Health Tips

Diabetes and your cardiovascular health

Malaysia is a ‘sweet nation’ — we’re on our way to achieve a 20% prevalence rate of type 2 diabetes in the population: that’s 2 in every 10 people you meet that might have diabetes! 

People rarely died of type 2 diabetes itself, but rather the complications of the disease. 7 in 10 Malaysians who died from COVID-19 had diabetes, which is one of the risk factors that increase COVID-19 death rate. In this article, we’re going to discuss how type 2 diabetes increases the risk of cardiovascular diseases, such as heart attack, chest pain and stroke.

💡Risk factor is something that increases a person’s chance of developing a disease.

Relationship between Type 2 diabetes and cardiovascular diseases

Cardiovascular diseases are a group of disorders of the heart and blood vessels and include:

Image credit: https://idf.org/our-activities/care-prevention/cardiovascular-disease.html

The scientific evidence is clear on this: diabetes increases the risk of cardiovascular diseases. In fact, people with diabetes are 2 to 4 times more likely than others to develop cardiovascular disease.

In the 2015-2016 acute coronary syndrome registry (National Cardiovascular Disease Database – NCVD-ACS registry), 44.7% of patients had T2DM as a cardiovascular disease risk. This was the 2nd most common cardiovascular disease risk factor, after high blood pressure at 63.3%. A 10-year follow up study of 5102 patients has found that a good diabetes control reduces the morbidity and mortality associated with many complications, including heart attack. 

Nonetheless, the relationship between diabetes and cardiovascular disease is slightly more complicated than that. Many patients with diabetes also have other medical conditions (called comorbidities), such as high blood pressure and high blood cholesterol, all of which also independently raise the likelihood of developing cardiovascular diseases. Scientists found that instead of aggressively controlling blood sugar only without addressing the other issues that may also lead to cardiovascular disease, it’s better to treat the patient as holistic as possible using the ABC acronym : treat the diabetes (A- HbA1c), high blood pressure (B), high blood cholesterol (C), practise a healthy diet (D), provide treatment to help stop smoking.

If you have diabetes, not only it’s important that you keep your blood sugar under control, but also to achieve the following:

• Optimal blood pressure: 130-139/70-79 mmHg

• Good blood lipid control, such as your cholesterol and triglyceride levels

• Maintain a healthy body weight through physical activity and a balanced diet

Collectively, these can help to reduce your risk of getting cardiovascular diseases. 

How does high blood sugar hurt your cardiovascular health?

Cardiovascular disease includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.

Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke.

Image credit to MedicineNet

Hardening of the arteries can happen in other parts of the body too. In the legs and feet, it’s called peripheral arterial disease, or PAD. PAD is often the first sign that a person with diabetes has cardiovascular disease. 

In people with diabetes, high blood sugar over a long period of time can damage blood vessels and the nerves that control your heart. With that and in addition to uncontrolled high blood pressure and blood lipid levels, you would have the “perfect” gateway to cardiovascular diseases.

Treatment for both diabetes and cardiovascular diseases

The following treatment is a standard regimen for most patients with diabetes:

• Blood glucose lowering medication, such as metformin, gliclazide or insulin injection therapy

• Blood cholesterol lowering medications, such as statins (e.g. simvastatin, atorvastatin) 

• Blood pressure medications

• Heart failure medications (if the person has heart failure), such as furosemide (‘water pill’)

These treatment regimens are important to lower the risk of getting, developing complications or dying from cardiovascular diseases. 

Photo by Laurynas Mereckas on Unsplash

Recently, two groups of diabetes medications known as Sodium-glucose Cotransporter 2 inhibitors (SGLT2-i) and Glucagon-like peptide-1 receptor agonist (GLP1-RA) emerge as the go-to choice for patients with diabetes and cardiovascular diseases. This is because recent scientific evidence has shown that both SGLT2-i and GLP1-RA (particularly liraglutide) have benefits for cardiovascular diseases, in addition to lowering blood glucose level. 

If you’re interested to learn more about this newly emerging therapy, consult your doctor. Even if you do not have access to them yet, taking care of your blood sugar levels using the medications you have is good enough. 

On top of pharmacological treatment, it’s equally important to:

• Quit smoking if you do

• Stay physically active

• Eat a healthy and balanced diet

• Maintain a healthy body weight

Pharmacological treatment alone without a healthy lifestyle is insufficient; taking your medications while also living healthily is the way forward to have a healthy cardiovascular system.

A word from DOC2US

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References

1. Ministry of Health, Malaysia - CPG Management of Type 2 Diabetes Mellitus (6th Edition)

2.  

   CDC. Diabetes and Your Heart. Centers for Disease Control and Prevention. Published May 7, 2021. Accessed November 25, 2021. https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html

3. Primary Prevention of Cardiovascular Diseases in People With Diabetes Mellitus | Diabetes Care | American Diabetes Association. Accessed November 25, 2021. https://diabetesjournals.org/care/article/30/1/162/28217/Primary-Prevention-of-Cardiovascular-Diseases-in

    

Cover image credit: Photo by Madison Agardi on Unsplash

Written by

Ms Joyce Toh