By Tanya Isch Caylor
If you have diabetes, you have to be concerned about cardiovascular disease. No matter how fit your body may appear on the outside, the reality is that heart problems are much more common for people with both type 1 and type 2 diabetes.
According to the American Heart Association, adults with diabetes are two to four times as likely to die from heart disease than the population at large. Among diabetes patients age 65 or older, at least 68 percent die from some form of heart disease. Another 16 percent die of stroke.
Cardiovascular disease (CVD) is a broad category of problems that can affect the heart and blood vessels. These include heart failure, stroke and coronary artery disease, just to name a few of the life-threatening conditions that may develop.
Part of the problem, particularly among those with type 2 diabetes, is that they are much more likely than the general population to struggle with other risk factors for CVD, such as obesity, cholesterol, high blood pressure and abnormal triglyceride levels. If they smoke, lead a sedentary lifestyle and overindulge in alcohol, that increases the risk even more.
But diabetic CVD is more than just a lifestyle issue. Though specific data on CVD and type 1 diabetes is more limited than on type 2 and the overall diabetes population, studies show that those with type 1 diabetes also face a much higher risk than the population at large.
Type 1 vs. Type 2
There is an increasing amount of interest in the specific pathology of how CVD affects the heart and blood vessels of those with diabetes. Though data distinguishing between how CVD is expressed in type 1 and type 2 diabetes is still limited, some differences have emerged. In one study, arterial plaque found in type 1 patients tended to be softer and more fibrous than that found in type 2 patients. In another study, type 2 patients were found to have both more obstructive lesions and more lesions in general than type 1 patients.
However, arterial plaque lesions found in both type 1 and type 2 diabetes patients contained more fats, blood clots and bloated white blood cells than nondiabetic patients, according to a September 2014 report in the journal Circulation.
Diabetic CVD symptoms
One of the scary things about diabetic CVD is that changes may be occurring in the tissue of both the heart and the blood vessels long before any symptoms are noticed. In some cases, CVD isn’t diagnosed until after a heart attack, stroke or heart failure. That’s why it’s so important to watch for symptoms and discuss them with your doctor. Men are more likely to have chest pain with CVD, while women may feel chest discomfort along with shortness of breath, nausea and fatigue. According to the Mayo Clinic, other symptoms to watch out for include:
- Pain, numbness or weakness in arms or legs
- Pain in the neck, jaw, throat, upper abdomen or back
Treating diabetic CVD
Doing the best you can to manage your diabetes is an excellent way to keep your heart and blood vessels healthy. You can reduce your risk of CVD by following the “ABCs,” a recommendation by the National Institutes of Health:
A – Aim for A1C test results below 7 percent.
B – Keep your blood pressure under control, ideally under 140/90 mm Hg.
C – Cholesterol can clog blood vessels. Keep your LDL (“bad” cholesterol) below 100 mg/dl. If you already exhibit signs of heart disease, aim for 70 mg/dl.
S – Smoking makes your heart work harder. Quitting reduces the risk of stroke and heart attack as well as nerve damage, kidney disease, vision problems and amputation. Your blood glucose, blood pressure, cholesterol and circulation may improve, too.
Though diet and exercise can help people with type 2 diabetes meet these goals, many need prescription drugs such as statins, a class of drug that blocks the production of cholesterol by an enzyme in the liver. (See chart.) Some experts believe that diabetes patients over age 40 should take a statin drug as a precaution even if they do not exhibit symptoms of heart disease.
Some drugs used to lower blood glucose levels in people with type 2 diabetes may also reduce the risk of cardiovascular death and heart failure. According to a November 2016 report in Cardiovascular News, some cardiologists are now prescribing empagliflozin (Jardiance) to patients who have both diabetes and cardiovascular disease. Another glucose-lowering drug that has been linked to a reduction in the risk of stroke and heart attack is liraglutide, also known as Victoza. (See chart.)
Intensive insulin treatment can also lower the risk of CVD. According to a 2005 study in The New England Journal of Medicine, the risk of a first heart attack or stroke was reduced 57 percent with “intensive insulin treatment,” defined as regular insulin injections or use of an insulin pump with dose adjustments to meet stringent blood-glucose goals. (In that study, “conventional treatment” consisted of one or two daily insulin injections with no specific blood glucose goals.)