Dr Russel Drummond discusses cardiovascular health and well-being.
Diabetes and the heart
Heart disease is amongst the most dreaded complications of Diabetes. Heart failure is a type of heart disease where the heart cannot pump adequately. Symptoms of heart failure include shortness of breath, chest pain, fatigue and swelling of the feet, ankles and legs. High blood sugar levels (Diabetes) and hypertension (high blood pressure) increase the risk of heart failure. Other factors like obesity, smoking and high blood cholesterol increase the risk of heart failure in people with Diabetes. People with Diabetes require specialised care to prevent, diagnose and treat heart disease.
Western diet and Indian genes
People of Indian origin who move to the UK tend to eat a more westernised diet. This combination of a western diet with Indian genes causes more harm than in people of Indian origin who eat an Indian diet. A western diet increases the risk of atherosclerosis (build-up of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow), heart attacks, strokes, occurring at a much younger age.
CVOT
Cardiovascular Outcome Trials (CVOT) were started in 2008 after the US Food and Drug Agency and European Medicines Agency became concerned that one of the historic drugs might be increasing cardiovascular (heart problems) risk. The agencies mandated that all new Diabetes drugs should demonstrate cardiovascular safety as a minimum. In the last 10 years, a quarter of a million people participated in studies demonstrating the safety of new Diabetes drugs.
However, in demonstrating safety, the findings of CVOT have also highlighted some interesting additional effect shown by the drugs that resulted in new guidelines that help direct a doctor to select the right drug. In case the individual has had a previous heart attack or a stroke, the trials indicated that some of the injectable GLP1 drugs – liraglutide, semaglutide, dulaglutide
- have additional benefits beyond sugar control. They reduce heart attacks and strokes
A new class of drugs called SGLT2 inhibitors have additional roles beyond treating sugar for people who have got heart failure or kidney failure. SGLT2 inhibitors work effectively by making you lose sugar through the urine. CVOT trials show that these drugs protect the heart in the long term
studies have shown that a moderate to high-intensity exercise at least 30 minutes for five days a week may improve metabolism and reduce body fat. Even a modest 5 per cent weight reduction over a 3 year period can improve microvascular function in people with and without Diabetes. This can prevent the onset of kidney disease or eye disease.
Smoking – Smoking is the single strongest predictor of premature stroke and heart attacks. Try to replace cigarettes with gum or nicotine patches to help you stop smoking.
Blood pressure and lipid control – It is important to not just lower blood sugar levels right but also improve all health parameters. Get your blood pressure checked on a regular basis. We have two types of cholesterol in our body – one is from what we eat and the other is what our body makes. The cholesterol which causes harm to us is made from within. Diet and medication like statins can lower cholesterol levels. Statins are known to reduce the risk
of heart attack and stroke irrespective of what your starting cholesterol is. Every person with Diabetes in the CVOT was seen to benefit from statin use.
Doctor-patient relationship
A good doctor-patient relationship is crucial to maintain good heart health. For a majority of people with Diabetes, timely medical treatment with the correct medicine not just lowers blood sugar levels but also lowers the risk of complications and drug side effects. Always discuss the following points with your doctor:
- When you visit any doctor, make it a point to always carry your current list of medications, the list of medications you have been prescribed and the list of
any extra medications you are taking.
- Do not be afraid to let your doctor know if you have stopped taking any prescribed medicine because it didn’t agree with you. The doctor can prescribe an alternative to help you manage any health condition.
- It is important to let your doctor know which other doctors you are seeing and what you are seeing them for. Tell your diabetologist if you are seeing a cardiologist separately and vice versa. This is because they may not have each other’s doctor’s notes.
- Report symptoms such as pain in the chest or in your calves or legs or difficulty breathing while walking and if the pain goes away when you rest or difficulty in breathing when you are lying down flat or if you are passing frothy urine. Based on this, the doctor could advise some tests to determine whether your medication may need to be changed.
- Report if you have experienced any side-effects to the medicines you have been In case of serious side effects, discuss with your doctor which tablet to stop and which to continue. Discuss drug alternative that may suit you better.
To conclude
Carefully note any symptoms and seek timely medical intervention as this can prevent heart attack and stroke especially if you have Diabetes. Regular consultations, lifestyle intervention and regular blood sugar monitoring can keep the heart healthy for a longer time.
