Heart disease is the leading cause of death among persons with diabetes, but only a third of them know this fact, according to a new survey by the American Heart Association (AHA).
The AHA reports that persons with diabetes are 2-3 times more likely to have heart disease or suffer a stroke compared to persons without diabetes. Despite the apparent risk of heart disease in the diabetic population, the AHA survey found that only 33% of diabetic patients consider heart conditions to be major diabetes-related complications.
“At a time when more than two thirds of diabetic patients die from heart disease or cardiovascular problems, we need to raise the awareness of these conditions among those patients,” says Sidney Smith, Jr., MD, chief science officer for the American Heart Association. “Because of the potential contribution insulin resistance makes not just to the diabetic state but also to the development of cardiovascular disease.”
Smith, who is also a professor of medicine at the University of North Carolina at Chapel Hill, says that increasing scientific evidence has pointed to the link between diabetes and cardiovascular disease, and the role insulin resistance plays in both. Insulin resistance plays a key role in type 2 diabetes, the most common form of the disease. It is a condition associated with blood lipid imbalances and hypertension.
Diabetes can lower the high-density lipoprotein (HDL) cholesterol or the good cholesterol and change the character of low-density lipoprotein (LDL) cholesterol or the bad cholesterol and make it worse. It can also raise levels of triglycerides (fat in the blood) that cause atherosclerosis (hardening of the arteries).
The new cholesterol guidelines issued by the National Cholesterol Education Program call for aggressive treatments in diabetic patients. It recommends that doctors treat all diabetics as if they have heart disease. The AHA also considers diabetes a major risk factor for cardiovascular disease.
“Unfortunately, diabetic patients still tend to treat heart disease as a separate concern,” says Smith. “There is a great disconnect between perception and reality when it comes to understanding diabetes and insulin resistance and their related complications.”
The survey interviewed 532 people with type 2 diabetes. It showed that only about half (52 percent) of respondents were familiar with the term insulin resistance. Of the patients polled, just over half (57 percent) were aware that insulin resistance is associated with heart disease.
The AHA survey also showed that:
- 46% have high blood pressure or hypertension, 28% have blood circulation problems and 19% have other heart conditions.
- 28% of patients reported having high cholesterol.
- A total of 83% of patients incorrectly defined insulin resistance.
- 43% of patients who take diabetic drugs did not know whether their current medication treated insulin resistance.
- According to body mass index calculations, 33% of type 2 diabetes patients are overweight, and nearly half are obese.
Robert Sherwin, MD, president of the American Diabetes Association, says that the survey shows that too much focus may have been placed on the classical diabetes complications, such as amputation of limbs and blindness, while overlooking the importance of diabetes in cardiovascular disease.
“Think heart disease when you have diabetes,” says Sherwin, who is also a professor of medicine at Yale University School of Medicine in New Heaven, Connecticut. “It’s a misconception by the population that diabetes and cardiovascular disease are separate processes. We need to retrain people to think that the two are intertwined.”
Sherwin points out that having diabetes magnifies a lot of the poor outcomes in terms of cardiovascular disease. The vast majority of diabetic patients develop heart disease, and 80% of them die of heart disease. But a third of the people who have diabetes don’t know it, says Sherwin. They commonly show up at the hospitals with heart attack, which is caused by diabetes.
“Diabetes is what causing the heart attack to occur in reality, and it is accelerating the process dramatically,” says Sherwin. “The approach to care of diabetes is not simply keeping glucose under control. It is really managing all the cardiovascular risk factors that are really the major cause of death.”
In the coming months, the American Diabetes Association is to launch a new diabetes and cardiovascular disease initiative to enhance the understanding of the relationship between the number one killer of Americans–heart disease–and its dominant risk factor, diabetes.
Article By: Hong Mautz, Medical Writer