Diabetes can affect the heart in a number of different ways. The most common thing that
we think about when we think about diabetes is narrowing of the blood vessels over time
where fat lines the blood vessels increasingly with duration of diabetes.
And that 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, it doesn't relax as well leading to heart failure.
So, the complications of diabetes are potentially heart attacks,
potentially strokes obviously affecting the brain, and heart failure.
Well one of the challenges in people with diabetes is that the pain threshold is a lot
different in people with diabetes. So 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.
So you need to have a high threshold for diagnosis. And if people with diabetes have
slightly atypical symptoms, maybe start to get breathless on walking,
that could be a sign that there's a problem with the blood supply to the heart
or it could be a sign that the heart muscle is not pumping adequately.
One of the challenges is the people with diabetes often have heart failure
where the heart is not pumping properly.
And it's undiagnosed in about 25% of people.
So, there are a couple of ways of thinking about diagnosing this.
One is with scans of the heart, two is basically blood tests that show that the heart is being
overworked and is being stressed. And the third thing is in in people with slightly
atypical symptoms whereby maybe they're getting a little bit of breathlessness on walking,
it's what's called a stress test either on a treadmill, a bicycle, or doing what's called
a stress echocardiogram of the heart; whereby increase the heart rate and you just take
images of the heart muscle to see if it's pumping properly in response to exercise.
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.
And we know that for one unit lowering in so-called bad cholesterol or LDL,
the patients 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.
And this is obviously on top of things like lifestyle.
Having diabetes, per se, gives you the so called "high-residual risk". So,
blood pressure, cholesterol and lifestyle factors become more important. And often you have
to treat those much, much more aggressively in people with diabetes.
The other problem that often need we find with diabetes is kidney problems.
And once kidney problems start, that often increases the likelihood of heart failure
and so that means that kidney disease needs to be treated much more early,
particularly when detected early.
The issue with diabetes is that 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.
So in order, if you like, to claw back those six years, you have to basically modify lifestyle
and think about medications that traditionally reduce the risk of diabetes progression or complications.
So that basically means cholesterol lowering, it means controlling blood sugars, blood glucose levels,
it meanscontrolling blood pressure and doing that early before complications develop.
So, prevention really starts early.
And if somebody's unfortunate enough to have diabetes and heart disease,
they need to be treated even more aggressively.
So, 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.
So, the main take-home message for people with diabetes is prevention long-term - starting early -
and aggressive control of risk factors early
and maintaining that throughout life.