How Diabetes Affects the Heart

Okay, so heart attacks are scary and awful and everyone should fear them. But why should a diabetes patient be more concerned about having "The Big One" than any other Tom, Dick, or Harriet on the street?

Because, compared to the general population, people with type 2 diabetes are two to six times more likely to have a heart attack. Furthermore, heart attacks tend to be fatal more often in diabetes patients. Scientists aren't sure why diabetes seems to increase the risk of cardiovascular disease, but some intriguing theories are taking shape.

For starters, virtually all patients with type 2 diabetes have developed resistance to their own insulin, so their pancreases keep churning out this critical hormone in an effort to herd glucose into cells. There is some scientific evidence that high levels of insulin in the blood cause damaging changes to the lining of blood vessels that lead to atherosclerosis.

Another theory suggests that blood sugar itself is the culprit. In all humans, a chemical reaction between glucose and proteins in the body produces compounds called advanced glycosylation endproducts, or AGEs. As the acronym suggests, your body produces greater numbers of AGEs as you get older. Since diabetes increases the amount of glucose in your blood that's available to be glycosylated, people with the disease tend to have high concentrations of AGEs. Unfortunately, these demon compounds may damage arteries, making them more likely to clog, in addition to increasing the risk for a long list of other common diabetes complications.

The role of AGEs and elevated blood sugar in heart disease remains up for debate. Not up for debate is the link between diabetes and hypertension. Read the next section to learn more.

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This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

More commonly known as high blood pressure, hypertension is one of the leading contributors to heart attacks. Pressure in the blood vessels naturally rises when you're stressed out or exercising hard. But if you have hypertension, your blood pressure is always high. Although people frequently claim they can feel their blood pressure soaring when they are angry or frustrated, hypertension actually has no symptoms. That's why high blood pressure is called a "silent" disease. Chronically elevated blood pressure forces your heart to work too hard, which may cause it to weaken over time. High blood pressure also increases wear and tear on the arteries.

At least half of patients with diabetes have hypertension, though it's not clear why. According to one study, up to half of people with diabetes have poor control over their blood pressure. Hypertension also increases the risk for many of the other diabetes complications.

In the next section, we'll discuss why diabetics should keep close tabs on their cholesterol.

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This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

We all know that high cholesterol can increase the risk of heart disease. But do you know the types of cholesterol and each one's effect on the heart? If not, read closely.

HDL Cholesterol

HDL (for "high-density lipoprotein") cholesterol is often described as the "good" kind, but what's so great about it? The liver makes cholesterol, which the body uses in a variety of roles, such as repairing cell walls. LDL (for "low-density lipoprotein") carries cholesterol around the body, but the process can get sloppy, with the fatty substance getting spilled here and there, slowly accumulating on artery walls.

That's why the liver also makes HDL, which acts like a DustBuster for the blood. HDL molecules travel around, sucking up leftover cholesterol, which it drags back to the liver to be eliminated. People who have high levels of HDL cholesterol have fewer heart attacks than people who have low levels.

Heavy-duty LDL Cholesterol

Although elevated LDL cholesterol levels increase the risk for heart disease, people with diabetes don't necessarily have too much of the fatty stuff. However, diabetes patients often have an especially sinister version of the so-called "bad" cholesterol. LDL cholesterol comes in several varieties. Some particles are puffy and buoyant, while others are small and dense. While puffy particles tend to float around in the blood, research suggests that small, dense particles are more likely to lodge in the arteries and form potentially deadly plaques. Unfortunately, people who have type 2 diabetes often have unusually high concentrations of these small, dense LDL particles in their blood.

Triglycerides

When you eat more food than your body needs for energy, the leftovers are stored as triglycerides, a form of fat. You burn triglycerides as backup energy between meals, but high levels of this blood fat have been linked to heart disease.

Blood clots can cause a heart attack or a stroke. Learn more about the relationship between blood clots and diabetes on the next page.

For more information on diabetes and its effect on the heart, try the following links:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

People with insulin resistance -- this means you, type 2 patients -- also tend to have blood containing high levels of a protein called fibrinogen. You need some fibrinogen, since its job is to clot blood; without it, you could bleed to death from a paper cut. However, having too much fibrinogen can make blood thick or "sticky," causing it to form clots too easily. And you definitely do not want random blood clots turning up in your coronary arteries. People with diabetes also tend to have high levels of several other blood proteins that promote the clotting process known as coagulation.

A blood clot can trigger a stroke. Read on to get the facts about a diabetic's risk for stroke.

For more information on diabetes and its effect on the heart, try the following links:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Doctors sometimes refer to strokes as brain attacks. The name calls to mind heart attacks, which is fitting since the two have much in common. Like heart attacks, strokes occur due to a sudden loss of blood circulation, in this case, to the brain. Both strokes and heart attacks are extreme -- and often deadly or debilitating -- medical emergencies. And, as with heart attacks, diabetes increases the risk of strokes. Compared to the general population, people with diabetes are two to three times more likely to suffer a stroke.

To be more precise, diabetes patients have a greatly increased risk for the most common variety of stroke. Ischemic strokes, which account for 80 to 85 percent of attacks, occur when a blood vessel to the brain becomes clogged. (Ischemia means "loss of blood flow.") They can occur due to the gradual buildup of fatty gunk on the vessel walls, the same way plaques accumulate in the arteries that feed blood to the heart. Or, a blood clot that formed somewhere else in the body may tear loose and float all the way to the brain's vessels before plugging up circulation.

The other major form of cerebrovascular disease is called a hemorrhagic stroke, which occurs when a weak spot in one of the brain's blood vessels bursts or leaks. The resulting blood flood puts damaging pressure on the brain. Hemorrhagic strokes make up about 15 to 20 percent of all strokes, and they don't seem to be linked to diabetes.

The results can be devastating with either kind of stroke. Although your brain makes up only about 2 percent of your body weight, the thinking machine sucks up 20 percent of the body's oxygen and around 15 percent of the blood your heart pumps out. When supply routes for oxygen-rich blood are jammed, brain cells start to die. Whatever function those dying neurons govern in the body -- such as talking, walking, and swallowing -- will suffer and may be lost. Here's the clincher: Studies show that a person with diabetes is more likely to die or suffer irreversible neurological damage resulting in a permanent disability from a stroke.

The good news: If you're taking steps to cut your risk of heart disease, you're doing double duty, because the same measures also limit the risk of stroke.

Think a heart attack and heart failure are the same condition? They're not. Find out how they differ in the next section.

For more information on diabetes and its effect on the heart, try the following links:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Many people think "heart failure" is a synonym for "heart attack," as in, I nearly had heart failure when Carl gave me the new Engelbert Humperdinck CD for my birthday! But while a heart attack can be a cause of heart failure, they are two different conditions. Heart attacks occur because a blocked artery prevents blood from reaching your ticker. When a person has heart failure, however, his or her heart can't pump an adequate volume of blood back into circulation. You could say that the heart still works, but it fails to meet the body's demands.

Furthermore, while heart attacks happen suddenly, heart failure is a chronic condition that gradually worsens over time. The first signs of trouble are usually fatigue and shortness of breath. Lying down can make the latter problem even worse. Eventually, the heart may become so weak that it can no longer efficiently push blood through the circulatory system. Stagnating blood begins to pool in the veins and cause swelling, usually in the legs and ankles, though any part of the body can be affected, especially the lungs. Because this condition causes blood in the circulatory system to become congested, it's often called congestive heart failure.

About five million Americans have heart failure. The condition has many causes, including heart attacks. Even before the Big One strikes, however, accumulating cholesterol and other crud in the arteries will narrow blood flow, making the heart work harder than normal, which may cause it to weaken. Hypertension, infections, and other diseases can cause heart failure, too. While atherosclerosis and high blood pressure often accompany diabetes, some doctors theorize that elevated blood sugar independently increases the risk for a weakened heart, a condition they have named cardiac myopathy. The theory remains controversial. However, there's no doubt that heart failure is a serious concern if you have diabetes. Men with diabetes have double the risk for heart failure, while women with diabetes are five times more likely to develop the condition than the general population.

Doctors usually order patients with heart failure to lose a few pounds and moderate their intake of sodium and fluids, especially alcohol, which could worsen fluid retention. Heart failure is often treated with many of the same medications prescribed for hypertension, including ACE inhibitors, beta-blockers, and diuretics, as well as digitalis, a class of drugs that makes the heart muscle contract more forcefully.

We'll discuss peripheral artery disease, or narrowing of the arteries, next.

For more information on diabetes and its effect on the heart, try the following links:

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Atherosclerosis, or the narrowing of blood vessels, is an equal opportunity disorder. While atherosclerosis in the coronary arteries leads to the number one cause of death in Western civilization, blood vessels throughout the rest of the body can get clogged, too. The problem, known as peripheral artery disease, or PAD, afflicts up to 12 million Americans, though only about half develop symptoms.

PAD can occur in the arms and other parts of the body but most often strikes below the belt. As blood flow to leg muscles slows down, pain and cramping can result in the calves, thighs, or hips while walking. The discomfort fades if you stop to rest. Because the pain comes and goes, it's known as intermittent claudication.

Many people who develop PAD symptoms never mention them to doctors, figuring a little pain now and then is part of aging. But over time, lack of adequate blood flow to the lower limbs can lead to some serious consequences. Poor circulation to the lower extremities can lead to nasty sores, gangrene, and even an amputated foot or two.

Here's why you should really care: People with diabetes are two to three times more likely than people who don't have the disease to develop PAD. In fact, as a diabetes patient, once you reach age 50, your odds are about one in three. Furthermore, when compared to other patients with PAD, people with diabetes are 10 to 30 times more likely to have a foot amputated.

And believe it or not, that isn't the scariest part. Doctors have come to think of PAD as a red flag -- a warning that a patient is a heart attack or stroke waiting to happen. One study found that 70 percent of people who have PAD also have severe blockages in their coronary arteries. Another determined that intermittent claudication shortens lifespan by about 10 years.

There is much more to the PAD story, but because it is exacerbated by nerve damage -- and because foot problems are a major part of managing diabetes.

Diabetes can affect a diabetic's heart health in several ways. Keeping your heart as healthy as possible -- while controlling your blood sugar -- is essential. Talk with your doctor about your potential risks.

For more information on diabetes and its effect on the heart, try the following links:

Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.

ABOUT THE CONSULTANTS

Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. She has developed educational programs that have benefited more than 5,000 patients with diabetes. She specializes in and speaks nationally on approaches to disease treatment, specifically diabetes.

Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E. is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes. He is an associate clinical professor at the University of California Natividad Medical Center and cofounder and medical director of the Diabetes Care Center in Salinas, California.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.