issues
Sources:
European Society of Cardiology (2009, June 4). Obesity and Diabetes Double Risk of Heart Failure: Patients with Both Conditions 'Very Difficult' To Treat. ScienceDaily. Retrieved November 12, 2009.
Delude, Cathryn, "Link between diabetes and heart disease scrutinized," The Orlando Sentinel, Tuesday November 3, 2009.
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