As an endocrinologist, I see an ever-growing number ofpatients with diabetes and heart disease. Many of my patients with prediabetesor diabetes do not realize the negative effect that disease has on theirhearts. There is now good evidence that heart disease actually begins just asglucose levels start to rise. Thus earlytreatment 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 bloodpressure, family history, and of course diabetes. However, the famous FraminghamHeart Study suggests diabetes is playing an even greater role in thedevelopment of heart disease. Researchers from the Framingham study collected data on more than9,500 individuals ages 45 to 64 during two different periods of time andcompared risk factors for heart disease and cardiovascular events, includingheart attacks. The initial study found that between 1952 and 1974, heartdisease 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 (between1975 and 1998).
This study raises some important red flags. First, it pointsto the growing epidemic of diabetes in our country. As Americans becomeheavier, and more sedentary, the number of people with diabetes (with andwithout heart disease) continues to grow. About 65 percent of patients with diabeteswill die from cardiovascular disease.
However, as I think about this study, what concerns me mostis what happens to those patients with diabetes and heart disease. In anearlier study (by different investigators), patients with diabetes, previousheart attacks, or both, were followed. At the end of seven years, patients withdiabetes and heart disease were more than twice as likely to have had anotherheart attack as heart disease patients without diabetes.
What do I tell my patients when they ask about studies likethis? First, avoid diabetes. Do whatever you can to prevent it: Weight loss andan active lifestyle are the most effective diabetes prevention strategies. Atthe very least, don’t gain weight. If you do have diabetes, talk to your doctorabout medications that will reduce your risk of developing heart disease. Thesemay include medications to treat high blood pressure and high cholesterol. Youshould also ask about the value of taking a daily aspirin, and if it’s rightfor you.
When I combine this new study with the fact that people withboth diabetes and cardiovascular disease are at such high risk of dying ofheart disease, I see an important message. Both patients and doctors need to bemore aggressive about preventing diabetes where we can, and making sure thatpeople with diabetes are appropriately treated to reduce the risk of heartdisease.
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.
