Health & Medicine / Heart Disease

As an endocrinologist, I see an ever-growing number of patients with diabetes and heart disease. Many of my patients with prediabetes or diabetes do not realize the negative effect that disease has on their hearts. There is now good evidence that heart disease actually begins just as glucose levels start to rise. Thus early treatment of even prediabetes makes a lot of sense.

The risk factors for heart disease can be rattled off by almost anyone who watches Grey’s Anatomy: high cholesterol, smoking, high blood pressure, family history, and of course diabetes. However, the famous Framingham Heart Study suggests diabetes is playing an even greater role in the development of heart disease. Researchers from the Framingham study collected data on more than 9,500 individuals ages 45 to 64 during two different periods of time and compared risk factors for heart disease and cardiovascular events, including heart attacks. The initial study found that between 1952 and 1974, heart disease was complicated by type 2 diabetes in 5.2 percent of patients. However, that number jumped to 7.8 percent for individuals in the later group (between 1975 and 1998).

This study raises some important red flags. First, it points to the growing epidemic of diabetes in our country. As Americans become heavier, and more sedentary, the number of people with diabetes (with and without heart disease) continues to grow. About 65 percent of patients with diabetes will die from cardiovascular disease.

However, as I think about this study, what concerns me most is what happens to those patients with diabetes and heart disease. In an earlier study (by different investigators), patients with diabetes, previous heart attacks, or both, were followed. At the end of seven years, patients with diabetes and heart disease were more than twice as likely to have had another heart attack as heart disease patients without diabetes.

What do I tell my patients when they ask about studies like this? First, avoid diabetes. Do whatever you can to prevent it: Weight loss and an active lifestyle are the most effective diabetes prevention strategies. At the very least, don’t gain weight. If you do have diabetes, talk to your doctor about medications that will reduce your risk of developing heart disease. These may include medications to treat high blood pressure and high cholesterol. You should also ask about the value of taking a daily aspirin, and if it’s right for you.

When I combine this new study with the fact that people with both diabetes and cardiovascular disease are at such high risk of dying of heart disease, I see an important message. Both patients and doctors need to be more aggressive about preventing diabetes where we can, and making sure that people with diabetes are appropriately treated to reduce the risk of heart disease.

Robert W. Lash, M.D. is an associate professor of internal medicine at the University of Michigan Medical School. His clinical interests include thyroid disease, diabetes, endocrine disorders in pregnancy, osteoporosis and metabolic bone disease, and medical education. A member of the LLuminari team of experts, a board certified internist and endocrinologist, Dr. Lash has an active clinical practice and is a hospitalist at the University of Michigan.

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