A guide to diabetes and your heart

Autore: Professor Kausik Ray
Pubblicato:
Editor: Nicholas Howley

How exactly does diabetes affect the heart? And what can you do to reduce your risk of heart failure and stroke if you have diabetes? We asked internationally renowned cardiologist Professor Kausik Ray, specialist in cardiovascular disease prevention and diabetic heart disease.

How does diabetes actually affect the heart?

Diabetes can affect the heart in a number of different ways. The most common process is the narrowing of the blood vessels over time, where fat lines the blood vessels increasingly with duration of diabetes. That in turn increases the risk of heart disease and strokes.

In addition to that, the effect of diabetes on the heart can affect the heart muscle directly whereby the heart muscle becomes stiff, and it doesn't relax as well, leading to heart failure.

So the potential complications of diabetes are heart attacks, strokes and heart failure.

How are heart problems diagnosed in diabetes patients?

Well, one of the challenges in people with diabetes is that the pain threshold is a lot different in people with diabetes.

Often typically when somebody's having a heart attack, they express chest pain, sweating, discomfort, and if you've had diabetes for a long time, patients actually don't get the same feelings of pain. So often, heart disease is more silent. Therefore, you need to have a high threshold for diagnosis.

If people with diabetes have slightly atypical symptoms – perhaps they start to get breathless on walking – that could be a sign that there's a problem with the blood supply to the heart, or that the heart muscle is not pumping adequately. Heart failure is undiagnosed in about 25% of people with diabetes.

We have a few ways to diagnose heart problems in diabetic patients. We can take scans of the heart or do some blood tests to check if the heart is being overworked and is stressed. In people with slightly atypical symptoms, we can do a stress test on a treadmill or a bicycle, where by increasing the heart rate, you can take images of the heart muscle to see if it's pumping properly in response to exercise.

Do heart problems in diabetic patients have to be treated differently?

No - heart problems in patients with diabetes are treated with the same medications as in people without diabetes.

So that basically means people with diabetes need cholesterol-lowering medications. We know that for one unit lowering in so-called bad cholesterol or LDL, the patient with diabetes get about a 22% reduction in risk.

But often even when you've lowered blood pressure, you've lowered cholesterol, you might often use things like aspirin. This is obviously on top of things like lifestyle changes.

That being said, having diabetes gives you a so-called “high residual risk”. This means often you have to treat those much, much more aggressively in people with diabetes. Part of this involves addressing kidney problems. Once kidney problems start, that often increases the likelihood of heart failure, so kidney disease needs to be treated much earlier, particularly when detected early.

How can I avoid heart disease if I have diabetes?

The issue with diabetes is the on average if you have diabetes you double the risk of heart disease throughout your life. And the earlier somebody develops diabetes the more life years you lose.

So on average, a 40-year-old with diabetes loses about 6 years of life. Half of those are going to be from heart disease or strokes. If you’re age 16 you've already got diabetes and have had heart disease, on average the number of life years lost is about 12.

In order to claw back those years, you have to modify your lifestyle and think about medications that traditionally reduce the risk of diabetes progression or complications. So that meanslowering your cholesterol, it meanscontrolling blood sugars, it means controlling blood pressure and doing that early before complications develop.

The main take-home message for people with diabetes is that prevention needs to start early, it needs to be long-term, and it needs to involve an aggressive control of risk factors, maintaining that through life.

*Tradotto con Google Translator. Preghiamo ci scusi per ogni imperfezione

Professor Kausik Ray
Cardiologia

Il professor Kausik Ray è un cardiologo di fama internazionale , professore di Public Heath, e direttore del Centro imperiale per la prevenzione delle malattie cardiovascolari, presso la School of Public Health dell'Imperial College di Londra. Si è specializzato in colesterolo (compreso l'uso di statine nel trattamento), cardiologia preventiva e problemi cardiaci nei pazienti diabetici . È un esperto in prima linea nel suo campo e sta sviluppando molte delle terapie nuove ed emergenti nella sua area di interesse. È anche consulente onorario cardiologo presso l'Imperial College NHS Trust che ha visitato i pazienti dell'NHS all'Hammersmith Hospital.

Il professor Ray si è laureato in medicina presso l'Università di Birmingham, prima di completare un MD presso l'Università di Sheffield, seguito da una borsa post-dottorato presso la Harvard Medical School e infine da un MPhil in epidemiologia presso l'Università di Cambridge. Membro di varie società accademiche, è noto per i suoi contributi al suo campo nella forma della sua vasta ricerca, in particolare sui lipidi , inclusa la terapia con statine, il diabete e la prevenzione delle malattie cardiovascolari, ed è stato recentemente incluso in Clarivate Analytics 2018 Most Cited, il che significa che è tra i migliori accademici più citati nel suo campo a livello mondiale .

*Tradotto con Google Translator. Preghiamo ci scusi per ogni imperfezione

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Valutazione generale del paziente


  • Altri trattamenti d'interesse
  • Infarto/ angina pectoris
    Aritmie
    Ipertensione arteriosa
    Pericardite
    Insufficienza cardiaca
    Lesioni valvolari
    Soffio cardiaco
    Ecocardiogramma
    Elettrocardiogramma
    Elettrocardiogramma in ambulatorio (Holter)
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