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Is type 2 diabetes putting you at risk of heart disease?

– here’s how to lower your risk of a cardiovascular event

If you have read this blog post, you will know of the connection between type 2 diabetes and heart disease. Doctors may not know everything about type 2 diabetes – including how to cure it – but they do know how to treat the symptoms effectively. And that happens to be important in the context of cardiovascular disease. To find out why, read on.

With a chronic disease, knowledge is power

The more you know about your health, the greater your chance of regulating and promoting it. This is especially important if you are living with a chronic condition such as type 2 diabetes, given its associations with other health issues such as cardiovascular disease. There is much to keep track of, so without further ado…

Let’s get into it!

Diabetes has to do with metabolism, right? Well, yes. Among those who are diagnosed with type 2 diabetes, many have been living with some metabolic issue for a while.

The following can all be risk factors for type 2 diabetes:

  • Obesity
  • Metabolic syndrome
  • Prediabetes – which falls into the two categories “impaired fasting glucose” and “impaired glucose tolerance”

Scientists and doctors have yet to understand precisely how the individual items on the list relate to each other, but their internal relationships are assumed to have a common basis in metabolism.1

The onset of type 2 diabetes is also, as you would expect, a metabolic phenomenon. Notably, when the condition emerges it doesn’t do so suddenly. Rather, we are commonly talking about a kind of evolution: the increasing or advancing breakdown of insulin’s normal functions.2

This breakdown of insulin’s normal functions – which is a pretty good summary of type 2 diabetes – has something important in common with the aforementioned risk factors: namely the association with increased cardiovascular risk.

The association is related to high blood sugar levels. And it is worth taking  seriously as it underlies a number of predispositions. For instance, if you have type 2 diabetes, your risk of having a stroke or heart attack is up to 4 times greater compared with someone without type 2 diabetes.3,4,5

Learn more about high blood sugar and cardiovascular risk in this blog post.

Are heart attack and stroke not really the same thing?

No, they’re not. Here are some of the ways in which they differ:

heart attack vs stroke table

Life after a heart attack or stroke may be limiting for the person. And caring for a family member who has had a cardiovascular event can be difficult and overwhelming.14,15

When considering health statistics such as these, remember this: The information is derived from vast data sets reflecting a wide spectrum of people. The people represent different ages, genotypes, environments and more. Your own personal risk profile can therefore deviate greatly from the mean.

But the take-home message remains the same. By managing your type 2 diabetes symptoms, you are simultaneously promoting your cardiovascular health.

Let’s find out more about how to do so effectively.

Bon appétit

Everybody’s got to eat. But if you want to both reduce your risk of developing cardiovascular disease and promote your health living with diabetes, you need to know a few things about diet.16

Your goal should be a balanced diet – and we will get to what that means in a second. Try to avoid foods that are high in saturated fat (commonly found in animal products), trans fats (typically found in fried food, cakes and sweet treats).17,18

It’s not that fat is simply bad and should be avoided altogether. Rather, studies suggest that if you replace saturated fats and trans fats with unsaturated fats (which are found in avocado, nuts, olive oils and vegetable oils), it can benefit your cardiovascular health.19

Everybody’s got to eat. But if you want to both reduce your risk of developing cardiovascular disease and promote your health living with diabetes, you need to know a few things about diet.16

A few more things...

And try to avoid too much alcohol, sugar and salt.

What’s wrong with salt, you ask? Well, your body naturally seeks to dilute the salt you eat by holding on to water. So, by eating salt you literally bind water to your body. This extra water increases your blood volume, making your heart work harder simply because it has to push more liquid through your blood vessels.20

Over time, this is quite rough on the blood vessels, which can turn stiff, raising the risk of stroke, heart attack, and heart failure.21

Taken all together, the dietary pointers presented here will help you to better manage your blood sugar, cholesterol, blood pressure and weight – all of which are risk factors of cardiovascular disease.22

Stock your kitchen well

Suppose you put this list of foods in your pocket next time you went grocery shopping:

  • Vegetables, fruits and nuts
  • Wholegrain options of bread, pasta and rice
  • Fish and low-fat meat
  • Eggs and other non-dairy sources of proteins
  • Milk and cheese

A rough shopping guide there, with hopefully something for everyone’s taste!

Why wholegrain variants, you ask? Well, darker foods are generally to be preferred over lighter, paler variants if you’re living with type 2 diabetes.

The reason has to do with a useful rule of thumb: Lighter foods are associated with faster-acting, less complex carbohydrates, which have the effect of causing your blood sugar levels to rise and fall quickly – not remain steady and well-regulated over longer stretches of time.23

So pick spinach over iceberg lettuce, brown rice over white rice, sweet potatoes over white potatoes, wholegrain bread over wheat bread and so on.24

Final tip concerns your general perspective: Try to see the list not so much as a limitation, but a clarification of what you can safely eat. With that in mind, be explorative. Use the internet! There are countless exciting yet easy-to-master recipes waiting to be discovered!

Thank you for not smoking!

Maybe you’re already there with this one. If so, good for you! But it needs to be said nonetheless that quitting smoking is one of the most effective things you can do if you hope to benefit your overall health, and especially your cardiovascular health.25

There are many support programmes available to help you stop smoking for good. Talk to your doctor about ways to help you stop smoking to reduce your risk of developing cardiovascular disease.

You don’t need a gym membership or access to a kinesiologist or fitness instructor to begin benefiting from physical activity.

A little sweat can work wonders

Your body is complicated. Its various functions are interdependent and connected in ways so complex and baffling that scientists are still catching up, trying to learn more.

But the interconnectedness of your body’s various systems comes with an advantage. It turns out that by engaging in one health-promoting activity, you can achieve a more general – more systemic or holistic – positive health effect.

Here’s an example: Regularly going for a walk, taking the bike instead of a car when you run errands or being physically active in other ways allows you to improve all of these conditions simultaneously:

  • Your blood pressure26
  • Your blood lipid levels (lipid means fat)
  • The ability to use insulin to lower your blood sugar27
  • The health of your heart and blood vessels28

As you might have guessed, all of these health benefits serve to reduce your likelihood of developing cardiovascular disease.

Read more about the relationship between high blood sugar and cardiovascular risk here.

Getting started is the most important part

Diabetes experts recommend 150 minutes of aerobic activity each week – which is less than half an hour per day.29 But if you are not used to anywhere near that amount of physical activity at the moment, don’t worry.

You don’t need a gym membership or access to a kinesiologist or fitness instructor to begin benefiting from physical activity.

Why not be a bit pragmatic about it in the beginning and making some pro-physical activity choices? Find little ways to sneak physical activity into your day, say. Here are some examples:

  • Take the stairs, not the elevator.
  • Take your bike to work, or walk, instead of taking the car or bus.
  • Choose a small detour (though it may seem silly) instead of the shortest route to the store.
  • Invite a friend to walk with you when you meet for a catch-up, instead of sitting at a cafe.

When you get used to taking 10 minutes here and 10 minutes there to be active instead of sitting still, the impact can be considerable over time.

Check out this blog post for advice on how to approach exercise.

If you are like most people living with type 2 diabetes, you can achieve a relationship with your condition that makes life both enjoyable and rewarding.

Type 2 diabetes management and cardiovascular risk reduction – two sides of the same coin

We’ve been seeing a clear overlap between the following aspects of health:

  • preventing the onset of type 2 diabetes
  • managing the symptoms of type 2 diabetes
  • controlling and keeping BMI steady
  • promoting cardiovascular health

But lifestyle changes – including a healthy diet, regular exercise and abstinence from smoke and large amounts of alcohol – are unfortunately not always enough.

On top of a health-promoting lifestyle, your personal condition may require medication. Surely, no one enjoys depending on a very complicated medical regimen. It’s important that you discuss the matter carefully with your doctor to decide which medication can best treat your type 2 diabetes and reduce the risk of cardiovascular events.

Living well means accepting medical help when necessary

If you are like most people living with type 2 diabetes, you can achieve a relationship with your condition that makes life both enjoyable and rewarding.

It may require developing a new, more pragmatic approach to your health – one characterised by taking regular action to help your metabolism do what it cannot do unaided.

Does your condition currently require medication? Or can your blood sugar be sufficiently well regulated through diet and exercise? Whatever the specifics of your condition, it is a good idea to…

… speak to your doctor regularly

Hopefully, this blog post has served as a good starting point for approaching your doctor (or any healthcare provider). When you do so, try to apportion time to discussing your diabetes requirements as well as your cardiovascular health. Both are important and deserve separate attention, even if one type of medicine can serve as treatment for both.

Talking to your doctor, you might suggest that your blood pressure and cholesterol levels be regularly monitored. Your doctor will be well aware of the advantages of this approach and will help you choose the best treatment.

And print out this quick guide before going to see your doctor – on foot or by bike and preferably by a circuitous route. It will give you an idea of the kinds of questions you may ask to drive the conversation around a few other important matters.

Good luck – and stay safe

And remember: Doctors are just people. They will find it easier to talk to you about your health if you make it clear to them from the start that you are ready to learn more and eager to identify solutions together. And so, hopefully, will you.

References
  1. Grundy SM: Pre-Diabetes, Metabolic Syndrome, and Cardiovascular Risk. Journal of the American College of Cardiology 59(7), 2012: 635-643.
  2. Scheen AJ: From Obesity to Diabetes: Why, When and Who? International Journal of Clinical and Laboratory Medicine, 55(1), 2000: 9-15.
  3. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, del Cañizo-Gómez FJ: Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World Journal of Diabetes, 5(4), 2014: 444-470.
  4. Lüscher TF, Creager MA, Beckman JA, Cosentino F: Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part ii. Circulation. 108(13), 2003: 1655-1661.
  5. Marso SP, Nauck MA, Monk Fries T, et al. Myocardial infarction subtypes in patients with type 2 diabetes mellitus and the effect of liraglutide therapy (from the LEADER trial). The American Journal of Cardiology. 121(12), 2018: 1467-1470.
  6. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, heart disease, and stroke. 2017. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke. Accessed July 12, 2018.
  7. Liang H, Vallarino C, Joseph G, et al.: Increased risk of subsequent myocardial infarction in patients with type 2 diabetes: a retrospective cohort study using the U.K. general practice research database. Diabetes Care. 37(5), 2014: 1329-1337.
  8. Schweickert B, Hunger M, Meisinger C, et al.: Quality of life several years after myocardial infarction: comparing the MONICA/KORA registry to the general population. European Heart Journal, 30(4), 2009: 436-443.
  9. CDC. Know the facts about stroke. https://www.cdc.gov/stroke/docs/consumered_stroke.pdf. Accessed July 12, 2018.
  10. National Stroke Association. Diabetes and stroke. http://www.stroke.org/sites/default/files/resources/Diabetes%20and%20Stroke_Fact%20Sheet.pdf. Accessed July 17, 2018.
  11. National Stroke Association. Physical. http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/physical. Accessed July 12, 2018.
  12. National Stroke Association. Memory loss. http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/cognition/memory-loss. Accessed July 12, 2018.
  13. US Department of Health and Human Services, National Institute on Aging. Stroke. https://www.nia.nih.gov/health/stroke. Accessed September 26, 2018.
  14. Sprigg N, Selby J, Fox L, et al.: Very low quality of life after acute stroke: data from the efficacy of nitric oxide in stroke trial. Stroke, 44(12), 2013: 3458-3462.
  15. Schweickert B, Hunger M, Meisinger C, et al.: Quality of life several years after myocardial infarction: comparing the MONICA/KORA registry to the general population. European Heart Journal, 30(4), 2009: 436-443.
  16. Rees K, Dyakova M, Ward K, Thorogood M, Brunner E: Dietary advice for reducing cardiovascular risk (Review). Cochrane Database of Systematic Reviews, 2013: 1-122 .
  17. Sara P: Cardiovascular Disease (CVD): The Overview. Inosr Applied Sciences, 4(1), 2018: 1-8.
  18. Dobe M: Hypertension: The prevention paradox. Indian J Public Health, 57(1), 2013: 1-3.
  19. Briggs MA, Petersen KS, Kris-Etherton PM: Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk. Healthcare, 5(2), 2017: 29.
  20. (Book chapter) He FJ, MacGregor GA: "Dietary salt, high blood pressure and other harmful effects on health", in Reducing Salt in Foods: Practical Strategies, ed. by Kilcast D and Angus F., 2007, pp. 18-54.
  21. (Book chapter) He FJ, MacGregor GA: "Dietary salt, high blood pressure and other harmful effects on health", in Reducing Salt in Foods: Practical Strategies, ed. by Kilcast D and Angus F., 2007, pp. 18-54.
  22. Mensah GA: Hypertension and Target Organ Damage: Don’t Believe Everything You Think! Ethnicity & Disease, 26(3), 2016: 275–278.
  23. Jenkins DJA, Taylor RH, Wolever TMS: The Diabetic Diet, Dietary Carbohydrate and Differences in Digestibility. Diabetologia, 23, 1982: 477-484.
  24. Wolever TMS, Jenkins DJA, Vuksan V, Jenkins AL, Buckley GC, Wong GS, Josse RG: Beneficial Effect of a Low Glycaemic Index Diet in Type 2 Diabetes. Diabetic Medicine, 9(5), 1992: 451-458.
  25. Sara P: Cardiovascular Disease (CVD): The Overview. Inosr Applied Sciences, 4(1), 2018: 1-8.
  26. Hellénius MLB, Faire UD, Berglund B, Hamsten A, Krakau I: Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis, 103(1), 1993: 81-91.
  27. 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.
  28. Hellénius MLB, Faire UD, Berglund B, Hamsten A, Krakau I: Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. Atherosclerosis, 103(1), 1993: 81-91.
  29. Gill JMR, Cooper AR: Physical Activity and Prevention of Type 2 Diabetes Mellitus. Sports Medicine, 38, 2008: 807-824.
  30. Selvin E, Bolen S, Yeh HC, et al.: Cardiovascular Outcomes in Trials of Oral Diabetes Medications: A systematic review. Archives of Internal Medicine, 168(19), 2008: 2070-2080.

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