Diabetes increases heart attack risk: Expert on prevention tips for diabetics

Diabetes and cardiac diseases are intimately related. Health expert reveals precautions and prevention tips for diabetics to avoid heart attack risk

Diabetes is often thought of as a disease with high blood sugar but unfortunately, that is only half the truth as diabetes is in reality a disease with multiple derangements in many body systems where high blood sugar is merely a "surrogate marker" of the disease and what that means is - diabetes is a warning sign that many serious diseases of the heart, kidney, brain, eyes etc are likely to occur unless diabetes is managed precisely. Having understood that diabetes is essentially a multi-system disorder, it becomes possible to understand its myriad of deleterious effects.

Diabetes increases heart attack risk: Expert on prevention tips for diabetics (Photo by Allec Gomes on Pexels)

In an interview with HT Lifestyle, Dr Kaushal Chhatrapati, MD DM, FACC FSCAI FESC, Interventional Cardiologist, explained, "Diabetes is associated with disordered cholesterol regulation. Mismanaged diabetes often has elevated levels of a type of "bad cholesterol" called LDL Cholesterol and high levels of Triglycerides. Both these are toxic to the arteries and can cause blockages in the arteries. Long standing uncontrolled diabetes is associated with Cholesterol deposits in arteries: in heart arteries, arteries supplying the brain and arteries of hand and legs. This can cause heart attack, stroke and limb claudication. What is even more unfortunate is that almost half the heart attacks in diabetics occur without any symptoms: that is they are "silent"."

He elaborated, "This means that these attacks go unrecognised and only manifest as heart failure. The therapeutic opportunity to treat the heart attacks is lost, as we never know when the attack occurred! This is most treacherous part, as the heart attacks go neglected and all the recent developments and triumphs of Interventional Cardiology cannot be applied to these attacks. As such, even mild symptoms such as sweating, breathlessness, feeling of unease or "acidity" should be taken seriously. Being hyper-vigilant in diabetics pays off, as full blown heart attacks are known to occur with deceptively mild symptoms."

He highlighted how in some cases, massive heart attacks in diabetics have presented with just a little acidity, hand pain or slight sweating and said, "Only when repeated ECGs are done can heart attacks be diagnosed. This is a rule of thumb: even mild symptoms need to be thoroughly investigated in diabetes. Long standing diabetes also causes weakening of the heart muscles called "Diabetic Cardiomyopathy", a condition which may be dangerous unless treated early. With strict diabetes control, and medications this condition can be normalised."

Asserting that diabetes is a cardiovascular risk factor equivalent, Dr Kaushal Chhatrapati emphasised, “What it means is all diabetics should be treated as if they already have heart disease. As such, all diabetics should always be on cholesterol lowering medicines. Such care lowers the incidents of heart attacks. Treatment of diabetes with medicines is not enough. Healthy diet, exercises, weight control, avoidance of tobacco, alcohol and managing other disorders like high blood pressure, thyroid, cholesterol etc. should always be part of a diabetes management protocol. Diabetes is a lifestyle disorder, and it should be fixed not only with medicines, but also with fundamental changes in lifestyle.”

He added, “What also needs to be discussed here is low blood sugar, which can occur in diabetics on Insulin or other drugs, can cause a heart attack. As such, low blood sugar episodes should be avoided. One of the ways of doing this is choosing newer drugs to treat diabetes, which have lower likelihood to cause low blood sugar. These newer drugs also benefit the heart pumping and kidney function.”

Establishing that diabetes and cardiac diseases are intimately related, Dr Kaushal Chhatrapati concluded, "Metabolic problems in diabetes form a spectrum with purely a mild sugar increase (so called pre-diabetes) on one end and multiple system involvement, including heart on the other end. Because of strong inter- twining between diabetes and heart disease, this branch of medicine has evolved into a separate specialty, "Cardio diabetes". Suffice to say, treatment of diabetes should be tailor- made so that cardiac diseases are prevented altogether. Treatment of diabetes should be expanded from merely "sugar control" to the management of entire plethora of issues including Cholesterol, heart disease, weight regulation, healthy diet, exercise and metabolic regulation. "Myopic" Diabetes care obsessed only with blood sugar values needs to give way to a holistic risk management program."