Appropriate assessment and management of cardiovascular risk is vital to prevent fatal and non fatal heart attacks and strokes and to improve health outcomes in individuals at high risk of cardiovascular events. Those at high cardiovascular risk include patients with established coronary heart disease and cerebrovascular disease as well as those with risk factors. These risk factors such as hypertension, diabetes, smoking, high blood lipids, physical inactivity, obesity and a positive family history often occur together and need to be treated in a comprehensive manner.
The most common condition that predisposes a person to heart attack is coronary heart disease, or coronary artery disease, due to atherosclerosis, or fatty build up of plaque on the inner lining of coronary arteries.About 1.5 million Americans suffer a heart attack each year (that’s 1 heart attack every 20 seconds).Many people die before getting medical attention. Approximately 90-95% of people who reach a hospital alive after a heart attack will survive. Overall, about one third of people who have a heart attack die.
Your risk of sudden death from a heart attack is the same as that of someone who has already had a heart attack. That's why diabetes is called a heart disease equivalent. Diabetes can damage your blood vessels, including the arteries that supply blood to your brain and heart. This damage makes it easier for fatty deposits (plaques) to form in the arteries. The buildup of arterial plaques, a condition called atherosclerosis, can choke off blood supply and drive up your blood pressure.You're two to four times as likely to have a heart attack or stroke as is someone without diabetes.You're more likely to die of a heart attack than you'd be if you did not have diabetes.
Globally, cerebrovascular disease (stroke) is the second leading cause of death. It is a disease that predominantly occurs in mid-age and older adults. WHO projects that in 2005, stroke will have accounted for 5.7 million deaths world wide, equivalent to 9.9 % of all deaths. Over 85% of these deaths will have occurred in people living in low and middle income countries and one third will be in people aged less than 70 years.
A brief interruption in the blood flow to the brain can cause a decrease in brain function. This is called a neurologic deficit. Too little blood flow to the brain for some time can cause brain cells to die.Approximately one third of all myocardial infarctions are silent, without chest pain or other symptoms. These cases can be discovered later on electrocardiograms or at autopsy without a prior history of related complaints. A silent course is more common in the elderly, in patients with diabetes mellitus.
If you have diabetes, you're at higher risk of heart attack, stroke and Peripheral Artery Disease (PAD).PAD is a condition similar to coronary artery disease (clogged arteries that supply blood to the heart muscle) and carotid artery disease (clogged arteries leading to the brain). But it affects arteries leading to areas outside the brain and heart, most often in the legs and feet. In PAD, fatty deposits build up in the inner linings of the artery walls of the legs. This can cause pain in the legs, especially when walking. In extremely severe cases, limb amputation may be needed. This same buildup in the arteries of the heart and brain significantly increases your risk of heart attack and stroke.
Aggressive blood pressure control is especially advantageous in the diabetic population.
In the Appropriate Blood Pressure Control in Diabetes (ABCD) study, researchers followed 950 people with type 2 diabetes (also called adult-onset diabetes) for five years. At the beginning of the study, 480 had normal blood pressure, and 53 had PAD. Participants were split into two groups.
As the number of Americans with type 2 diabetes has soared over the past 50 years, so, too, has heart disease linked to the blood sugar illness, researchers report.
"The proportion of heart disease due to diabetes has increased about 60 percent over time," said lead author Dr. Caroline S. Fox, a medical officer at the National Heart, Lung, and Blood Institute's Framingham Heart Study. "Compared with other risk factors for heart disease, diabetes is becoming more of an issue," she said.
"I'm not surprised, but I am frightened," added Dr. Larry Deeb, president for medicine and science at the American Diabetes Association. "If you have diabetes and you have a heart attack, you don't do as well and the death rates are worse," he said.
The only solution is to prevent diabetes, Deeb said. In one major prevention trial, "we showed that with a half-hour of exercise a day and the loss of 10 to 15 pounds, you reduce the new diabetes cases by over 58 percent," he said.
In obesity-linked type 2 diabetes, the body either doesn't produce enough insulin -- the hormone that converts blood sugar to energy for cells -- or the cells ignore the insulin. Left untreated, the disease can produce complications such as heart disease, blindness, nerve and kidney damage.
Almost two-thirds (65 percent) of diabetics will die from heart disease or stroke, according to the American Heart Association.
In this study, Fox's team collected data on 9,540 people age 45 to 64, who participated in the Framingham Heart Study, a large population-based study.
The researchers used the data to compare risk factors for heart disease and cardiovascular events such as heart attacks from two different time periods. The first group was examined between 1952 and 1974, and the second group was examined between 1975 and 1998, according to the report.
They found that risk for heart disease attributable to type 2 diabetes was 5.2 percent between 1952 and 1974. However, that number jumped to 7.8 percent between 1975 and 1998. The majority of the increased risk occurred among diabetic men.
In addition, Fox's group also found that the prevalence of diabetes among those with heart disease almost doubled between the time periods. The prevalence of obesity also increased over time, they found.
The findings echo those from a study published by the same group last June in Circulation. In that study, Fox's team looked over data on more than 3,400 Americans aged 40 to 55 who were also participating in the Framingham study. Following the participants from the 1970s through to the 1990s, Fox and her colleagues found that rates of diabetes have doubled over that period of time.
"In terms of public health, diabetes needs to be more effectively managed with respect to cardiovascular disease management," Fox concluded. "Ultimately, diabetes needs to be prevented," she said. That includes curbing the obesity epidemic, experts say.
Deeb added that while much diabetes is caused by obesity, genetics also plays a role, especially among blacks, Hispanics and people from South Asia. "There are lots of variables that come into play besides your body mass index," he said.
Another expert agreed that more needs to be done. "This is a very important study that highlights the increased risk for cardiovascular disease that patients with diabetes face," added Dr. Gregg Fonarow, a professor of clinical medicine at the University of California, Los Angeles.
"There is an urgent need to aggressively treat all patients with diabetes with cardiovascular protective medications, risk factor control, and lifestyle change as recommended in national guidelines," Fonarow said.
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