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How Does Diabetes Affect My Heart?

November 09, 2020

Americans with type 2 diabetes are twice as likely to develop heart disease and particularly coronary artery disease, which is a major cause of morbidity and mortality. But what many diabetics may not know is why these serious conditions are linked. 

Understanding this connection is especially important for women with diabetes. Studies show their risk of heart fatality is almost double that of their male counterparts. This is partly due to diabetes being more commonly accompanied by other cardiovascular risk factors that are unique to women, according to the American Diabetes Association

What is the overall relationship between type 2 diabetes and heart disease? For one, diabetic patients develop plaque in their arteries differently than nondiabetics and are at higher risk for thrombosis. Insulin resistance causes numerous dysfunctions for the arteries as well as the platelets. Compared to a nondiabetic, the diabetic patient has a significantly higher incidence of coronary artery disease and a greater number of diseased vessels. What this means is more arteries in the heart have blockages, often with a higher incidence of severe disease in them. 

There may be a connection between the extent of coronary disease and the degree of glycemic control. Additionally, patients with diabetes have a greater burden of risk factors, including hypertension, obesity and lipid abnormalities. 

Can Early Detection Lower My Risk? 

Most often, your doctor will discuss strategies for lowering your other risk factors for cardiovascular disease, including:  

  • Quitting smoking 

  • Lowering your cholesterol with a prescribed statin  

  • Controlling your blood pressure with an antihypertensive  

  • Controlling your blood sugar 

  • Improving your diet and nutrition

  • Increasing how much exercise you get 

For asymptomatic diabetic patients who are being treated with appropriate risk-factor reduction, screening for coronary heart disease has not been shown to improve clinical outcomes. For intermediate risk patients over the age of 40, doctors may run tests such as coronary artery calcium scoring for cardiovascular risk assessment. 

Exercise and Low-Carb Diet: Keys to Prevention

Regular exercise is associated with a lower risk of both coronary heart disease and cardiac death. How much exercise should you get? At least 30 minutes a day for five days a week is recommended by the American Heart Association, with strength training (weights/resistance) two days a week. Strive to be active at least five hours per week and less sedentary whenever possible. 

As for diet, keep a close watch on your daily carbohydrate intake, keeping in mind that one gram of carbohydrates has four calories. Aim to limit your carb intake to less than 200 grams a day. Some patients who choose ketogenic diets are on very low carb diets, or less than 50 grams of carbohydrates per day. Lowering your daily carbohydrate intake can significantly reduce blood sugar levels, promote weight loss and improve heart health in those with diabetes. 

Peripheral Artery Disease Is a Risk, Too 

Just as type 2 diabetes affects the heart, having the condition can affect other vascular beds in the body. Peripheral artery disease (PAD) of the legs is common in diabetics, with one in three patients over the age of 50 likely to have PAD. Because some patients may go for a long time without knowing they have diabetes, they may not seek out a doctor until their symptoms become severe — for instance, after they’ve developed foot wounds. These wounds may have gone unnoticed because patients also have peripheral neuropathy and difficulty feeling their feet, putting them at increased risk for limb loss. If you’re a patient with type 2 diabetes, ask your doctor whether you should be screened for PAD. 

Be an active participant in your healthcare with your doctor. If you suspect you have type 2 diabetes, seek out your primary care doctor and ask for a diagnosis. Know your blood sugars, practice good foot care and tell your doctor if you’re having any chest pain. You also should visit an eye doctor annually as well as an endocrinologist who can help with all aspects of diabetic care. Most importantly, see a cardiologist right away if you’re having any symptoms related to chest pain or shortness of breath with exertion, or find it difficult to carry out your daily activities. Do not downplay your symptoms, because diabetics are at a greater risk than others.

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