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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 life choices to help lower your risk of cardiovascular disease—and rightly so! If you have read this article, you will know that if you have type 2 diabetes, your risk of having a stroke or heart attack is up to four times greater compared with someone without type 2 diabetes.

So, making changes in your lifestyle to promote your cardiovascular health is really worth taking seriously. If you have read this blog post, you will know of the connection between type 2 diabetes and heart disease. This article will build on that knowledge to discuss stroke as a cardiovascular disease. 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 accident. Cerebro means related to the brain and we know that vascular means related to the blood vessels. 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 play.

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 body.

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 steady.

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 neck.

A stroke can have a significant effect on physical and mental health—it can cause movement problems, pain, numbness, and problems with thinking, remembering or speaking. Some people also experience emotional problems, such as depression, after a stroke.

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 diabetes.

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 suddenly, with no warning.  

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

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

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 do:

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

You can read more about lifestyle changes promoting cardiovascular health in this blog post.

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 be managing this risk well.

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.

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(4):444–470. 
  2. Lüscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part ii. Circulation 2003;108(13):1655–1661. 
  3. 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). Am J Cardiol 2018;121(12):1467–1470. 
  4. Jain V, Langham MC, Wehrli FW. MRI estimation of global brain oxygen consumption rate [published correction appears in J Cereb Blood Flow Metab 2010;30(12):1987] [published correction appears in J Cereb Blood Flow Metab 2011;31(5):1336]. J Cereb Blood Flow Metab 2010;30(9):1598–1607. 
  5. Association for Psychological Science. Myth: We Only Use 10% of Our Brains [online] 29 August 2018. Available from: https://www.psychologicalscience.org/teaching/myth-we-only-use-10-of-our-brains.html [Last accessed: April 2021]. 
  6. MedlinePlus. Cerebral hypoxia [online]. Available from: https://medlineplus.gov/ency/article/001435.htm [Last accessed: April 2021]. 
  7. American Diabetes Association. Stroke [online]. Available from: https://www.diabetes.org/diabetes/complications/stroke [Last accessed: April 2021].
  8. Kaarisalo MM, Räihä I, Sivenius J, et al. Diabetes worsens the outcome of acute ischemic stroke. Diabetes Res Clin Pract 2005;69(3):293–298. 
  9. National Heart, Lung and Blood Institute. Atherosclerosis [online]. Available from: https://www.nhlbi.nih.gov/health-topics/atherosclerosis [Last accessed: April 2021]. 
  10. Funk SD, Yurdagul A Jr, Orr AW. Hyperglycemia and endothelial dysfunction in atherosclerosis: lessons from type 1 diabetes. Int J Vasc Med 2012;2012:569654. 
  11. Dokken BB. The Pathophysiology of Cardiovascular Disease and Diabetes: Beyond Blood Pressure and Lipids. Diabetes Spectrum 2008;21(3):160–165. 
  12. Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a prothrombotic factor? J Thromb Haemost 2010;8(8):1663–1669. 
  13. Drenjančević-Perić I, Jelaković B, Lombard J, et al. High-Salt Diet and Hypertension: Focus on the Renin-Angiotensin System. Kidney Blood Press Res 2011;34(1):1–11. 
  14. Mukamal KJ, Chen CM, Rao SR, Breslow RA. Alcohol Consumption and Cardiovascular Mortality Among U.S. Adults, 1987 to 2002. J Am Coll Cardiol 2010;55(13):1328–1335. 
  15. 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(8):1764–1766. 
  16. 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(20):1925–1936. 

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