Not everything is bad news: Why you can minimise the risk of heart attack even when you are diabetic

The woman sitting across the table was consulting me after a gap of three years. She was diagnosed with diabetes about ten years ago and was regular in her follow-ups. But she did not have any tests done during the pandemic, a story which is not unusual among patients over the last two-and-a-half years. Much to my relief, most blood test results were within acceptable limits. But she was not her usual pleasant self. Something was not quite right. “I feel I am getting old, doctor, although I am only 50. I get fatigued so quickly nowadays. It is getting worse day day. I can’t even climb up a single flight of stairs without getting tired.” She denied any hory of chest pain.
I immediately suggested a series of cardiac tests and discovered evidence of blockage in one of her coronary arteries. It was promptly attended to, her symptoms improved, and she is doing fine now.
Did diabetes have anything to do with my patient’s heart condition
Most certainly, yes. Diabetes and the heart are closely linked with each other. A heart attack, which results when one (or more) of the arteries supplying blood to the heart gets blocked, is two to four times more common in people with diabetes than in those without. It has been shown that people with diabetes have about the same risk of getting a heart attack as someone who has already had an attack earlier. Recent research has shown us that diabetes affects not just the arteries but also the heart muscles. Weakening of heart muscles leads to a condition called heart failure. Heart failure does not mean that the heart has completely “failed” but is nevertheless a serious condition that indicates a weakness of the pumping system of the heart. In general, heart failure is present in 10–30 per cent of all subjects with Type 2 diabetes, and is especially common above the age of 70. A combination of these two effects — artery blockage and muscle weakness — makes the heart particularly vulnerable in diabetes. In addition, diabetes negates the relative protection that women have from heart disease. It seems that having a “sweet’’ heart is not the best thing
Go beyond the classic symptoms, especially if you are a woman
Like our patient, many with diabetes may not feel the classic symptoms of a heart attack — crushing central chest pain with a feeling of choking. They may, instead, report breathlessness, fatigue or an episode of fainting and, therefore, the diagnosis may often be missed. This is particularly true of women. It’s important to be alert to the possibility of heart disease in people with diabetes presenting with these symptoms.
Not everything is bad news
Is it all bad news or can people with diabetes protect their heart? The risk of heart complications in diabetes can be reduced very substantially a right mix of lifestyle measures and medication. Even those who have had a heart related event can reduce their future risks significantly. Maintaining or achieving ideal body weight following a healthy diet and regular exercise (45 minutes daily) is a critical component of any heart protection strategy.
Replacing simple/refined carbs with fibre rich complex carbs and trans-or saturated fats with good fats from nuts like walnuts and almonds is recommended. Adding protein to our carbohydrate rich Indian diets helps.
In case there are days when one cannot find dedicated time for exercise, increasing daily activities can make a difference too – for example climbing the stairs (instead of using the elevator) or walking for daily chores. It helps to avoid sitting for prolonged periods. Sitting, they say, is the new smoking. Getting up from the desk every 30-60 minutes to walk to a colleague’s desk or just stretching the body makes a difference. And it’s never too late to chuck the smoking habit and reduce alcohol intake. Just do it!
What parameters should you really work on
Maintaining an ideal blood sugar level (usually a three month average- HbA1c <7 per cent) is important but not enough to protect our heart from the effects of diabetes. Controlling cholesterol levels and blood pressure is even more important. Keeping LDL cholesterol in control (below 100 or 70 mg/dl, depending on the situation) is vital. A group of drugs called statins are the mainstay for lowering cholesterol and reducing the risk of heart attacks. Much reviled in the media, these drugs are actually life-savers when used in the right patients. The much talked about side effects of statins are uncommon. Do not fall prey to anti-statin propaganda, especially if you have a hory of heart attack or stroke or, even in the absence of such a hory, are at high risk for heart disease. Achieving blood pressure targets (typically <140/90; <130/80 in some situations) is also important, with the use of right medication. Lowering salt intake and avoiding excess alcohol will help in achieving blood pressure goals.
The most remarkable advancement in recent times has been the development of glucose-lowering medications that can also reduce the risk of heart (and kidney) complications independent of their glucose-lowering effects. Two such groups of medications – the SGLT2 inhibitors and the GLP1RA molecules – have brought about a paradigm shift in our approach to treating diabetes. Both these groups reduce the risk of heart attacks; SGLT2 inhibitors are useful in preventing and treating heart failure as well.
Have a heart to heart talk with your doctor during your next consultation. You will agree, when it comes to matters of the heart, no effort is too big!