The Dangerous Link Between Diabetes and Women’s Heart Disease
By Stephanie Coulter, MD
One of the least publicized—and deadliest—risk factors for cardiovascular disease is type II diabetes. Type II diabetes increased by 33 percent nationally during the previous decade and remains on the rise, especially among minority women. In 2001, seventeen million Americans had the disorder, and six million of them didn’t even know it.
Having diabetes puts you at much greater risk of cardiovascular events such as stroke, heart attacks, chest pain, and kidney disease. Thousands of women every year find out they have diabetes only after they’ve been rushed to an emergency room with a heart attack or stroke. Undiagnosed and unmanaged diabetes is the source of a cardiovascular disease epidemic waiting to happen.
Diabetes and Cardiovascular Disease
The statistics showing the association between diabetes and cardiovascular disease are sobering: A person with diabetes has a 50 percent chance of having a heart attack compared with a risk of 5 percent for people without diabetes or who don’t know if they have a vascular disease. In fact, diabetes puts you at the same risk for a heart attack as a non-diabetic who has had a heart attack and whose risk of another is therefore high. Diabetics who have already experienced a heart attack have a 40 percent likelihood of having another within seven years’ time.
In the past, the strategy for mitigating the effects of diabetes focused on managing glucose levels to prevent “microvascular events” such as blindness and kidney failure. For preventing microvascular events, this strategy works. However, managing glucose levels is not sufficient for warding off cardiovascular events. The best time to prevent cardiovascular disease is before a diagnosis of diabetes, not after.
What Is Type II Diabetes?
The increase in the incidence of type II diabetes directly relates to our society’s soaring obesity rates. Today, over half the adult population is overweight, not because of genetics but as a result of our poor diets and lack of exercise. Nearly all diabetics are obese (meaning having a body mass index, or BMI, over 30) at the time of diagnosis.
In type II diabetes, the problem starts with adipose tissue—fat—in the abdomen. This fat is actually embedded in the organs. Although the pancreas still produces plenty of insulin (unlike the pancreas of someone with Type I diabetes, which makes no insulin), the adipose tissue interferes with the body’s response to it, causing insulin resistance. The cells may be starving for glucose, but there’s no “key” to unlock the door and let it in.
Once you exceed a 126 fasting glucose level, you officially have diabetes, and you always will. Some people have been told they have “borderline diabetes” or “a touch” of diabetes, but the truth is you either have it or you don’t.
To make matters worse, nearly all diabetics have high blood pressure and high cholesterol, conditions that lead to cardiovascular disease but also increase insulin resistance. All the patients I care for have high blood pressure, and fully half of them also have diabetes.
Pre-Diabetes: The Metabolic Syndrome
Although there is no such thing as “a little diabetes,” there is a pre-diabetic period called the Metabolic Syndrome, which may last up to 20 years before glucose levels exceed 126. During this stage, the pancreas is pumping out insulin, trying to overcome the cells’ resistance and keep up with the fat accumulating in the belly.
No simple blood test exists for the pre-diabetic stage; the condition has to be diagnosed clinically by a physician. A person is pre-diabetic if she has three of these four conditions: a waist size of 35 inches or more; blood pressure greater than 130/85; a fasting glucose of 110 or higher; and high cholesterol levels, especially triglycerides greater than 150.
In addition, if you have a first-degree relative—a mother, father, brother, or sister—with diabetes and you have two of these conditions, you’re well on your way to having diabetes and the accompanying risks of cardiovascular disease.
The Answer to Staving Off Diabetes
The Metabolic Syndrome has become a huge area of medical interest. What if there were a way to intervene in the progression toward diabetes? What if we could increase the life of the pancreas and in the process reduce the risk of vascular events and improve life expectancy?
Ideally, people with the Metabolic Syndrome and diabetes would lose weight and exercise; I know of no other condition in which diet and exercise matter more.
Realistically, we know that losing weight is a struggle that many people do not permanently achieve. But even if your weight-loss efforts are unsuccessful, you can take steps to prevent Metabolic Syndrome from developing into diabetes. The secret: exercise. Exercise is the answer to diabetes prevention. It is the key that unlocks the door to allow glucose into your starving cells and to stop diabetes before it happens.
Preventing Vascular Events When You Have Diabetes
If you already have diabetes, you should take very special care of yourself to avoid a vascular event. It’s never too late to lose weight or start exercising, and above all else, don’t smoke. A smoking diabetic is suicidal.
In addition to your diabetes and any hypertension medications, you should also faithfully take the medications necessary for protecting your vascular system: a daily aspirin (or Plavix if you’re aspirin intolerant); beta blockers; an ACE-inhibitor to prevent kidney disease; and cholesterol medication. The list of precautions a diabetic must take is lengthy and the expense high—but not nearly as high as the costs of ignoring them.
In a cardiologist’s perfect world, we would all eat a good diet and get the exercise our bodies need to protect our vascular system. Short of that, we would pay attention to our physical condition, see our doctors regularly, and make adjustments to our lifestyle when we get off track. Doing so would save the most precious thing we human beings possess: our health.