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Diabetes and Heart Health

By Dr. Ambrish Mithal in Endocrinology & Diabetes

Sep 29 , 2022 | 2 min read

Diabetes and the heart have a strong and intimate relationship. The risk of people with type 2 diabetes getting a heart attack is 2 to 4-fold greater than those without diabetes. It has been shown people with diabetes have about the same risk of getting a heart attack as someone who has already had an attack earlier.

Recent research has also shown that heart failure- weakening heart muscle- is common in people with diabetes. A combination of these two effects makes the heart particularly vulnerable to diabetes, making heart disease the leading cause of death in diabetes. Diabetes also negates the relative protection that women have from heart disease. It does seem that having a "sweet" heart is not the best thing!

People with diabetes may often not feel the classic symptoms of heart attack- crushing central chest pain with a feeling of choking. Instead, they may present with just breathlessness, fatigue, or an episode of fainting; therefore, the diagnosis may often be missed. It is important to be alert to the possibility of heart disease in people with diabetes presenting with these symptoms.

How should people with diabetes protect their hearts? Controlling blood sugar levels is essential but not enough. To significantly impact heart disease is controlling cholesterol levels and blood pressure. Maintaining or achieving ideal body weight through healthy diets and regular exercise (~45 mins daily) is another critical element in protecting our hearts.

Replacing simple/refined carbs with fibre-rich complex carbs and trans-or saturated fats with good fats from nuts like walnuts and almonds is recommended. Adding protein to our carbohydrate-rich Indian diets helps! In case there are days when you cannot find dedicated time for exercise, increasing daily activities can make a difference – e.g. climbing the stairs (instead of using the elevator) or walking for daily chores.

Avoid sitting for prolonged periods. Get up from your desk every hour to walk to a colleague's desk or just stretch your body. And it's never too late to chuck the smoking habit. Just do it!

The use of appropriate medication is important for cardiac protection. Keeping LDL cholesterol in control (below 100 or 70 mg/dl, depending on the situation) is vital. Statins are the mainstay for lowering cholesterol and reducing the risk of heart attacks. Much reviled in the media, these drugs are actually life savers when used in the right patients.

The much talked about side effects of statins are uncommon. Do not fall prey to anti-statin propaganda, especially if you have a history of heart attack or stroke or, even in the absence of such a history, are at high risk for heart disease. Achieving blood pressure targets is also necessary with the use of proper medication. Lowering salt intake and avoiding excess alcohol will help you to reach your goals.

The most remarkable advancement in recent times has been the development of anti-diabetic medications that can reduce the risk of heart (and kidney) complications independent of their glucose-lowering effects.

Two such groups of medications – the SGLT2 inhibitors and the GLP1RA molecules have brought about a paradigm shift in our approach to treating diabetes. The good news is that we can prevent or delay heart disease despite diabetes by using all the tools at our disposal. Listening to your doctor is the best strategy.