Double Trouble

By Rachel Hedstrom

Adults with diabetes are twice as likely to have a heart attack or stroke than people without diabetes. While that may sound intimidating, there is good news: Educating yourself about the risks and acting now, experts say, can make a difference.

If you have Type 2 diabetes, learning about the associated risks is one of the best ways to take care of yourself. That’s why Mended Hearts has partnered with the American Heart Association and the American Diabetes Association on “Know Diabetes by Heart.”This important initiative was created to help combat the risks associated with Type 2 diabetes and cardiovascular disease.

Diabetes and Heart Disease: The Connection

Over time, high blood sugar can damage the blood vessels and nerves that control your heart. People with diabetes are also more likely to have other conditions known to raise the risk of heart disease, including high blood pressure and too much LDL (“bad”) cholesterol in the bloodstream. Also, the combination of high triglycerides — a type of fat in the blood — and low HDL (“good”) cholesterol or high LDL can contribute to hardening of the arteries, according to the Centers for Disease Control and Prevention (CDC).

“The way I often explain it to my patients is that having diabetes is like having glue inside your blood vessels. It makes everything kind of sticky,” explains Tracy Wang, M.D., MHS, MSC, a cardiologist and associate professor at Duke University. “The more things get clogged up in there, the more it leads to heart attacks and strokes.”

When Dr. Wang talks to patients with diabetes, she stresses the importance of keeping the disease under control and trying to prevent other cardiovascular risk factors resulting from diabetes from having an impact.

“We’re not talking about de-clogging the system,” she says. “We’re talking about slowing down the gunk build-up, a process that has been shown to improve cardiovascular outcomes for patients living with diabetes.”

Know the Risks

The American Heart Association points to studies showing that cardiovascular disease is the leading cause of death and a major cause of heart attacks, strokes and heart failure for people living with Type 2 diabetes. However, a recent online survey by The Harris Poll of people 45 and older with Type 2 diabetes found that only half recognize their risk or discussed their risk for heart attacks or strokes with their health care provider.

According to the CDC, heart disease is still the leading cause of death for both men and women in the U.S. But you’re twice as likely to have heart disease or
a stroke if you have diabetes. Also, the longer you have diabetes, the more likely you are to have heart disease.

“For example, if you look at patients with heart failure, one-third or more also had diabetes,” Dr. Wang says. “Patients with Type 2 have other cardiovascular risk factors, like high blood pressure, high cholesterol, obesity and lack of physical activity, some of which may be because of diabetes.”

People with both types of diabetes are at higher risk for heart disease, but for different reasons. For those with Type 2, it’s often because years of poor diet, lack of regular exercise and excess weight have made their bodies unable to use insulin effectively or secrete enough insulin to keep up with demand, according to the American Heart Association.

“Type 2 diabetes can cause congestive heart failure,” Dr. Wang says. “The heart muscle gets weakened over time, and that causes congestive heart failure.”

Adopting a Healthy Lifestyle

Heart disease experts recommend that all people with diabetes (whether or not they have experienced a cardiac event) have their heart disease risk factors treated as aggressively as people who have already had heart attacks.

According to the CDC, these lifestyle changes can help people with diabetes lower their risk for heart disease and manage diabetes:

• Follow a healthy diet. Eat more fresh fruits and vegetables, lean protein and whole grains. Eat fewer processed foods (such as chips, sweets, fast food) and avoid trans fats. Drink more water, fewer sugary drinks and less alcohol.

• Aim for a healthy weight. If you’re overweight, losing even a modest amount of weight — 5 to 7% of your body weight — can help lower your triglycerides and blood sugar.

• Get active. Being physically active makes your body more sensitive to insulin, which helps manage diabetes. Physical activity also helps control blood sugar levels and lowers your risk of heart disease. Try to get at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.

• Manage your ABCs:
o A: Get an A1C test to measure your average blood sugar every two to three months; try to stay in your target range as much as possible.

o B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).

o C: Manage your cholesterol levels. o S: Stop smoking or don’t start.

• Manage your stress. Stress can raise your blood pressure and lead to unhealthy behaviors, such as drinking too much alcohol or overeating. Instead, try visiting a mental health counselor, practicing deep breathing or meditation, getting some physical activity or seeking support from friends and family.

“I wish I knew, before everything happened to me, that I could control the diabetes to a certain extent,” says Hyvelle Ferguson, an ambassador for the “Know Diabetes by Heart” program and a member of Mended Hearts Chapter 60 in Ft. Lauderdale, Florida.

Ferguson survived a heart attack and stroke at the age of 41 and recommends that you “join a community of people who are exercising and eating better.” “I found it lonely at first. Exercise was not a big thing for me. But once I found out that exercising helps a lot, just modifying your behaviors and the foods you eat, I did it.”

Ferguson and others also stress how important it is that people with diabetes take the medicines prescribed by their doctor as directed. “Every day is an opportunity to get it right,” she says.

Life-saving Advice

In addition to having more risk factors for heart disease, people with diabetes may also suffer from atypical heart attack symptoms, like shortness of breath, dizziness, passing out or experiencing nausea, upset stomach or incontinence.

“Years prior to my heart attack, I was diagnosed with sciatica, back pain,” Fer- guson says. “I was never given an EKG, but that could have been a sign.”

“I actually had a patient that went to the dentist with what she thought was tooth pain,” Dr. Wang says of a woman with atypical heart attack symptoms. “She was so short of breath by the time she got there that her dentist told her to go to the hospital.”

The neuropathy often associated with diabetes can put someone at risk from suffering a “silent” heart attack, a condition where the nerves in the body might not signal typical heart attack pain. Instead, it might show up with atypical symptoms or no symptoms at all. A heart attack can weaken the heart muscle and is sometimes not detected until
the condition is severe enough to cause congestive heart failure.

“Patients really need to get much more hands-on in their care,” Dr. Wang says. “Vague symptoms need to be evaluated, blood sugars need to be monitored and routine clinical visits are important. It’s increased vigilance and activation on a day-by-day basis.”

Get Educated

Ferguson’s own health journey — one that she says led her to death’s door multiple times — has given her a unique perspective on the role that lifestyle plays for those who have diabetes and could (or do) have heart disease: “It’s all about controlling it so it doesn’t control you,” she says.

If you or a loved one has diabetes, Mended Hearts and the American Heart Association urge you to get educated on your risk factors for heart disease. Find out more and get connected with resources at knowdiabetesbyheart.org.