Diabetes can affect the heart in a number of different ways. The most common thing that we think about when we think about diabetes is narrowing of the blood vessels over time where fat lines, the blood vessels increasingly with a duration of diabetes and that increases the risk of heart disease and strokes.
In addition to that, the effect of diabetes in the heart can affect the heart muscle directly, whereby the heart muscle becomes stiff. It doesn’t relax as well leading to heart failure. So, the complications of diabetes are potentially heart attacks, potentially strokes, obviously affecting the brain and heart failure.
How are heart problems diagnosed in diabetic patients?
One of the challenges in people with diabetes is that the pain threshold is a lot different in people with diabetes. So often, typically, when somebody’s having a heart attack, they express chest pain, sweating discomfort and if you’ve had diabetes for a long time, they actually don’t get the same feelings of pain. So, it’s so often heart diseases are more silent.
So you need to have a high threshold for diagnosis and if people with diabetes, have slightly atypical symptom, maybe start to get breathless on walking, that could be a sign that there’s a problem with the blood supply to the heart. Or it could be a sign that the heart muscle is not pumping adequately.
One of the challenges is, people with diabetes often have heart failure where the heart is not pumping properly and it’s undiagnosed in about 25% of people. So, there are a couple of ways of thinking about diagnosing this. The first is with scans of the heart. The second is basically blood tests that showed that the heart is being overworked and is being stressed and the third thing is in people with slightly atypical symptoms whereby maybe they’re getting a low breathlessness on walking.
This is what’s called a stress test, either on a treadmill, a bicycle or doing what’s called a stress echocardiogram of the heart whereby increase the heart rate in you. Just take images of the heart muscle to see if it’s pumping properly in response to exercise.
Do heart problems in diabetic patients to be treated differently?
Heart problems in patients with diabetes are treated with the same medications as in people without diabetes. That basically means that people with diabetes will also need cholesterol-lowering medications and we know that for one unit, lowering in so-called bad cholesterol or LDL, the patients with diabetics with diabetes got about a 22% reduction in risk.
But often, even when you’ve lowered blood pressure, you’ve lowered cholesterol, you might often use things like aspirin and this is obviously on top of things like lifestyle. Having diabetes per se gives you the so-called high residual risk. So blood pressure, cholesterol and lifestyle factors become more important and often you have to treat those much, much, more aggressively in people with diabetes.
The other problem that often we find with diabetes is kidney problems and once kidney problems start, that often increases the likelihood of heart failure, and so that means that kidney disease needs to be treated much more early, particularly when detected early.
How can I avoid heart diseases if I have diabetes?
The issue with diabetes is that on average if you have diabetes, you double the risk of heart disease throughout your life. And the earlier somebody develops diabetes, the more life-years you lose. So, on average, a 40-year old with diabetes loses about 6 years of life. Half of those are going to be from heart disease or strokes.
If you like to claw back those six years, you have to basically modify your lifestyle. Think about medications that traditionally reduce the risk of diabetes progression or complications. So, that basically means cholesterol lowering. It means controlling blood sugars, blood glucose levels. It means controlling blood pressure and doing that early before complications develop.
Prevention really should start early and if somebody’s unfortunate enough to have diabetes and heart disease, they need to be treated even more aggressively. So, if your age 16 and you already got diabetes and have had heart disease, on average, the number of life-years lost is about 12.
So the main take-home message for people with diabetes is prevention, long term, starting early, aggressive control of risk factors early and maintaining that throughout life.