Diabetes mellitus is an independent risk factor for heart disease that amplifies the effects of other risk factors such as hypertension and dyslipidaemia or abnormal blood fat levels. Compared to people who don’t have diabetes, people who have diabetes are at higher risk for heart disease and may develop it at a younger age and more severely. Nevertheless numerous studies have shown the efficacy of controlling individual risk factors in preventing or slowing heart disease in people with diabetes.
Effect on lipids
Dyslipidaemia denotes abnormal levels of lipids (fat) in the blood including high LDL, high TGL (triglycerides) or both, or a low HDL level that contributes to atherosclerosis and heart disease. The most common pattern in individuals with Type 2 diabetes is elevated TGL levels and decreased HDL levels. Patients with diabetes tend to have a higher proportion of smaller and denser LDL particles, which are more susceptible to oxidation, a process which ultimately leads to thickening of the arteries. Uncontrolled diabetes causes changes in lipid metabolism and lipoprotein composition. This is why diabetics are prescribed a low dose of cholesterol lowering drug despite normal cholesterol levels.
Initial therapy involves lifestyle intervention that incorporates weight loss, increased physical activity, restricted saturated fats and transfat and more fibre in the diet, reduction of alcohol and stopping smoking. Improved blood sugar control usually lowers TGL to an appreciable level. If targets are not met pharmacological intervention needs to be considered.
Hypertension
Hypertension is commonly found along with diabetes, with prevalence depending on type of diabetes, age, obesity, and ethnicity. It is a major risk factor for diabetic heart disease. Blood pressure should be measured at every routine visit, (at least) once in 3 months. Lifestyle therapy consists of weight loss, increased physical activity, increased consumption of vegetables, reducing sodium and alcohol intake and avoiding smoking .
These strategies may also have a positive impact on blood sugar control and lipid control. In case this does not meet the needs, pharmacologic therapy may be required. Multiple drug therapy (two or more drugs) is generally required in diabetic patients.
Stringent blood sugar control may be appropriate for individual patients. Goals should be individualised based on duration of diabetes, age/life expectancy, co-morbid conditions, known heart disease or other advanced complications. In individuals with overt heart disease, a lower LDL cholesterol goal of <70 mg/dL is ideal.
Risk factors you can control
Smoking: damages blood vessels, leads to unhealthy cholesterol levels and raises blood pressure. It also limits the amount of oxygen that reaches the heart and tissues.
Central obesity: is carrying extra weight around the waist. Waist circumference reflects the amount of high risk internal fat. Regardless of weight, reducing waist circumference will reduce risk of heart disease.
Unhealthy diet: Make healthy choices when eating out. Eat home-cooked food as much as possible. Limit portion size during each meal. Snack on salad, soup, buttermilk, sundal, sprouts, brown bread sandwiches.
Stress: and anxiety can cause arteries to tighten, raise blood sugar and blood pressure. Stress also makes you more likely to smoke and consume alcohol or foods high in fat and sugar.
