Last month, we launched a new series on diabetes complications. The idea is definitely not to use scare tactics to convince you to take better care of yourself, but rather to embrace the notion that “knowledge is power” and that if you are diagnosed with a complication, life goes on…
(Hey, we’re facing our own worst fears here, too)
It just so happens that February is National Heart Month (go figure), so this month we’re focusing on that nasty thing that can happen to your heart with diabetes: cardiovascular disease. Our expert help is Dr. Robert Eckel, an endocrinologist and past president of the American Health Association. Not only is he a professional expert, he’s also had type 1 diabetes for the past 50 years!
PWDs are two to four times more likely to suffer with cardiovascular disease, so listen up! Like retinopathy, there are several types of cardiovascular disease, with their own symptoms and treatments:
1. Coronary artery disease: This is the first type of heart disease and is caused by narrowing or blocking of the blood vessels that travel to your heart via fatty deposits. If the blood vessels to your heart become partially or totally blocked, then the blood supply is reduced or cut off. When that happens, a heart attack can occur.
Coronary artery disease can cause a heart attack. During a heart attack, symptoms include:
- chest pain or discomfort
- pain or discomfort in your arms, back, jaw, neck, or stomach
- shortness of breath
- sweating
- nausea
- light-headedness
Dr. Eckel points out that due to nerve damage from diabetes, a heart attack could be painless, and you might not even know if you’ve had one. Scary! If you have had a heart attack, your doctor may put you on a blood thinner, like aspirin, which can help reduce the chances of a second heart attack.
2. Heart failure: This is a bit of a misnomer because it does not mean the heart stops working. This second type of heart disease occurs when the heart isn’t able to pump as much blood as it should. There are actually different types of heart failure. Symptoms include shortness of breath, coughing, wheezing, fatigue and increased heart rate. Although damage to heart tissue that causes heart failure cannot be reversed, treatments like blood thinners, statins, ACE inhibitors and other medications can help alleviate the symptoms.
3. Stroke: A stroke happens when the blood supply to part of your brain is suddenly interrupted, which then causes damage to brain tissue. Especially scary stuff. A stroke often causes movement and speech problems.
During a stroke, symptoms include:
- sudden weakness or numbness of your face, arm, or leg on one side of your body
- sudden confusion, trouble talking, or trouble understanding
- sudden dizziness, loss of balance, or trouble walking
- sudden trouble seeing out of one or both eyes or sudden double vision
- sudden severe headache
If you have symptoms of a heart attack or stroke, you need medical attention right away! Call 911 or have someone near you call 911. Getting medical attention within an hour of a stroke can help prevent long-term damage, and doctors will be able to run medical tests to assess your needs and what kinds of medications you may require.
4. Peripheral arterial disease (PAD): This happens when blood vessels in the legs are narrowed or blocked by fatty deposits, and blood flow to your feet and legs decreases. Unfortunately, if you have PAD, you also have an increased risk for heart attack and stroke. An estimated 1 out of every 3 people with diabetes over the age of 50 have this condition.
Peripheral arterial disease affects the blood flow to the legs. Blood vessels are blocked or narrowed, and can cause the following symptoms:
- Leg pain, especially when walking or exercising
- Numbness, tingling, or coldness on legs and feet
- Sores or infections on your feet or legs that heal slowly
If you have PAD, managing your risk factors like lowering your cholesterol and A1c can help, especially since folks with PAD are at an even higher risk for heart attack and stroke. There are also some surgical procedures that can be done to treat PAD to open or bypass arteries.
Other Symptoms
Another sign of heart disease is angina, which is a pain that occurs when a blood vessel to the heart is narrowed and the blood supply is reduced. Chest pain is often the most noticeable symptom, though pain can also occur in shoulders, arms, jaw or the back. The pain can be more noticeable during exercise.
Chest pain is the main symptom for men, but women may also notice shortness of breath or a crushing chest pain. Again, chest pain may not be as severe in people with diabetes because diabetes can cause nerve damage, which damages pain receptors, Dr. Eckel says, and women suffer chest pain less often than men.
Treatment
In addition to specific treatments for each specific type of heart disease, the main treatment for heart disease is to get back on track with some lifestyle changes: a heart-healthy diet (lots of fruits and veggies, lean meats, and fish), lowering LDL cholesterol and triglycerides, reducing A1c, exercising more often, and dumping any bad habits, like smoking.
With coronary heart disease, “reversibility occurs only as stabilization of plaque,” Dr. Eckel says. Like the plaque on your teeth, this plaque is a build-up, in this case of cholesterol in the arteries. You can modify the plaque, not in terms of volume, but in terms of its makeup. Lowering your cholesterol and taking better care of your health means the plaque will get firmer, and less likely to cause a barrier to your blood stream. That is, a heart attack when plaque breaks up and causes a clot, so you want the plaque to be as firm as possible. Heart failure cannot be reversed once damage is done, but medications can help offset the symptoms.
Prevention
As in… let’s try not to go there. To avoid cardiovascular disease, you need to know your numbers — specifically your lipids, blood pressure and A1c.
As a reminder: LDL is the bad kind of cholesterol, and HDL is the good kind. For people with diabetes, your LDL goal should be under 100. High levels of LDL cholesterol and triglycerides can cause a build-up in the arteries, increasing your risk of heart attack or stroke. Everyone with diabetes (type 1 or type 2) should have their lipids checked once a year, through a blood test at a laboratory. This is never much fun, but it’s over in a flash, and could help you prevent serious health problems!
Dr. Eckel recommends that all PWDs (for women, only those not planning a pregnancy soon) should be on a statin once they reach adulthood. Statins are those much-discussed pills to lower cholesterol: many studies, including the UK’s Heart Protection Study, showed they were effective in reducing the risk of cardiovascular disease in folks who are at risk. However, Dr. Eckel does say that the long-term impact of statins remains “uncertain.” So you have to weigh the risks and benefits for yourself.
The ADA sets a goal for blood pressure of under 130/80. Of course, you should have yours checked during every routine medical visit. If you have diabetes and high blood pressure, the ADA recommends the use of an ACE-inhibitor or ARB to lower blood pressure. ACE inhibitors prevent a hormone called angiotensin from forming and narrowing blood vessels, while ARBs keep blood vessels open and relaxed. Both also help to protect your kidneys.
Although the impact of A1c on cardiovascular disease is still being studied, all the powers that be recommended we maintain an A1c of 7% or lower to reduce our risk. A reduction in A1c also lowers the risk for all complications, so as we know, this is definitely a number to pay attention to!
These numbers, plus other risk factors like family history, will clue your doctor into your risk and help him/her decide whether any preemptory medications or additional tests are in order. Although the ADA offers a laundry list of medical tests that can be done to find out if you have heart disease, Dr. Eckel says that in the absence of any hint of symptoms or elevated cholesterol or blood pressure, screenings are probably not necessary.
And finally: don’t smoke. “Smoking and diabetes is an oxymoron,” Dr. Eckel says. “Those two should never coexist.”
Heart disease is definitely one of the most prevalent and scary-sounding diabetes complications, but there is a lot we can do to prevent it from happening, starting with taking a good, hard honest look at our lifestyle choices and current test result numbers. Of course, some people are just unfortunate in their gene pool – so unfair!
Have you experienced heart disease yourself, or someone you love with diabetes has? We’d love to hear your experiences in the comments below.
One side of my family has all died from heart disease, hart attack or stroke so it’s something that is always on my mind. The stats about people not knowing they are at risk or what the risk factors are is quite scary.
This is what the company I work for did this year. They also donated $5 to the American Heart Association for each person who wore red. 26 people in the office did.
http://tinyurl.com/6jhm8hv
Why take a statin (which has proven dangerous side effects) if you don’t need one? Sounds like ridiculous advice and I don’t understand the recommendation.
Those who are “unfortunate in their gene pool” still can do a lot via a healthy lifestyle and I hope they don’t feel they’re hard work doesn’t go in vain. Genes don’t account for 100% of the outcome of our health.
Thanks for all the great heart health info, DiabetesMine, I’m bookmarking this.
@Sysy: Obviously, you will want to discuss with your doctor before going on a statin, and Dr. Eckel did mention that studies showing the long-term impact of statins were unclear. Sadly, things are never as simple as we want them to be!
So true, I’m crossing my fingers on that one!
I had a coronary artery spasm when I was 44. That means that my arteries weren’t clogged, but had just clamped down, and the result was like a heart attack. My father had his first heart attack before the age of 53, which is when he had his second, and the evidence of the first showed up on the EKG. He was thin as a rail, and non-diabetic, but his cholesterol was up in the 300′s (this was before cholesterol-lowering drugs), and I have inherited that tendency. And, of course, I have diabetes. So I have a triple-whammy for heart disease. I’m doing everything I can for it, and have a good cardiologist who has taken care of me for 19 years, and so far, so good, but I’m always aware of the risks. I DO take statins, because of my high risk, and have NO side-effects from them. You just have to do your best, and let nature take its course.
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To Sysy’s comment on taking statins: Our 12 year old T1 son was prescribed a statin 6 months ago due to an LDL level of 119. After much discussion with other medical professionals and much time spent in consideration of the real risks we opted to revisit the idea of a statin in several years rather than expose a child to a dangerous medication with no real knowledge of the long term consequences. Our thinking was that increased risk of heart disease is not the same thing as having heart disease and the long term unknowns of giving statins to a growing child are not worth playing with. Our Endo was pretty pushy about it but we were increasingly convinced that our course was best for our son. So imagine our surprise when we learned that his LDL level is probably not really that high. It turns out that most cholesterol tests use a calculation to estimate your LDL levels because a separate test that really does measure LDL is time consuming and expensive. The Friedewald calculation says LDL = total cholesterol – HDL – (triglycerides/5). However the calculation is thrown off by high or low triglyceride levels. So if your triglycerides are below 40, as our son’s are, or above 400, you would need a specific LDL test to accurately measure your LDL. With that in mind I am stunned that statins are so frequently offered as a first line of defense against heart disease especially for children. Whether their known side effects concern you or not, they definitely have not been around long enough for long term results to be determined. So why wouldn’t every patient insist on an accurate testing of their LDL level before embarking on a dangerous drug? My guess is that, like my family, they have no idea their LDL hasn’t really been measured.
I have 2 sisters and a nephew with Type I diabetes. My oldest sister was 14 at diagnosis and lived in denial. She began smoking in her teens and smoked until she had a heart attack at 65. She was lucky to be alive that long, as she never managed her diabetes well at all. Her husband could hardly awaken her many mornings. She’s still alive, but can barely function and looks 40 years older than she is. I share this to help your readers understand the consequences of not caring for him or herself.
Five years ago, I had quadruple bypass surgery. I was 39 at the time. I have had T1 now for 34 years, and I can say with a great amount of certainty that I wouldn’t have needed such extreme treatment had I taken better care of my condition as a younger person. (I now wear a pump and CGM, but struggle keeping my A1C below 8%. I’ve just started the CGM, so I’m hoping for some good news on the AIC front in the next 3 to 6 months when I get it checked.) Although heart disease does run in my family (my brother passed away suddenly at 37 from heart failure, my father at 66), I’ve never had the addiction to cigarettes that they did. So whose to say? Me without diabetes, them without cigarettes – we’d all be here now sans chest scars and cigarette stained fingers. Anyway, since the surgery (five years) I’ve been on an ACE inhibitor, a statin, aspirin, and a beta blocker. My blood pressure and cholesterol (HDL, LDL, triglycerides) are well within acceptable range, my weight is steady at a BMI of 21. (I’m 5’6″, 140 lb) I keep regular appointments with my endo and cardiologist, but at my last cardio visit, I was told unless I was having any suspcious symptoms, he really didn’t need to see me again for another year.(!!!) So, my utterly uneducated conclusion is, something’s working.
I think the concerns about the long term effects of the meds I’m taking are completely justified, especially if they are being taken by people younger than, say, 20-25. But since I didn’t start taking them until I was 39, I figure I’ve beat some pretty good odds just making it this far. (One doctor told me that the long term prognosis for a person with diabetes who’s had the surgery I did was 10 years. Combine that with the fact that I was told at the age of 10 that I would be lucky to make it to 40, and you can see why I’m tickled to still be here
Just my two cents.
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