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How diabetes can break your heart

Cardiovascular disease and diabetes go hand in hand. Of the half-million people in the U.S. who experience heart attacks each year, at least half have diabetes.

Cardiovascular disease and diabetes go hand in hand.

Of the half-million people in the U.S. who experience heart attacks each year, at least half have diabetes.

Why is diabetes the No. 1 risk factor for cardiovascular disease? Elevated blood sugars damage large and small blood vessels throughout the body. When vessels aren't healthy, it's much more difficult for oxygen in the blood to get where it needs to go.

But doctors also know high sugars alone aren't responsible for cardiovascular issues.

About 90 percent of people with diabetes share important risk factors for cardiovascular problems, including high blood pressure, unhealthy levels of cholesterol, and obesity.

Other factors that can contribute to cardiovascular disease include smoking and a lack of physical activity.

It's this dangerous combination of additional risk factors with diabetes that leads to heart disease, peripheral vascular disease, and stroke - all forms of cardiovascular disease.

Yet, although 70 percent to 80 percent of people with diabetes will end up dying of cardiovascular disease, for some reason the diabetes-cardiovascular connection remains under the radar.

"People with type 2 diabetes don't relate diabetes to heart attacks and strokes, but do relate it to limb loss," says Mark Schutta, director of the Penn Rodebaugh Diabetes Center. "They tell me, 'I want to get my diabetes under control because I have a friend or neighbor who lost a leg.'

"They're always asking me, 'How much longer do I have before I lose a leg?' "

The question is particularly puzzling as amputations are much less frequent among people with diabetes now than in the past.

One reason for this persistent association may be that although limbs are visible, the heart is not. Rhondalyn Forde-McLean, an assistant professor of cardiovascular medicine at the Perelman School of Medicine, recently gave a talk to a group at Susan G. Komen for the Cure and asked what they thought was the most likely cause of death for women. Predictably, most answered breast cancer.

"But the risks of death associated with breast cancer are about two and a half times more than other causes compared to nine times more for women with cardiovascular disease," McClean pointed out.

It's a particularly important point because women with diabetes are even more likely than men with the condition to have heart issues.

"If you look at men in general, those with diabetes are four times more likely to develop heart disease; women with diabetes are six times more likely," she said.

Why aren't people more aware of these odds?

"Part of it is advertising," said McClean. "Everyone wears a pink ribbon but no one talks about cardiovascular disease in that way."

And risk factors for cardiovascular disease tend to be "silent."

"You don't actually feel high blood pressure, and most people with high cholesterol don't know it," said McClean.

Treating cardiovascular conditions often involves a combination of drugs and lifestyle modifications.

Decreasing blood sugars remains paramount, although there has been only one notable research study showing the link between lowering high blood sugar and reducing heart disease.

The study, published several years ago in the British Medical Journal, found a 35 percent decrease in heart attacks when people controlled their blood glucose. McClean said the research continues.

"We do know if we can control blood sugars, peripheral artery disease gets better or stabilizes, and we like to think good glucose control contributes to a lower chance of heart disease," she said. "There is not a good study that shows that perfectly, but we like to think that lowering blood sugars will decrease morbidity and mortality," she said.

McClean recommends her patients keep their A1C reading (a three-month average of blood glucose values) below 7. Other doctors advise 6.5.

Patients also need to reach a blood pressure level of below 135/80 and pay attention to their cholesterol.

Drug therapy includes insulin or insulin sensitizers like metformin, aspirin, beta blockers, ace inhibitors, or lipid-lowering agents.

"We also know that lifestyle modifications work, " said McClean. These include at least 30 minutes of moderate-intensity aerobic activity at least five days a week or at least 25 minutes of vigorous aerobic activity at least three days a week. A healthy, nutrient-dense diet is also important.

McClean has the numbers to prove it.

"When we control lipids, we know that we decrease the risk of dying of heart disease by 36 percent, the risk of heart attack by 50 percent, and the risk of stroke by 60 percent. If we can control blood pressure, we can reduce the risk of stroke, cardiac, and heart disease by 50 percent," she said.

The takeaway is that taking charge of your blood sugars, blood pressure, and cholesterol is vital.

"It's important to note that the most common cause of mortality in industrialized nations is cardiovascular disease," said McClean. "It's very common in patients with diabetes, and there are consequences for both individuals and on a broader scale, in terms of health-care dollars."

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