Relationship Between Heart Disease and Diabetes
Atherosclerotic cardiovascular disease (ASCVD) and heart failure are two leading causes of illnesses and deaths in individuals with diabetes.1 ASCVDs are heart diseases originating from atherosclerosis, the hardening of the arteries from build-up of cholesterol plaques. Examples of ASCVDs include coronary heart disease, peripheral arterial disease, and cerebrovascular disease.
Diabetes and these heart diseases have a close relationship because they often share common coexisting conditions such as obesity, hypertension (ie, blood pressure defined as >130 mm Hg/80 mm Hg), and dyslipidemia (ie, imbalance of blood lipid levels). In addition, having diabetes is an independent risk factor for developing heart disease. Insulin resistance in diabetes is associated with increased inflammation and lipid accumulation, which can negatively affect the health of blood vessels and accelerate atherosclerosis.
Preventing and Managing Heart Disease in Diabetes
As heart disease is a big disease burden in the diabetic population, it is important to manage its risk factors early on. The ASCVD risk calculator by the American College of Cardiology/American Heart Association is a useful tool that estimates the 10-year risk of a first ASCVD event by taking into account various risk factors such as blood pressure, cholesterol levels, diabetes status, and smoking status. In reducing risk factors, controlling blood pressure and blood lipid levels are considered a priority.
Blood Pressure Control – Hypertension is a major risk factor for heart disease and is much more prevalent in the diabetic population, possibly due to factors such as diabetes-associated changes to kidney function, obesity-induced insulin resistance, hyperinsulinemia (ie, high levels of insulin).1,2
Blood pressure management has shown to effectively reduce the risk of ASCVD events and heart failure.1 The American Diabetes Association recommends routine blood pressure screening and that individuals with elevated blood pressure to engage in lifestyle intervention and receive antihypertensive therapy. For individuals with blood pressure of >120/80 mm Hg, weight loss, increased physical activity, and eating a Dietary Approaches to Stop Hypertension (DASH)-style diet (reducing sodium intake while increasing potassium intake, with moderate alcohol intake) are recommended. For individuals with blood pressure of >130/80 mm Hg, antihypertensive therapy should be considered, beginning with a single drug.
Lipid Control – Insulin resistance, hyperglycemia, and hyperinsulinemia in diabetes increase the levels of low-density lipoprotein cholesterol (ie, “bad” cholesterols) while decreasing levels of high-density lipoprotein cholesterol (ie, “good” cholesterols), contributing to conditions favorable to atherosclerosis.2 Lipid profile should be assessed regularly and lifestyle modifications should be initiated, including weight loss, exercise, eating a Mediterranean or a DASH-style eating pattern, reducing saturated and trans fat intake, and increasing omega-3 fatty acid and fiber intake. In individuals with diabetes at risk of ASCVD, statin therapy may be initiated in addition to engaging in lifestyle changes. In individuals of all ages with diabetes and ASCVD, high-intensity statin therapy should be initiated to reduce LDL cholesterol levels, along with other medications as needed.
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