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Spotlight on stroke in type 2 diabetes: How the risk of these devastating events can potentially be reduced

If you are living with type 2 diabetes, your doctor has probably asked you to make healthy lifestyle choices to help lower your risk of cardiovascular disease—and rightly so! We have previously discussed the connection between type 2 diabetes and heart disease, and this article explains that having type 2 diabetes increases your risk of stroke or heart attack by 2-4 times compared with someone without type 2 diabetes1,2.

Wondering how to start a conversation with your doctor?

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.

Watch the video below to discover the importance of making lifestyle changes to support your cardiovascular health. In the video, Jean shares her experiences of having a stroke following a diagnosis of type 2 diabetes.

To find out more, read on. 

Cardiovascular disease and where stroke comes into it

Let’s start with a recap on terminology: cardio means related to the heart, vascular means related to the blood vessels.  

The medical term for a stroke is a cerebrovascular accident3. Cerebro means related to the brain and we know that vascular means related to the blood vessels3. In this blog post, we want to explain why people with type 2 diabetes are at increased risk of suffering a stroke and what can be done to help prevent it from happening, including the role that your diabetes medicine could play1.

What happens during a stroke?

Although your brain is about 2% of your body weight, its intense activity means that it consumes about 20% of the oxygen that enters your body4.

Brain facts

Oxygen reaches the brain through the blood, so to ensure normal functioning of the brain, it’s important that its blood supply remains steady6.

A stroke happens when the blood supply to part of your brain is suddenly interrupted, starving the brain of oxygen and resulting in damage to brain tissue. Most strokes happen because a blood clot blocks a blood vessel in the brain or neck7.

A stroke can have a significant effect on physical and mental health. It can cause pain, difficulty with movement and pain. In addition, those who have experienced strokes can experience problems with thinking, memory and speach. Some people also experience emotional problems, such as depression7.

Unfortunately, when people with diabetes have a stroke, they are at an increased risk of dying or being left with a long-term disability, versus someone without diabetes8.

Why does type 2 diabetes increase stroke risk?

Our blog post on heart disease explains that when there is damage to blood vessels, fatty material (sometimes referred to as ‘plaque’) can build up and obstruct the blood flow in a process known as atherosclerosis. Atherosclerosis can build up for many years without you knowing—it is a silent disease, and a stroke can happen suddenly9.  

Uncontrolled blood sugar levels in people with diabetes damage the walls of the blood vessels, thereby speeding up the process of atherosclerosis9. People with diabetes also tend to have high levels of the types of fats in their blood that get turned into plaques10,11.

High levels of sugar in the blood also make blood more likely to stick together to form clots12. When a clot reaches the brain, it can lead to a stroke7

Infographic displaying the damage of sugar on blood vessels.

How your self-care helps lower your risk

Some risk factors for stroke can be kept in check by making your lifestyle as healthy as possible. Here are some things that you can do13-16:

  • Eat a healthy, balanced diet that is low in cholesterol and salt
  • Stop smoking
  • Only drink alcohol within recommended limits
  • Exercise regularly
  • Maintain a healthy weight

You can read more about lifestyle changes promoting cardiovascular health in this blog post1,2,13-16.

Reducing your risk further with help from your diabetes doctor

You might already know about medicines that work to reduce certain risk factors for cardiovascular diseases, like medicines that reduce cholesterol or high blood pressure. If you haven’t had your cholesterol or blood pressure checked in a while, why not make a note to ask your doctor if it’s worth checking that they are under control? 

As someone with type 2 diabetes, even if your diabetes and all of your other risk factors for cardiovascular disease are well-controlled, you may still, unfortunately, have a higher risk of developing cardiovascular disease than the general population. Only 6% of people with type 2 diabetes are thought to have the risk under control17.

Talk to your diabetes doctor to ensure you are on the right treatment to help you manage your risks.

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.

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References
  1. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, et al. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength? World J Diabetes. 2014;5:444-470. doi: 10.4239/wjd.v5.i4.444
  2. Lüscher TF, Creager MA, Beckman JA, et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II. Circulation. 2003;108:1655-1661. doi: 10.1161/01.Cir.0000089189.70578.E2
  3. Cleveland Clinic. Cerebrovascular Disease. Available at: https://my.clevelandclinic.org/health/diseases/24205-cerebrovascular-disease. Last accessed: January 2024.
  4. Jain V, Langham MC, Wehrli FW. MRI estimation of global brain oxygen consumption rate. J Cereb Blood Flow Metab. 2010;30:1598-1607. doi: 10.1038/jcbfm.2010.49
  5. Association for Psychological Science. Myth: We Only Use 10% of Our Brains. Available from: https://www.psychologicalscience.org/teaching/myth-we-only-use-10-of-our-brains.html. Last accessed: January 2024. 
  6. MedlinePlus. Cerebral hypoxia. Available from: https://medlineplus.gov/ency/article/001435.htm. Last accessed: January 2024.
  7. American Diabetes Association. Stroke. Available from: https://www.diabetes.org/diabetes/complications/stroke. Last accessed: January 2024. 
  8. Kaarisalo MM, Räihä IJ, Sivenius J, et al. Diabetes worsens the outcome of acute ischemic stroke. Diabetes research and clinical practice. 2005;69 3:293-298. 
  9. National Heart, Lung and Blood Institute. Atherosclerosis. Available from: https://www.nhlbi.nih.gov/health-topics/atherosclerosis. Last accessed: January 2024. 
  10. Funk SD, Yurdagul A, Orr AW. Hyperglycemia and endothelial dysfunction in atherosclerosis: lessons from type 1 diabetes. Int J Vasc Med. 2012;2012:569654. doi: 10.1155/2012/569654
  11. Dokken BB. The Pathophysiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids. Diabetes Spectrum. 2008;21:160-165. doi: 10.2337/diaspect.21.3.160
  12. Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost. 2010;8:1663-1669. doi: 10.1111/j.1538-7836.2010.03910.x
  13. Drenjančević-Perić I, Jelaković B, Lombard JH, et al. High-salt diet and hypertension: focus on the renin-angiotensin system. Kidney Blood Press Res. 2011;34:1-11. doi: 10.1159/000320387
  14. Pan B, Jin X, Jun L, et al. The relationship between smoking and stroke: A meta-analysis. Medicine (Baltimore). 2019;98:e14872. doi: 10.1097/md.0000000000014872
  15. Mukamal KJ, Chen CM, Rao SR, et al. Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002. J Am Coll Cardiol. 2010;55:1328-1335. doi: 10.1016/j.jacc.2009.10.056
  16. Venkatasamy VV, Pericherla S, Manthuruthil S, et al. Effect of Physical activity on Insulin Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus. J Clin Diagn Res. 2013;7:1764-1766. doi: 10.7860/jcdr/2013/6518.3306
  17. Wright AK, Suarez-Ortegon MF, Read SH, et al. Risk Factor Control and Cardiovascular Event Risk in People With Type 2 Diabetes in Primary and Secondary Prevention Settings. Circulation. 2020;142:1925-1936. doi: 10.1161/circulationaha.120.046783

 

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