Every year, the International Diabetes Federation observes a World Diabetes day to address issues facing the global diabetes community. You can also make a valuable contribution on this day by spreading awareness about this metabolism disorder. Many health conditions are linked with diabetes, such as poor heart health. Here are some expert inputs from Dr Dheeraj Kapoor, Consultant Endocrinologist at Artemis Health Institute, Gurgaon to help us better understand the links between diabetes and heart health. But first let's take a look at how diabetes is linked to other diseases at large...

Most of the food we eat is broken down into glucose, the major form of sugar in blood, and it is the main source of fuel for the body. Diabetes develops when the pancreas, a large gland behind the stomach doesn’t make enough insulin and the cells in the muscles, liver and adipose tissue (fat cells) don’t use insulin properly. As a result, the glucose accumulates in the blood stream while the body is starved of it. Uncontrolled diabetes can affect your nerves, eyes, kidneys and blood vessels leading to heart diseases & stroke.

Connection between diabetes & heart disease: People with diabetes are twice as likely to suffer from heart disease as compared to their non diabetic counterparts. They also tend to develop heart disease at a younger age. In fact serious cardiovascular disease can begin before the age of 30 years in diabetics. The chance of a middle aged diabetic getting a heart attack is similar to that of a person who has already had a heart attack in the past. Women who have not undergone menopause have a lesser risk of heart attacks as compared to their male counterparts of the same age, an advantage that is nullified if they have diabetes. 

What causes heart diseases in persons with diabetes? Persons with diabetes experience changes in blood vessels which include thickening of the lumen & also formation of plaques. Diabetics also have lipid abnormalities and their blood is more prone to clotting because of high fibrinogen or plasminogen activator inhibitor levels in blood which makes it more vulnerable to clotting, resulting in blockage of blood supply leading to heart attack.

What are the risk factors for heart disease in people with diabetes:

• Family history of heart disease is a risk factor, more so if the family members have had a heart attack at a younger age, that is males before age 55 and females before the age of 65.
• Central obesity- Central obesity which means carrying extra weight around the waist, as opposed to hips is defined as a waist measurement of more than 40 inches in men and more than 35 inches in women. This excess abdominal fat increases the production of LDL, a type of bad cholesterol, which accumulates in the lumen of blood vessels leading ultimately to blockade.
• Abnormal blood cholesterol levels- Low density lipoprotein (LDL) can deposit inside the blood vessels, which in turn can become blocked leading to heart attacks. Triglyceride, another form of bad fat can cause structural changes in LDL making them denser and more likely to deposit in the blood vessels. Keeping the above points in mind, the upper limit of both these components have been kept lower in diabetic patients. Triglyceride levels should be less than 150 mg/dl & LDL levels should be below 100 mg/dl in diabetics. HDL is (High density lipoprotein) the god cholesterol, which scavenges LDL from the vessel lumen and therefore low HDL levels also increase the rate of a heart attack. HDL levels should be above 40 m/dl in men and above 50 m/dl in women. 
• High blood pressure- In hypertension, the heart has to work harder to pump blood which can strain the heart, damage the blood vessels and increase the risk of a heart attack. Blood pressure levels in a diabetic should be aimed below 130/80 mmHg
• Smoking- Smoking on its own doubles the risk of having heart disease since it narrows down blood vessels and it can only worsen the impact of diabetes on blood vessels. It also increases the risk of other complications like eye and kidney problems, besides increasing the risk of amputation. Hence it is paramount for a diabetic to quit smoking.

Prevention of heart attack  

Heart friendly diet- Diet planning should be done in coordination with a dietician to achieve the following goals:

• Include at least 14 gms of fibre daily for every 1000 kcal consumed. Foods high in fibre help lower the blood cholesterol. Oats, whole grain bread, dried beans, peas, fruits and vegetables are good sources of fibre. Isabgol has a good impact on lipids.
• Saturated fats should be cut down to a minimum, as they increase the cholesterol levels. Foods that need to be avoided include red meat, butter ghee, dairy products with fat and oils like coconut oil. Egg yolk should be avoided. 
• Cholesterol intake ideally should not exceed 300 mg per day. Cholesterol rich foods include red meat, dairy products & eggs.
• Transfats which raise blood cholesterol levels should also be reduced in diet. Therefore food items like cookies, crackers, snacks, bakery products, salad dressings, fried foods & microwave popcorns are best avoided.
• Contrary to popular belief of restricting carbohydrates in the diet , at least 60% of our daily calories should come from carbohydrates.

Make physical activity a routine

The aim should be at least 30 mins of regular exercise. These may include a brisk walk, swimming, cycling or a treadmill. It is a good idea to use stairs instead of elevators. The above mentioned exercises should be done at least 5-6 days a week. If one has not been exercising of late, one must consult the doctor before embarking upon a rigorous exercise schedule. 

Reach & maintain a healthy body weight

If the patient is overweight one must try to achieve an ideal body weight. The body mass index which is weight in kg divided by the square of height in meters should be less than 23 kg/msq. The aim should be to lose no more than 1-2 pounds per week. 

Two major heart diseases in diabetic patients

• Coronary artery disease- It is also called ischemic heart disease and is caused by thickening and ultimate blockage of vessels carrying blood to the heart. That causes vessels to the heart becoming narrower or blocked by fatty deposits, leading to a heart attack.
• Heart failure- It is a chronic condition in which the heart cannot pump blood properly. It doesn’t mean that the heart has stopped functioning. Symptoms can worsen over time.

Diabetics are at a higher risk of heart failure than non diabetics. Blockage of blood vessels and high blood glucose levels can damage the heart muscle and cause irregular heartbeats. Diabetes can interfere with pain signals normally transmitted by the nerves and diabetics may therefore have a painless heart attack.

Symptoms: These include chest discomfort and pain radiating to arm, back, jaw neck or stomach. There may be shortness of breath, sweating or nausea. Women are less likely to have chest discomfort and more of breathlessness.

Prevention: One should get checked at least once a year for heart disease risk factors like cholesterol and blood pressure. Further testing may be required in those having high risk of heart diseases or symptoms. 

Diabetes and heart disease go hand in glove and prevention encompasses strict sugar control along with tight blood pressure and lipid control and cessation of smoking along with exercising regularly. 

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