Heart and Diabetes



This page is for information on Heart Disease an Diabetes. You will find articles to help you find what you want to know. If you have any reason to think you have any of these problems you should talk with your Doctor. The main type of Diabetes we are talking about here is Type 2 which is adult onset. At the bottom of the page you can find NEW updated information links.

Index of Mini-Articles:

Preventing Heart Disease in People with Diabetes
Type II Diabetes & Heart Disease
Blood Pressure Drugs & Diabetes
Preventing Diabetes Related Heart Attacks
Type I Diabetes
Cholesterol
Blood Pressure

Weight
Links for Diabetes


Preventing Heart Disease in People with Diabetes

As many people with diabetes know, they need to work harder than most others to prevent heart disease. In diabetes, insufficient insulin — the hormone that allows the body to use sugar from food — causes unused sugar to build up in the blood. High levels of blood sugar have been shown to speed up the artery clogging that leads to heart attacks. High blood pressure and high cholesterol frequently accompany diabetes, injuring the arteries further. Thus, the same lapses in diet and exercise that cause little harm to most people can bring on heart trouble surprisingly swiftly for those with diabetes. And once a person with diabetes has had a heart attack, the risk of further heart trouble skyrockets.


Type 11 Diabetes and Heart Disease

Controlling blood pressure is crucial in preventing heart attacks and heart failure for people with type 2 diabetes, a new study finds, confirming similar conclusions from other recent studies (see the August and September/October Heart Watch issues).

Researchers reported in the September 12 British Medical Journal that among more than 1,000 people with both type 2 diabetes and hypertension, lowering blood pressure to 144/82 with drugs cut heart attacks by about a fifth and heart failure by more than half, compared with reducing blood pressure only to 154/87. Lowering blood pressure further – to 130/80 – may reduce the risk of heart attack even more, according to other recent studies.

The researchers also studied the effects of tight blood sugar control, which has been suspected but not proven to reduce complications from type 2 diabetes. They found that improved blood sugar control, achieved through more aggressive drug therapy, helped reduce certain complications not related to the heart. But the people receiving aggressive therapy had only slightly fewer heart attacks than people receiving conventional treatment, which uses fewer drugs or lower doses. In fact, the difference in the number of heart attacks was so small that it could have been due to chance alone. The investigators published this portion of their research in the September 12 Lancet.

This study isn't the last word on whether good blood sugar control helps prevent heart attacks for people with diabetes; even tighter blood sugar control over a longer time might prove to make a bigger difference. If you have type 2 diabetes, tight blood sugar control is important for your overall health. But remember that you need to control your heart disease risk factors too, particularly your blood pressure

Blood Pressure Drugs and Diabetes

The body’s chemical complexity makes it difficult to develop drugs that help one system without influencing another. As a result, beneficial drugs can cause vexing side effects, such as headache and nausea, or even an unrelated disease. For example, drugs used to treat high blood pressure have been suspected of promoting diabetes. Now a study in the March 30 New England Journal of Medicine shows that — with the exception of beta-blockers — high blood pressure medications do not increase your chances of developing diabetes. The study also shows that having high blood pressure, in and of itself, dramatically boosts your risk of becoming diabetic.

Researchers recruited 12,550 people aged 45 to 64 who did not have diabetes to participate in a 6-year study. People were considered to have high blood pressure if they had a systolic pressure (top number) of 140 or more, a diastolic pressure (bottom number) of 90 or more, or if they reported using medication to control high blood pressure. Diabetes was 2.5 times as likely to develop in people with hypertension as it was in people with normal blood pressure. In addition, one class of drug — beta-blockers — increased the risk of developing diabetes by 28 percent. But thiazide diuretics, angiotensin-converting-enzyme (ACE) inhibitors, or calcium channel-blockers did not add to the diabetes risk.

While this study provides further incentive to control high blood pressure, its findings should not necessarily discourage people from taking beta-blockers. Under many circumstances these drugs yield cardiovascular benefits that outweigh their effects on diabetes risk. Your doctor can help you sort out which blood pressure drug or drugs will produce the greatest overall benefits.

Preventing Diabetes Related Heart Attacks

As many people with diabetes know, they need to work harder than most others to prevent heart disease. In diabetes, insufficient insulin — the hormone that allows the body to use sugar from food — causes unused sugar to build up in the blood. High levels of blood sugar have been shown to speed up the artery clogging that leads to heart attacks. High blood pressure and high cholesterol frequently accompany diabetes, injuring the arteries further. Thus, the same lapses in diet and exercise that cause little harm to most people can bring on heart trouble surprisingly swiftly for those with diabetes. And once a person with diabetes has had a heart attack, the risk of further heart trouble skyrockets.


Type 2 Diabetes

Most of the estimated 16 million Americans with diabetes have type 2, also called adult-onset diabetes. People who have type 2 diabetes usually don't have to take insulin, because their bodies still produce some insulin. Many develop diabetes because they are overweight. Excess weight increases the amount of insulin the body needs, and when insulin production can't meet that need, diabetes develops. When this happens, the heart is at risk from both the diabetes (because high blood sugar speeds artery clogging) and the obesity, which raises blood pressure and LDL (bad) cholesterol.

But not everyone who develops type 2 is overweight. Some people — especially African Americans, Asians, Hispanics, and Native Americans — develop diabetes because of a genetic predisposition to insulin resistance, a condition that often leads to type 2.

Insulin resistance makes the body less efficient at using insulin. So the body usually responds by making more insulin, but eventually it can't keep up and type 2 diabetes develops. Many people develop heart damage in this stage, because the symptoms of diabetes — such as thirst and frequent urination — are often too mild to notice in type 2, so the diabetes goes untreated. Even before diabetes develops, however, insulin resistance may itself predispose people to heart disease.

Just how great a heart disease risk people with type 2 diabetes face was driven home by a recent study comparing heart attack rates in 2,400 people with or without type 2 diabetes. Researchers counted how many people had heart attacks during the seven-year study. They found that heart attacks were about as common among people with diabetes who'd had no prior heart attacks as among nondiabetics who had had one — striking about one in five people in both groups. This finding suggests that doctors should treat heart disease risk factors in people with type 2 diabetes and no known heart disease as aggressively as they do in nondiabetics who've already had a heart attack. The study appeared in the July 23 New England Journal of Medicine.


Type 1 Diabetes

Between 500,000 and 1 million Americans have type 1 diabetes, the inability to make any insulin. This form of diabetes, which develops in childhood to early adulthood, is thought to result from the immune system mistakenly attacking insulin-producing cells. People with type 1 diabetes typically start with fewer heart disease risk factors than those with type 2, but they aren't entirely off the hook either. Uncontrolled type 1 leads to high blood sugar, which can eventually damage blood vessels in the kidneys. This renders the body unable to regulate blood pressure and cholesterol. So heart disease is a major cause of death for people with type 1 diabetes, just as it is for those with type 2. In recent years, intensive insulin therapy — multiple daily injections of insulin — has been shown to reduce the risk of complications from type 1 diabetes more than the former standard therapy of only one or two daily injections. Fewer people on intensive therapy develop heart disease, because blood sugar remains more stable, in turn controlling blood pressure and cholesterol.

But intensive therapy may actually increase the risk of heart disease in a minority of people, according to a study in the July 8 Journal of the American Medical Association. Researchers tracked more than 1,000 people with type 1 diabetes assigned to either intensive or conventional treatment. The researchers found that those on intensive therapy lowered their blood sugar levels, which lowers cholesterol. But during the six-year study, they were more likely to gain weight, which increases cholesterol. Those who gained at least 40 pounds ended up with increased cholesterol, even though their blood sugar levels improved.

Both this study and the NEJM study argue for aggressively treating heart disease risk factors in people with either type of diabetes. But exactly what should people with diabetes do to control these risk factors? To start, they should do the same things as nondiabetics: quit smoking, control their weight, exercise, and eat a healthy diet. In addition, people with diabetes must often put in some extra effort.


Cholesterol

Many doctors tell their diabetic patients to aim for an LDL cholesterol level of 130 milligrams per deciliter – lower than the goal for healthy nondiabetics. But in light of the NEJM study, even this level may not be low enough for those with type 2 diabetes. Nondiabetics who've already had a heart attack usually aim for an LDL of 100 or lower, and anyone with diabetes should shoot for the same level. For many people with diabetes, though, high LDL but low HDL (good) cholesterol and high triglyceride levels. Niacin, the B vitamin normally recommended in such situations, may interfere with blood sugar control. So many doctors prescribe the triglyceride-lowering drug gemfibrozil (Lopid) for their diabetic patients, which can raise HDL slightly. Exercise also raises HDL levels, though nothing can raise HDL more than a few points.

Blood Pressure

The American Diabetes Association (ADA) recommends that diabetics keep blood pressure at or below 130/85. But recent studies suggest that all people with diabetes would benefit from going even lower — to 80 points diastolic, the second number in the blood pressure reading (see the August Heart Watch). "There's a push to go even lower than the current recommendations," says ADA president Gerald Bernstein, MD. "It makes sense to try, because we have the medications now to help people reach those lower levels." It's clear that when people with diabetes do need drug therapy to lower their blood pressure, drugs called ACE inhibitors are the first choice. That's because these drugs also protect the kidneys from damage due to diabetes. If you have an intolerance to ACE inhibitors, your doctor may prescribe a calcium channel blocker, which has similar but smaller benefits.

News Item: Help for Diabetes (Ace Inhibitors from Ivanhoe News)


Weight

People with type 1 diabetes usually gain a few pounds when they begin taking insulin, because their bodies start using sugar instead of dumping it out through their urine. But excessive weight gain is rare, even with intensive insulin therapy. Those who gained more than 40 pounds in the JAMA study may represent a minority with an inherited predisposition to gain weight. If you gain excessive weight during intensive therapy, discuss with your doctor whether you should back off your insulin regimen in order to lose the weight. But don't consider the possibility of weight gain a reason not to try intensive therapy. For most people, gaining even a few pounds won't undo the effects of improved blood sugar levels, which cut the risk of all type 1 diabetes complications. Once heart disease develops, people with diabetes have a far worse prognosis than nondiabetics with the same heart problems. Treatments for heart disease often must be modified for people with diabetes. And studies of heart disease treatments often exclude diabetics, because the effects of diabetes might be confused with the effects of the treatment. So doctors may be reluctant to have people with diabetes use these treatments, because it's unclear whether they'll really help. (We'll address heart disease treatments for people with diabetes in a future issue.)

The good news is that people with diabetes can avoid having to settle for less aggressive or more uncertain heart disease treatment, by preventing heart disease from developing.


INSULIN RESISTANCE: A DANGEROUS PRECURSOR TO TYPE 2 DIABETES

Type 2 diabetes often develops from a condition called insulin resistance, in which the body's cells need extra insulin in order to use the sugars from food. Researchers speculate that some people are genetically prone to develop insulin resistance along with many heart disease risk factors. But recent studies suggest that insulin resistance by itself may be a strong contributor to heart disease, no matter which other risk factors are involved — even if a person never develops full-blown diabetes. One study, in the August Journal of Clinical Endocrinology and Metabolism, followed 147 men and women free of diabetes, cardiovascular disease, and cardiovascular risk factors. After four years, those who had developed the most insulin resistance had the highest rates of cardiovascular disease. Many of these people had also acquired other heart disease risk factors, but only insulin resistance predicted whether they developed cardiovascular disease.

One of the body's responses to insulin resistance is to produce more insulin, a condition called hyperinsulinemia. In another recent study, researchers followed almost 1,000 men for 22 years. Within the first 10 years, hyperinsulinemia was linked to heart attack and heart disease deaths more closely than any other heart disease risk factor, though over the next 12 years hyperinsulinemia became less important than blood pressure or smoking. This study appeared in the August 4 Circulation.

Although these studies suggest a connection between insulin resistance and heart disease, it's too soon to recommend that everyone have their insulin levels measured. But if you know you have insulin problems, discuss with your doctor strategies for preventing diabetes, including weight loss, exercise, and improved diet. And everyone over age 45 should be tested for diabetes every three years.

LINKS !!

New Diabetes Guidelines Focus on Prevention, Treatment Aug. 21, 2001 (Washington) --Two groups at the forefront of diabetes research and treatment issued new care guidelines, which are aimed at curbing the deadly disease that now afflicts an estimated 16 million Americans.

What Are The Effects Of Exercise On Diabetes? Diabetes, particularly type 2, is reaching epidemic proportions throughout the world as more and more cultures adopt Western dietary habits. Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes. But yo must check with your Dr. before starting any exercise routine.

Recipes For Diabetes and Heart We've put together a unique collection of over 800 diabetic and heart-healthy recipes that have been developed for your personal use so that you and your family and friends can all sit down to a meal together, knowing that you'll be enjoying delicious food while helping you to control your diabetes.





Source :

FOR MORE INFORMATION: American Diabetes Association, 1-800-DIABETES, for the pamphlets “Diabetes Day By Day: Cardiovascular Health” and “First Things First: Complications”

Url is www.heart-help.net
angelgin@bellsouth.net
LeeJRoush@msn.com
Last Modified on October 29, 2001