Diabetes mellitus and cardiovascular disease
Dr. Gudrun Sadik
What are the most common heart complications from diabetes? Please tell us what type of patients (weight, age, gender, any other concomitant diseases) each of them is typical for.
Complications of blood vessels due to diabetes are classified as macro- and microvascular (diabetic micro- and macroangiopathy). Microvascular diseases are diseases of small diameter vessels, for example, capillaries (small vessel desease), and macrovascular diseases are diseases of veins and arteries.
Macrovascular pathologies lead to various cardiovascular diseases, the most common of which are atherosclerosis, coronary heart disease (ischemic heart disease), heart attack and stroke. Almost three quarters of patients with diabetes die due to the consequences of macrovascular pathologies.
Another typical problem of patients with diabetes mellitus is high blood pressure, which can result in heart failure and, which has been increasingly diagnosed in recent years, atrial fibrillation. 40-50% of diabetics suffer from atrial fibrillation. It depends on both age and gender. With age, the risk of cardiovascular disease increases
65% of patients die from a heart attack or other cardiovascular disease. Statistics say that 75% of patients with cardiovascular disease have diabetes. Thus, diabetes mellitus is one of the most important factors affecting the development of cardiovascular diseases. According to WHO statistics, many more patients die from heart failure than from cancer. Every second diabetic is diagnosed with a heart attack, and some patients do not even know that they had this condition.
This is due to the fact that diabetes mellitus affects the nerve endings, including those that are on the surface of the heart, diabetic neuropathy of the heart (cardiac neuropathy) occurs, as a result of which patients do not feel a heart attack, which can become even more dangerous. In another way, it is called silent myocardial ischemia. It can only be diagnosed by cardiac sonography or ECG. Due to massive damage to the heart nerves, patients do not feel like they have had a heart attack.
As for atrial fibrillation, the causes of its occurrence are not entirely clear. However, it is known that diabetes mellitus plays a huge role in the occurrence of atrial fibrillation. Patients with diabetes mellitus, unfortunately, often develop stroke, which is also a very dangerous complication.
A recent report to the German Diabetes Society said that atrial fibrillation and heart failure are now the most dangerous for people with diabetes.
Yes, that's right. These diseases are very dangerous, however, do not underestimate the role of stroke and heart attack, as mentioned above. Atrial fibrillation is the most common heart rhythm disorder and one of the most common causes of outpatient and inpatient hospital stays (among cardiovascular diseases). Diabetes mellitus is an additional risk factor for atrial fibrillation and heart failure.
What happens to the walls of blood vessels and to the heart itself in chronic hyperglycemia? What are these processes like?
A large amount of sugar in the body leads to the fact that cholesterol is deposited on the walls of blood vessels. The vascular lumen gradually narrows, which over time can lead to atherosclerosis. The blood becomes thicker, which increases the risk of thrombosis. Diabetic cardiac neuropathy is another typical complication of the heart in patients with diabetes mellitus, which was mentioned earlier.
This affects the functionig of the heart muscle. Thus, patients suffering from diabetes mellitus for a long time are even more susceptible to cardiovascular pathologies, since the vessels are affected by improper metabolism for a long time.
Is there a different approach for people with a long or short history of diabetes?
Yes, there is, This has changed in recent years. Previously, it was believed that it is necessary to lower sugar in all patients and this will lead to an improvement in the condition and help avoid the consequences of diabetes. Recent studies have shown that lowering blood Hba1c (glycated hemoglobin) is not a viable therapy for all patients.
Thus, an intensive decrease in glycated hemoglobin is necessary only for patients with a short history of diabetes, not suffering from cardiovascular diseases. In addition, if glycated hemoglobin in the blood is intensively reduced in patients with long-term diabetes mellitus, the risk of heart failure increases. Therapy of patients with diabetes mellitus being increasingly individualized.
Treatment of long-term diabetes should be carried out with "mild" methods, with great care, since due to the fact that sugar has been increased for many years, many internal organs are damaged. For patients who were diagnosed with diabetes mellitus recently, it is adivsable to to apply the method of intensively lowering blood sugar and therefore avoid complications in the heart and blood vessels.
On average, patients with diabetes mellitus live 10-15 years less. Cardiovascular diseases play an important role in these statistics. However, if the diabetes is well compensated, it is always a great benefit for the patient. It is especially important to diagnose this disease in the early stages. This allows to significantly minimize the risks of complications, both on the heart and blood vessels, and on other internal organs. Statistics show that patients with well-compensated diabetes from early stages tend to have the same life expectancy as healthy people.
What effect does poorly compensated diabetes have on the heart and blood vessels?
As mentioned above, diabetes mellitus poses a huge risk for the occurrence of cardiovascular disease. This risk increases if diabetes is poorly compensated. Most often, patients with diabetes mellitus are overweight. This suggests that lipids will be elevated in the blood. This is detrimental to blood vessels. Sugar, which is deposited in blood vessels, plus lipids, platelets - all this leads to the formation of vascular plaques, which narrow or even clog blood vessels, and this in turn already leads to various cardiovascular pathologies.
How do heart medications and sugar-lowering medications work together? Can they be taken at the same time?
In recent years, many studies have emerged aimed at identifying the interaction of diabetes medications and cardiovascular diseases.
10 years ago there were only 3 medicines that were prescribed for diabetes mellitus, today there are many of them. All of them, of course, are tested for the effect on internal organs and compatibility with other medicines. The most popular drug is GLP 1. It is compatible with many medications that patients take in the presence of heart failure or heart attack and has almost no contraindications. One of the most important benefits of this drug is the weight loss factor.
Therefore, it is very popular with patients. However, there are also medications that are contraindicated in patients with heart failure. As for heart medications, it is worth paying attention here not to how they affect sugar and are combined with medications for diabetes, but to the kidneys, which are very often damaged in patients with diabetes. This applies, for example, to medicines for high blood pressure, which exert stress on the kidneys.
Have any innovative methods of treating the cardiovascular system in people with diabetes appeared recently?
As we mentioned above, the choice of drugs for diabetes mellitus today is much wider than, for example, 10 years ago. Insulin pumps, devices for determining or monitoring sugar levels have improved more. For example, non-contact glucometers have appeared, which allow you to monitor blood sugar without taking blood. These devices can be connected to smartphones, which allows the patient to constantly monitor the state of sugar.
Control is always very important and is an integral part of therapy. As for the newest methods, I will once again mention the GLP-1 medication, which needs to be injected depending on the doctor's prescription - once a week, month or daily. It is a non-insulin drug, so it does not contribute to weight gain, but even weight loss. This is of course a huge advantage, since the risks of complications are reduced. GLP-1 is compatible with all other medications for lowering blood sugar, and research is underway to find its compatibility with insulin.
Austria is in one of the first places in the world for scientific developments in the treatment and diagnosis of diabetes mellitus.
Are there any typical misconceptions about the state of the heart and blood vessels in people with diabetes?
I rarely had to deal with the misconceptions of patients about the state of the heart and blood vessels, rather with a lack of information or its complete absence. Patients underestimate the complications of diabetes on the heart and blood vessels. It is important here to mention common misconceptions when it comes to diabetes. For example, that patients develop diabetes mellitus solely through their own fault, when they neglect themselves, lead an immobile lifestyle, and eat improperly.
It is not always so. Being overweight and lacking movement are significant risk factors, but genetic factors still play a decisive role. Or, many people think that diabetes is a disease of the elderly, which is also a misconception.
Type 2 diabetes is common in people who are over 40 or even younger. Many misunderstandings are encountered when type 1 diabetes is distinguished from type 2. Some people believe that the most "terrible" diabetes is type 1 diabetes, which occurs in childhood, from which patients die early. This is not entirely true.
Type 1 diabetes is an autoimmune disease in which cells in the pancreas that are responsible for the production of insulin are destroyed. It is assumed that this may be due to some viruses. Life expectancy and prognosis of the disease still depend on the correct therapy and discipline of a patient with diabetes of all types.
What can help people with diabetes maintain heart and vascular health? Vitamins, dietary supplements or giving up some habits?
Prevention plays a huge role, both for patients with diabetes mellitus and for healthy people. This avoids many unpleasant consequences both on the cardiovascular system and on other organs. Prevention of diabetes mellitus is complex: it consists in maintaining a healthy lifestyle - giving up bad habits, healthy eating, physical activity, as well as in conducting systematic preventive examinations to identify the risks of cardiovascular diseases.
These preventive examinations include extended laboratory tests, cardiac ultrasound, ECG, ergometry, 24-hour pressure monitoring and cadiogram, vascular diagnosis, and a visit to a cardiologist. We offer all this to patients at the Döbling Private Hospital.
What changes should people with diabetes make in their diet to help their heart without raising their glucose at the same time?
There is a so-called “food pyramid” that is recommended for all patients with diabetes. In this pyramid it is written what foods and their quantity are recommended to be eaten.
The basis of such a pyramid is products from grains or cereals - 6-11 servings per week, followed by vegetables - 3-5 servings, dairy products - 2-3 servings and at the very top of the pyramid are fruits and sugar-containing foods, which should either be avoided or use in very small portions with extreme caution
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