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Cardiovascular disease – why living with type 2 diabetes doesn’t have to be heartbreaking

Being diagnosed with type 2 diabetes means that you have an increased risk of developing cardiovascular disease. Therefore, it’s a good idea to know the facts, take them seriously and take steps to reduce your cardiovascular risk as much as possible.
In other words, it’s a good idea to continue reading because we will cover all that here.

If you are a regular reader of the articles on this website, you will be very familiar with the symptoms of type 2 diabetes. You will also know that the principal type 2 diabetes symptom – high blood sugar levels, or hyperglycaemia – can be managed through a combination of medication, physical activity and a carefully laid meal plan.

That knowledge will come in handy as we explore the relationship between type 2 diabetes and cardiovascular disease. Why? Because it turns out that high blood sugar levels are strongly correlated with heart health.

“I went to an annual check-up with my doctor, which we men over 50 do. Everything was perfect – besides the fact that I actually had type 2, and I had no idea.”

-Disease expert living with type 2 diabetes

Time for a heart-to-heart

Let’s start with a quick note on terminology: Cardio means related to the heart. Vascular means related to the blood vessels.

Thus, cardiovascular disease is simply the name given to a class of diseases affecting the heart and blood vessels.

High blood sugar levels can damage the walls of blood vessels. Therefore, the longer a person lives with diabetes, the higher the risk of developing cardiovascular disease.1,2

Furthermore, studies show that high blood sugar can damage the nerves that control the heart and blood vessels.3

“The doctors said, ‘Okay, we have to try to put you on some medicine to control your blood pressure.’ So now we monitor it all the time. And they make changes in my medicine from time to time."

-Disease expert living with type 2 diabetes

Fatty material

When there is damage to the blood vessels, fatty material (sometimes referred to as “plaque”) can build up and obstruct the blood flow.4

At least two problems directly spring from this:

  • First, the body’s organs require a steady supply of oxygen-rich blood to keep functioning normally. They cannot maintain healthy functioning for long in the absence of healthy circulation, a condition known as ischemia.5
  • Second, when the build-up of fatty material limits the body’s ability to send blood to the organs, the body typically responds by pumping the blood harder. In medical terms, this is known as increased blood pressure.

The problem is that the heart and vessels are not able to circulate blood well under these conditions in the long run. Over time, the risk of actual damage to the heart goes up and may take the form of irregular heartbeat, heart attack or stroke.6

Infographic displaying the damage of sugar on blood vessels.

A sticky situation

There is a further complication to living with high levels of blood sugar. It can result in the blood sticking together and forming blood clots.7 A blood clot that travels to the arteries or veins in the brain, heart, kidneys, lungs or limbs can cause serious problems: heart attack, stroke, organ damage or even death.8

It is for these reasons that we want to encourage you – especially if you are living with type 2 diabetes – to take the relationship between high blood sugar levels and increased cardiovascular risk seriously.

“I know that this condition that I have is potentially a life-threatening condition – and I know all the diseases that might come up. But I always try to keep up a positive perspective and focus on the day ahead of me.”

-Disease expert living with type 2 diabetes

Where to start – and how?

When it comes to cardiovascular disease, preventive efforts are primarily to do with lifestyle management and risk factor interventions. However, in a great many cases, optimal treatment also has a medical dimension. Certain blood sugar lowering treatments can, for example, help lower your risk for heart attack or stroke.9

Remember that every condition is different and requires a personal approach. Why not have a conversation with your doctor about it this week and see what would work best in your case?

It is important to be aware that despite achieving good blood sugar levels, you are still at higher risk of a heart attack or stroke.10 However, the good news is that with healthy lifestyle choices you can lower the risk of heart attack and stroke, especially in combination with medication.11 And here it is important to discuss with your doctor if your blood glucose lowering medication can help reduce your cardiovascular risk.

There are many ways to define a healthy lifestyle, so let’s get precise. In this context, making “healthy lifestyle choices” refers to the constant attempt to limit exposure or vulnerability to known causes of narrowing or clogging in blood vessels.

In addition to high blood pressure and high blood sugar levels, as pointed out above, these include:

  • Living with high cholesterol
    Clinical evidence shows that a cholesterol level reduction may lower the mortality rate from cardiovascular disease. However, bear in mind that cholesterol is not one thing. It’s important to distinguish triglycerides from "good" and “bad" cholesterol (HDL and LDL, respectively).12 Talk to your doctor about keeping your blood triglyceride level under 150 mg/dL and your HDL above 40 mg/dL (for men) or 50 mg/dL (for women).13
  • Eating unhealthy food
    A nutritionally limited or poor diet can lead to high cholesterol and high blood pressure.12 Eating high amounts of sodium/salt can also lead to high blood pressure by preventing fluids from leaving the body.14
  • Smoking
    Smoking is also a significant risk factor for CVD. The harmful substances in tobacco can damage and narrow your blood vessels.15
  • Drinking too much alcohol
    Studies have indicated a positive correlation between cardiovascular mortality and alcohol when consumed above recommended limits.15
  • Physical inactivity
    Regular exercise can help reduce body fat and thus increase sensitivity to insulin in the cells.16 As a result, blood sugar can better enter the cells and is less likely to build up in the bloodstream.
  • Living with obesity
    As mentioned above, there is a correlation between the reduction of body fat and insulin sensitivity. Receiving help or finding ways to address excess weight is therefore a great way to achieve steady blood sugar levels. Physical activity is merely one of several ways.

Fortunately, evidence suggests that even modest, and therefore achievable, alterations of the risk factors associated with lifestyle can have substantial effects on a person’s cardiovascular risk.17

“When I introduce myself to other people, I don't introduce myself as ‘the diabetes patient Eva’. I just introduce myself as Eva. Eva just so happens to have diabetes.”

-Disease expert living with type 2 diabetes

What does this mean for you who are living with type 2 diabetes?

Like any other chronic disease, type 2 diabetes is a lifelong disease. Achieving a life full of meaning, achievement and happiness despite the associated cardiovascular risks will depend on:

  • developing a healthy lifestyle
  • getting regular exercise
  • careful monitoring of blood sugar levels

Here’s a guide to help you have a good conversation with your healthcare provider about the current state of your type 2 diabetes with regards to cardiovascular risks.

 

References
  1. Gary-Webb TL, Suglia SF, Tehranifar P: Social Epidemiology of Diabetes and Associated Conditions. Current Diabetes Reports, 13, 2013: 850–859.
  2. Huo X, Gao L, Guo L, et al.: Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The Lancet Diabetes & Endocrinology, 4(2), 2016: 115-124.
  3. Serhiyenko V and Serhiyenko A. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. World J Diabetes, 9(1), 2018: 1-24
  4. National Institutes of Health. Atherosclerosis. Available at: https://www.nhlbi.nih.gov/health-topics/atherosclerosis. Last accessed: September 2020
  5. Bowering CK, Diabetic foot ulcers. Pathophysiology, assessment, and therapy, Canadian Family Physician May 2001, 47(5): 1007-1016.
  6. Mensah GA: Hypertension and Target Organ Damage: Don’t Believe Everything You Think! Ethnicity & Disease, 26(3), 2016: 275–278.
  7. Lemkes BA, Hermanides J, Devries JH, Holleman F, Meijers JCM, Hoekstra JBL: Hyperglycemia: a prothrombotic factor? Journal of Thrombosis and Haemostasis, 8(8), 2010: 1663-1669.
  8. Konieczynska M, Fil K, Bazanek M, Undas A: Prolonged duration of type 2 diabetes is associated with increased thrombin generation, prothrombotic fibrin clot phenotype and impaired fibrinolysis. Thrombosis and Haemostasis, 111(4), 2014: 685-693.
  9. Buse J, Wexler D, Tsapas A.. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 43(2): 487-493.
  10. American Diabetes Association. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(S1), 2020: S111-S134
  11. American Diabetes Association. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. Clinical Diabetes. 38(1), 2020: 10-38
  12. Jeong S, Choi S, and Kim K et al. Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults. Journal of the American Heart Association. 7(12), 2018: e008819
  13. Know your numbers. Available at: https://www.novomedlink.com/​content/dam/novonordisk/​novomedlink/​resources/​generaldocuments/​KnowYourNumbers_EG.pdf. Last accessed: September 2020.
  14. Drenjančević-Perić I, Jelaković B, and Lombard J et al. High-Salt Diet and Hypertension: Focus on the Renin-Angiotensin System. Kidney and Blood Pressure Research. 34, 2011:1-11
  15. Mukamal KJ, Chen CM, Rao SR, Breslow RA: Alcohol Consumption and Cardiovascular Mortality Among U.S. Adults, 1987 to 2002. Journal of the American College of Cardiology, 55(13) 2010: 1328-1335.
  16. Venkatasamy VV, Pericherla S, Manthuruthil S, Mishra S, Hanno R: Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus. Journal of Clinical and Diagnostic Research, 7(8), 2013: 1764-1766.
  17. Mozaffarian D, Wilson PWF, Kannel WB: Beyond Established and Novel Risk Factors. Lifestyle Risk Factors for Cardiovascular Disease. Circulation, 117(23), 2008: 3031–3038.

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