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Heart Disease and Diabetes: There’s a Link

09 November 2022

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Heart disease, AKA cardiovascular disease, affects people with diabetes disproportionately. Most people who have type 2 diabetes will also experience cardiovascular disease. In the United States, about one in ten people has diabetes. Of the many people who have diabetes, about 95 percent have type 2 diabetes.  Those are some big numbers. 

What’s the relationship, though? And exactly what is cardiovascular disease? While diabetes’ effect on the body, specifically the blood vessels, can trigger or hasten the development of heart disease, what’s perhaps even more striking is how many of the risk factors for heart disease are also risk factors for diabetes. The good news, though, is that many of these risk factors are lifestyle driven, meaning they are things you can change for the better!

First of all, heart disease (AKA cardiovascular disease) is a little bit of a catchall phrase. It’s used to describe conditions or events including arrhythmia, AKA palpitations, AKA a fluttery feeling in your chest; coronary artery disease (CAD), which decreases blood flow to the heart, increasing the odds of a heart attack or stroke; myocardial infarction (heart attack), a malfunctioning of the heart caused by blocked/decreased blood flow; or sudden cardiac arrest, the abrupt loss of heart function, consciousness and breathing (yet not the same as a heart attack). 

Diabetes is the word used to describe the three types of diabetes. This chronic disease is all about how your body makes and/or uses insulin, a hormone produced by the pancreas, in enchantingly-named areas called Islets of Langerhans. These are little clusters containing four types of cells, each of which secrete a different peptide: alpha cells secrete glucagon; beta cells secrete insulin; delta cells secrete somatostatin and P (F) cells secrete pancreatic polypeptide. Glocagon mobilizes glucose; insulin is in charge of sugar storage; somatostatin inhibits alpha and beta cells and pancreatic polypeptide regulates the enzyme secretion of other pancreatic cells.

The three types of diabetes are:

Gestational diabetes occurs in pregnant women who’ve never had diabetes. It increases the likelihood of health problems for the baby. For the mother, gestational diabetes can increase the risk of developing type 2 diabetes later. About half the women who develop gestational diabetes also develop type 2 diabetes. The CDC reports that gestational diabetes will affect between 2 and 10 percent of pregnancies in the US. Risks to the infant include being extra large (more than 9 pounds), potentially making for a difficult delivery: premature birth, which can cause breathing problems; having low blood sugar; type 2 diabetes later in life.  

Type 1 diabetes stops the body from making insulin. It’s thought to be triggered by an autoimmune reaction – wherein the body’s immune system attacks your own body by mistake. Usually, type 1 diabetes is discovered in young adults, teens and children. Symptoms tend to develop quickly. People with type 1 diabetes must take insulin daily. Some day researchers will discover how to prevent type 1 diabetes, but we don’t know how just yet. Only five to 10 percent of people with diabetes have type 1.

Type 2 diabetes means your body isn’t terrific at using its insulin and isn’t able to regulate blood sugar effectively. This is the most common form of diabetes. Ninety to 95 percent of people with diabetes have type 2. This form of diabetes is usually diagnosed in adults. It progresses slowly, and symptoms may not be noticeable, so folks who are at risk should be tested. Rick factors include being older than 45, being physically active fewer than three times per week, having prediabetes, being overweight and having had gestational diabetes. Type 2 diabetes can be diagnosed with a blood test and managed (or even eliminated) with lifestyle changes including healthy diet, weight loss and exercise.

Diabetes and heart disease are linked. If you have diabetes, you’re twice as likely to also have heart disease (or a stroke) than a person who does not have diabetes. You’re also likely to develop it at a younger age. The ways diabetes can cause or raise the risk for heart disease can be sneaky, with no noticeable symptoms.

High blood sugar can, over time, damage your blood vessels. It can also damage the nerves that control your heart. Also, diabetes contributes to the likelihood of high blood pressure; unhealthy cholesterol levels (specifically too much LDL or ‘bad’ cholesterol); and/or high triglycerides (a type of fat found in the blood). This plus the unhealthy cholesterol levels can contribute to hardening of the arteries (coronary artery disease, see above).

Risk factors that contribute to the development of heart disease and type 2 and gestational diabetes include:

  • Obesity 
  • Smoking 
  • Lack of physical activity 
  • Poor dietary choices

Changes you can make to lower your risk for type 2 and gestational diabetes and heart disease include: 

Testing. To test for type 2 or gestational diabetes, your doctor will perform one or more of the following:

A1C tests measure your average blood sugar level over the last two to three months. Normal A1C is below 5.7 percent. Between 5.7 percent and 6.4 percent is considered pre0diabetic; a percentage of 6.5 or more means you’ve got diabetes.

Glucose tolerance tests measure your blood sugar levels before you drink a beverage containing glucose – and after. Before the test, you’ll fast overnight. You’ll have blood drawn before you drink the glucose and again at the one-, two- and three-hour marks afterward. Blood sugar should be 140 milligrams per deciliter (mg/dL) or lower. A person with prediabetes will be in the 140-199 mg/DL range; a result of 200 mg/dL or higher means diabetes.

Fasting blood sugars tests measure the sugar in your blood after not eating overnight (fasting). A normal fasting blood sugar level is 99 mg/dL; 100 to 125 mg/dL is prediabetes; 126 mg/dL or higher indicates diabetes.

Random blood sugar tests measure your blood sugar level at that moment. A result of 200 mg/dL or more means diabetes. This test is performed without fasting.
 To test for heart disease, your doctor may order one or more of the following:

Holter monitoring involves wearing a portable electrocardiogram (AKA EKG or ECG) for 24 hours or longer so it can record your heart’s activity. It is able to detect fluctuations in heartbeat that aren’t detectable by EKG testing.

Exercise (stress) tests involve riding a stationary bike or walking on a treadmill while your heart is monitored. These tests indicate how your heart handles physical activity and whether exercise triggers symptoms of heart disease.

Echocardiograms are noninvasive, imaging tests which use sound waves to create a ‘picture’ of your heart, and your blood as it moves through. It also shows how well blood moves through your heart’s valves. These tests are useful in determining whether a valve may be leaky or narrowed.  

Elelctrocardiograms (ECGs or EKGs) are quick, painless tests which can indicate whether your heart is beating too slowly or too fast by recording its electric signals.

Cardiac MRI. A magnetic resonance imaging (MRI) of the heart uses computer-generated radio waves and a magnetic field to create images of the heart.

Cardiac catheterization involves inserting a thin, long, flexible tube into a blood vessel – often in the wrist or groin – which is then guided to the heart. Dye is sent through the tube, which helps the arteries of the heart show up more clearly during X-rays taken during the test.


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