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Diabetes and heart disease a double-edged sword

By Dr Bikash Rai Das

More and more young people have diabetes today. If the father turned diabetic at 60, the son would become diabetic at 50 and the grandson would develop the condition much earlier because of changing lifestyles. People who have diabetes are more susceptible to heart attacks. These heart attacks may frequently go unnoticed in diabetics.

Heart disease may occur at an earlier age in diabetics than others. The rate of heart attack is the same for both men and women with diabetes. Diabetes confers a substantially greater risk (3-4-fold higher) of heart attack and cardiac death among Indians than Europeans.

What is diabetes?

Diabetes is a disorder of metabolism (the way our bodies use digested food for energy). Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the body�s main source of fuel.

After digestion, glucose enters the bloodstream. Then glucose goes to cells in the body where it is used for energy. However, a hormone called insulin must be present to allow glucose to enter the cells. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from the blood into the cells. However, diabetes develops when the pancreas does not make enough insulin or the cells in the muscles, liver and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases while the cells are starved of energy.

Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease, the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other health problems as well, such as stroke, vision loss, kidney failure and amputations.

What is the connection between diabetes and heart disease?

People with diabetes tend to develop heart disease at an earlier age than other people. If one is middle-aged and have type 2 diabetes, some studies suggest that one's chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.

People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials inside the blood vessels. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).

What are the risk factors for heart disease in people with diabetes?

Diabetes itself is a risk factor for heart disease. Also, many people with diabetes have other conditions that increase their chance of developing heart disease. One risk factor for heart disease is having a family history of heart disease. If one or more members of one's family had a heart attack at an early age (before age 55 for men or 65 for women), one may be at increased risk.

One can�t change whether heart disease runs in one�s family, but one can take steps to control the other risk factors for heart disease listed here:

Central obesity: Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means one have central obesity. One's risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited inside of blood vessel walls.

Abnormal blood fat (cholesterol) levels:

� LDL cholesterol can build up inside one�s blood vessels, leading to narrowing and hardening of one�s arteries-the blood vessels that carry blood from the heart to the rest of the body. It may block the arteries. Therefore, high levels of LDL cholesterol raise one's risk of getting heart disease.

� Triglycerides are another type of blood fat that can raise one's risk of heart disease when the levels are high.

� HDL (good) cholesterol removes deposits from inside one�s blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase one�s risk for heart disease.

High blood pressure: If one has high blood pressure, also called hypertension, one's heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase one's risk of heart attack, stroke, eye problems and kidney problems.

Smoking: Smoking doubles one's risk of getting heart disease. Both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in one's legs and increase the risk of amputation.

What can one do to prevent or delay heart disease?

Even if one is at high risk for heart disease, one can help keep one's heart and blood vessels healthy. One can do so by taking the following steps:

�Heart-healthy� diet: Food high in fibre may help lower blood cholesterol. Oatmeal, whole-grain bread and cereals, beans and peas, fruits and vegetables are all good sources of fibre.

To cut down on saturated fat: It raises one�s blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil.

Cholesterol is found in meat, dairy products, and eggs.

We have to keep the amount of trans-fat in our diet to a minimum. It�s a type of fat in food that raises blood cholesterol. Limit one�s intake of crackers, cookies, snack food, commercially prepared baked goods, cake mixes, microwave popcorn, fried food, salad dressings and other food made with oil. Check for trans-fat in the �nutrition facts� section on the food package.

If one has the habit to smoke, he or she must quit.

Points to remember

Controlling the ABCs of diabetes-A1C (blood glucose), blood pressure and cholesterol can cut one�s risk of heart disease and stroke.

Choosing food wisely, quitting smoking and taking medications (if needed) can help lower one's risk of heart disease and stroke.

If someone has any warning signs of a heart attack or a stroke, get medical care immediately. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart.

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