Diabetes and coronary artery diseaseHaving Diabetes means there is an increased likelihood of having a heart attack and stroke. Longstanding Diabetes damages the blood vessels and nerves in the heart. The longer the duration of Diabetes, greater are the chances of having a heart attack. Studies have shown that people who have Diabetes are more likely to have an early heart attack than those who don't. People who have other cardiovascular conditions in particular such as metabolic syndrome and a multitude of other heart conditions are at a high risk of a heart disease. There is also probably a genetic predisposition to heart problems.Obesity, sedentary lifestyle, unhealthy food habits and impaired metabolism are the major causes of heart disease in Diabetes.The link explainedThere are several reasons responsible for the high rate of deaths caused by heart- related complications. For example, people with Diabetes often have other cardiovascular risk factors such as high blood pressure and high cholesterol levels which increase the risk of having cardiovascular disease. It might also be that Diabetes in itself causes heart disease. The exact mechanism is still unknown, it might be high blood glucose levels or it might be oxidative stress but the exact cause is unknown.High blood glucose levels associated with Diabetes damage the arteries by making them stiff and hard. Atherosclerosis results when plaque (fat, cholesterol, calcium deposits) builds up inside your arterieswhich carry blood to the heart and other parts of the body. These deposits reduce the blood flow to the heart or brain as it blocks the arteries. Reduced blood flow leads to heart attack and stroke.The most seen heart condition in people with Diabetes is myocardial infarction or a heart attack. Along with this, angina, heart failure and arrhythmic problems are linked to Diabetes. People with Diabetes have more often been diagnosed with hypertension and hypertension is one of the major causes of heart failure.Adults with Type 1A Swedish study published in Lancet Diabetes and Endocrinology looked specifically at the likelihood of heart failure in people with Type 1 Diabetes as compared with the general population. The research study found that people withType 1 Diabetes had four times the risk of heart failure over an average of 8 years, compared with people without Type 1 Diabetes from the general population. The study has also found that women with Type 1 Diabetes have a higher risk of heart failure than men with Type 1 Diabetes.Poor glycaemic control can increase the risk of heart failure by 10 times. People with Type 1 Diabetes and with albuminuria have 18 times greater risk of heart failure. These risks increase as glycaemic control and renal function continue to worsen. People with well controlled Type 1 Diabetes and normal renal function also have an increased risk of heart failure. This risk is still more than double with well-controlled Diabetes and three times greater with normal renal function..Children and adolescents with Type 1Heart attacks and stroke are not generally expected to occur during childhood, even in children and adolescents with Type 1 Diabetes. However, the atherosclerotic process begins during childhood. Children and adolescents with Type 1 Diabetes have displayed heart-related abnormalities even within the first decade of diagnosis of Diabetes.The Diabetes Control and Complications Trial (DCCT) has studied the effects of glycaemic control during childhood on heart related events. The study has shown that good glycaemic control during adolescence delayed the onset and progression of retinopathy (eye problems) and nephropathy (kidney problems) but not a cardiovascular disease (heart-related problems).Adults with Type 2The link between Type 2 Diabetes and heart disease has been firmly established by extensive research studies. The American Diabetes Association (ADA) considers Diabetes as one of the seven major controllable risk factors for cardiovascular disease. The ADA states that people with Diabetes have two to four times increased risk of death by heart disease than adults without Diabetes. More than 68 per cent of people aged 65 or above and with Diabetes have an increased risk of death due to some form of heart disease and more than 16 per cent die of stroke.Know your riskPeople with Diabetes require specialized care to prevent, diagnose and treat heart disease. Understanding the risks of a heart attack is half the prevention battle. People with Type 1 and Type 2 Diabetes should check and treat cardiovascular disease risk factors early and often. Some of these risk factors are:Smoking - Smokers are two to three times more likely to develop coronary heart disease than non-smokers.Being overweight - Losing weight can help cut down your heart disease risk.Sedentary lifestyle - Getting more exercise may also help people with Diabetes reduce heart disease risk.High blood pressure / cholesterol - Lowering blood pressure and cholesterol levels remain the greatest shield against heart diseaseWhat is coronary artery disease?In coronary artery disease (CAD), the blood vessels that supply oxygen and nutrition to the heart are deeply affected. Coronary artery disease develops when plaque (cholesterol deposits) clogs the arteries and causes inflammation. Major blood vessels carrying blood are damaged or unable to function optimally. Plaque narrows and hardens the artery walls thereby decreasing blood flow to the heart. Decreased flow of blood may cause angina (chest pain) and shortness of breath. A completely blocked artery can cause a heart attack. Thrombotic occlusion (blood clots in blood vessels) is caused if:arteries are blocked by atherosclerosis.impacted blood circulates in the heart.plaque in the arteries cracks and the tissue fluid comes in contact with the blood.These clots block the blood circulation, oxygen and nutrition in the arteries. If not diagnosed in time, the blood clots can affect blood circulation to the heart. This over the period causes myocardial infarction (heart attack). Typical symptoms of heart attacks may include tiredness, swollen feet and difficulty in breathing.Research studies have shown that coronary artery disease is still a major cause of death, though the number of deaths has decreased. But the number of hospitalisations continues to remain high even though the incidence of coronary artery disease has lowered. If the number of deaths, impacted lives and number of hospitalisations are combined, coronary artery disease remains the major factor responsible for health emergencies. It is also one of the costliest diseases. The risk of heart failure and heart complications remain high in people who have undergone myocardial infarction..Risks and symptomsMajor risk factors for CAD include:Age: Older age increases your risk of getting CAD.Sex: Men have a higher risk then women. But risk increases for post- menopause women. Men and women who have Diabetes have almost the same risk of onset of CAD.Family history: A family history of heart disease increases risk of coronary artery disease. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65.Smoking: Smoking increases risk of CAD.High blood pressure: Uncontrolled high blood pressure can harden the arteries resulting in CAD.High blood cholesterol levels: High levels of cholesterol can lead to plaque deposits and lead to CAD.Diabetes: Diabetes is associated with an increased risk of CAD.Other risk factors for CAD include:ObesityLack of exerciseHigh stressSleep apnoea: A sleep disorder where breathing repeatedly stops and starts during sleep. The resulting fluctuations in blood oxygen levels that occur can possibly affect heart health leading to CAD.High sensitivity C-reactive protein: High sensitivity C-reactive protein increases in amount as a reaction to inflammation in the body. Narrowing of arteries may lead to consistent high levels which may lead to CAD.High triglycerides: Increase in lipid (fat) in the blood increases risk of CAD, especially in women.Homocysteine: High levels of this amino acid in the body may increase risk of CAD.Symptoms of CAD include:chest painfeeling of heaviness or tightness or squeezingburning sensationpain in the arms or shouldersshortness of breathsweatingdizzinessIn addition to these symptoms, women may also experience nausea, vomiting, back pain, jaw pain and shortness of breath without feeling chest pain..Heart attack explainedHeart attack, which is a life-threatening condition, is caused by a complete closing of the blood vessel of the heart. This requires emergency medical attention and each minute delay may result in poorer health, including death. Apart from a heart attack, chest burn is also caused by numerous mild external symptoms, including indigestion and acid reflux. These symptoms are far more common than heart attack and are often experienced by people every day.Angina is a type of chest pain that is similar to the pain of a heart attack. Rather than the reduced supply of blood to the heart being caused by a coronary artery blockage, it is caused by narrowing of the vessel. People with angina are at greater risk of having a heart attack. Anyone who has angina should be under medical care and should be aware of this risk. The most common form of angina is temporary pain that goes away after rest or medication.This is called stable angina. Unstable angina raises the risk of a heart attack.The symptoms of heartburn may mimic those of angina or a heart attack (or vice versa). If uncertain, one should not hesitate to seek emergency medical help for an evaluation as soon as possible, especially people with risk factors for heart attack, like Diabetes, high blood pressure, smoking, family history of heart attack and others.The associated symptoms that will point towards heart attack are:Uncomfortable pressure, squeezing, fullness, burning, tightness, or pain in the centre of the chestPain, numbness, pinching, prickling, or other uncomfortable sensations in one or both arms, the back, neck, jaw, or stomachShortness of breathSudden nausea or vomitingLight-headedness or dizzinessUnusual fatigueHeat/flushing or a cold sweatSudden heaviness, weakness, or aching in one or both arms.Symptoms of a heart attack vary from person to person. Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest.However, the more signs and symptoms you have, the greater the likelihood of having heart attacks. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest.As with men, the most common heart attack symptoms in women are chest pain or discomfort. But women are somewhat more likely to experience some of the other common symptoms than men, particularly shortness of breath, nausea/vomiting and back or jaw pain. The pain may radiate to both arms instead of only the left arm, as commonly seen in men. Unusual fatigue is also a common symptom in women. In view of atypical symptoms, women tend to delay seeking medical attention.Heart attacks can be silent without obvious symptoms. It is discovered days, weeks, or months later with an electrocardiogram test, used to diagnose a heart problem. Silent heart attack:is more common in women than in mencan happen to women younger than 65 years. Younger women who have silent heart attacks without chest pain are more likely to die compared to younger men who have silent heart attacks without chest pain.is more likely to happen in women with Diabetes. Diabetes can change how you sense pain, making you less likely to notice heart attack symptoms.If you think you or someone else may be having a heart attack, call emergency medical services for an ambulance right away. Do not drive yourself to the hospital. You may need medical help on the way to the hospital. Ambulance workers are trained to provide necessary medical help on the way to the emergency room.Getting to the hospital quickly is important. Treatments for opening clogged arteries work best within the first hour after a heart attack starts. The best treatment for a heart attack is primary angioplasty where a balloon catheter is passed across the occluded artery and the balloon inflated to open the closed segment so that the blood circulation is re-established. A stent, which is a metallic scaffold, is placed to maintain the opening created in the artery..Lower risk of heart failurePeople with Diabetes are advised to undergo annual tests like ECG, stress test and 2-D Echo to ensure timely medical intervention to avoid heart failure, if required. In case people with Diabetes are detected to have blockages in their blood vessels, relieving them via surgery may also protect their heart. It is possible to lower your risk of heart disease and circulation problems by:Keeping your blood glucose levels under control,Stopping smoking,Losing weight if you are overweight,Keeping your blood pressure in the proper range,Getting regular physical activity andKeeping your blood fats and cholesterol levels in a healthy range.Abstaining or limiting alcohol intakeReducing salt and fat in dietExercising regularly.ManagementThere are various steps to manage CAD. It is important to quit smoking. Passive smoking or breathing in a smoke-filled environment can also cause heart attacks. It is advisable to check blood sugar levels regularly. Many people with atherosclerotic disease either have glucose intolerance or have Diabetes. This may affect the blood vessels in the long run. If you have blocked arteries, you may be recommended coronary angiography to look for the blockages. It helps to understand whether the blockages can be dilated, or they require bypass surgery for removal..MedicationA person with established coronary artery disease is recommended aspirin because aspirin reduces the risk of blood clots. They are almost always recommended statins to lower bad cholesterol (LDL-C) levels. Many people with coronary artery disease also have high blood pressure. They are recommended anti-hypertensive drugs and for people who have Diabetes, anti-diabetic drugs are prescribed.Coronary angioplasty and coronary artery bypass graft surgery Surgical options such as bypass surgery can help to control the damage caused by CAD. One in three people who have CAD undergo coronary angioplasty and stenting. A catheter is used to displace the plaque attached to the artery walls and improve blood flow. Another technique involves removing the plaque by cutting it away.Stenting involves inserting a wire mesh into the artery which supports the damaged artery walls. This reduces the chance of the artery wall closing and cutting of blood flow. Coronary artery bypass graft (CABG) is performed when angioplasty is not possible and when the artery is too small or there are multiple blockages in the artery.10 per cent people who have CAD will undergo CABG surgery. People who have multiple blockages need to have bypass surgery. A healthy artery or vein from the leg or arm is used to create path to bypass the blockages.Lifestyle modificationDietA person with Diabetes and coronary artery disease can eat just about the same as everyone. It is important to be careful of what you eat, how much you eat and how often do you eat. Do not eat too much too often. Watch your weight and do not put on excess weight. Avoid sugar and excess carbohydrates. Eat a variety of foods with lots of fruit and vegetables. Choose lean cuts of meat and fish and eat modestly.ExerciseThe best combination of exercise for people with Diabetes and coronary artery disease is combining aerobics and high intensity exercises such as swimming, running or brisk walking with static exercises such as lifting weights and stretching. Aerobics and high intensity exercises increases oxygen intake and static exercise help improve muscle strength. It is important to remain active and move around for at least three to four hours a day. Exercises such as swimming and bicycling activate a large group of muscles.Consult your doctor before starting or modifying your exercise routine.The American Sports Medicine guidelines suggest a heart check-up if:You are not normally activeYou have had any heart problems or any other health condition that may predispose heart problems like diabetic neuropathy or hypertension or kidney disease or lung problem.You will be participating in a high intensity activity.If you answer yes to any of these then it may be necessary to consider a heart check-up as you may be at a higher risk of having a cardiac event during exercise. This check-up would include blood pressure measurement, pulse rate, body mass index and treadmill test.It is also necessary to get medical help if you experience any of these symptoms while you are exercising or notExcessive shortness of breathChest painPalpitationDizzinessNear syncope (loss of consciousness and muscle strength characterised by a fast onset, short duration, and spontaneous recovery)Significant swelling on your legsThe overall risk to cardiac event during exercise is low. You should always start slowly with warm-up. Do not build up too fast on intensity and length of time. People who don't exercise are almost twice as likely to get heart disease as people who are active. Regular exercise can help you -Burn caloriesLower blood pressureLower LDL (bad cholesterol)Increase HDL (good cholesterol)Dr Abhay Khode is Consulting Cardiologist in Pune.
Diabetes and coronary artery diseaseHaving Diabetes means there is an increased likelihood of having a heart attack and stroke. Longstanding Diabetes damages the blood vessels and nerves in the heart. The longer the duration of Diabetes, greater are the chances of having a heart attack. Studies have shown that people who have Diabetes are more likely to have an early heart attack than those who don't. People who have other cardiovascular conditions in particular such as metabolic syndrome and a multitude of other heart conditions are at a high risk of a heart disease. There is also probably a genetic predisposition to heart problems.Obesity, sedentary lifestyle, unhealthy food habits and impaired metabolism are the major causes of heart disease in Diabetes.The link explainedThere are several reasons responsible for the high rate of deaths caused by heart- related complications. For example, people with Diabetes often have other cardiovascular risk factors such as high blood pressure and high cholesterol levels which increase the risk of having cardiovascular disease. It might also be that Diabetes in itself causes heart disease. The exact mechanism is still unknown, it might be high blood glucose levels or it might be oxidative stress but the exact cause is unknown.High blood glucose levels associated with Diabetes damage the arteries by making them stiff and hard. Atherosclerosis results when plaque (fat, cholesterol, calcium deposits) builds up inside your arterieswhich carry blood to the heart and other parts of the body. These deposits reduce the blood flow to the heart or brain as it blocks the arteries. Reduced blood flow leads to heart attack and stroke.The most seen heart condition in people with Diabetes is myocardial infarction or a heart attack. Along with this, angina, heart failure and arrhythmic problems are linked to Diabetes. People with Diabetes have more often been diagnosed with hypertension and hypertension is one of the major causes of heart failure.Adults with Type 1A Swedish study published in Lancet Diabetes and Endocrinology looked specifically at the likelihood of heart failure in people with Type 1 Diabetes as compared with the general population. The research study found that people withType 1 Diabetes had four times the risk of heart failure over an average of 8 years, compared with people without Type 1 Diabetes from the general population. The study has also found that women with Type 1 Diabetes have a higher risk of heart failure than men with Type 1 Diabetes.Poor glycaemic control can increase the risk of heart failure by 10 times. People with Type 1 Diabetes and with albuminuria have 18 times greater risk of heart failure. These risks increase as glycaemic control and renal function continue to worsen. People with well controlled Type 1 Diabetes and normal renal function also have an increased risk of heart failure. This risk is still more than double with well-controlled Diabetes and three times greater with normal renal function..Children and adolescents with Type 1Heart attacks and stroke are not generally expected to occur during childhood, even in children and adolescents with Type 1 Diabetes. However, the atherosclerotic process begins during childhood. Children and adolescents with Type 1 Diabetes have displayed heart-related abnormalities even within the first decade of diagnosis of Diabetes.The Diabetes Control and Complications Trial (DCCT) has studied the effects of glycaemic control during childhood on heart related events. The study has shown that good glycaemic control during adolescence delayed the onset and progression of retinopathy (eye problems) and nephropathy (kidney problems) but not a cardiovascular disease (heart-related problems).Adults with Type 2The link between Type 2 Diabetes and heart disease has been firmly established by extensive research studies. The American Diabetes Association (ADA) considers Diabetes as one of the seven major controllable risk factors for cardiovascular disease. The ADA states that people with Diabetes have two to four times increased risk of death by heart disease than adults without Diabetes. More than 68 per cent of people aged 65 or above and with Diabetes have an increased risk of death due to some form of heart disease and more than 16 per cent die of stroke.Know your riskPeople with Diabetes require specialized care to prevent, diagnose and treat heart disease. Understanding the risks of a heart attack is half the prevention battle. People with Type 1 and Type 2 Diabetes should check and treat cardiovascular disease risk factors early and often. Some of these risk factors are:Smoking - Smokers are two to three times more likely to develop coronary heart disease than non-smokers.Being overweight - Losing weight can help cut down your heart disease risk.Sedentary lifestyle - Getting more exercise may also help people with Diabetes reduce heart disease risk.High blood pressure / cholesterol - Lowering blood pressure and cholesterol levels remain the greatest shield against heart diseaseWhat is coronary artery disease?In coronary artery disease (CAD), the blood vessels that supply oxygen and nutrition to the heart are deeply affected. Coronary artery disease develops when plaque (cholesterol deposits) clogs the arteries and causes inflammation. Major blood vessels carrying blood are damaged or unable to function optimally. Plaque narrows and hardens the artery walls thereby decreasing blood flow to the heart. Decreased flow of blood may cause angina (chest pain) and shortness of breath. A completely blocked artery can cause a heart attack. Thrombotic occlusion (blood clots in blood vessels) is caused if:arteries are blocked by atherosclerosis.impacted blood circulates in the heart.plaque in the arteries cracks and the tissue fluid comes in contact with the blood.These clots block the blood circulation, oxygen and nutrition in the arteries. If not diagnosed in time, the blood clots can affect blood circulation to the heart. This over the period causes myocardial infarction (heart attack). Typical symptoms of heart attacks may include tiredness, swollen feet and difficulty in breathing.Research studies have shown that coronary artery disease is still a major cause of death, though the number of deaths has decreased. But the number of hospitalisations continues to remain high even though the incidence of coronary artery disease has lowered. If the number of deaths, impacted lives and number of hospitalisations are combined, coronary artery disease remains the major factor responsible for health emergencies. It is also one of the costliest diseases. The risk of heart failure and heart complications remain high in people who have undergone myocardial infarction..Risks and symptomsMajor risk factors for CAD include:Age: Older age increases your risk of getting CAD.Sex: Men have a higher risk then women. But risk increases for post- menopause women. Men and women who have Diabetes have almost the same risk of onset of CAD.Family history: A family history of heart disease increases risk of coronary artery disease. Your risk is highest if your father or a brother was diagnosed with heart disease before age 55 or if your mother or a sister developed it before age 65.Smoking: Smoking increases risk of CAD.High blood pressure: Uncontrolled high blood pressure can harden the arteries resulting in CAD.High blood cholesterol levels: High levels of cholesterol can lead to plaque deposits and lead to CAD.Diabetes: Diabetes is associated with an increased risk of CAD.Other risk factors for CAD include:ObesityLack of exerciseHigh stressSleep apnoea: A sleep disorder where breathing repeatedly stops and starts during sleep. The resulting fluctuations in blood oxygen levels that occur can possibly affect heart health leading to CAD.High sensitivity C-reactive protein: High sensitivity C-reactive protein increases in amount as a reaction to inflammation in the body. Narrowing of arteries may lead to consistent high levels which may lead to CAD.High triglycerides: Increase in lipid (fat) in the blood increases risk of CAD, especially in women.Homocysteine: High levels of this amino acid in the body may increase risk of CAD.Symptoms of CAD include:chest painfeeling of heaviness or tightness or squeezingburning sensationpain in the arms or shouldersshortness of breathsweatingdizzinessIn addition to these symptoms, women may also experience nausea, vomiting, back pain, jaw pain and shortness of breath without feeling chest pain..Heart attack explainedHeart attack, which is a life-threatening condition, is caused by a complete closing of the blood vessel of the heart. This requires emergency medical attention and each minute delay may result in poorer health, including death. Apart from a heart attack, chest burn is also caused by numerous mild external symptoms, including indigestion and acid reflux. These symptoms are far more common than heart attack and are often experienced by people every day.Angina is a type of chest pain that is similar to the pain of a heart attack. Rather than the reduced supply of blood to the heart being caused by a coronary artery blockage, it is caused by narrowing of the vessel. People with angina are at greater risk of having a heart attack. Anyone who has angina should be under medical care and should be aware of this risk. The most common form of angina is temporary pain that goes away after rest or medication.This is called stable angina. Unstable angina raises the risk of a heart attack.The symptoms of heartburn may mimic those of angina or a heart attack (or vice versa). If uncertain, one should not hesitate to seek emergency medical help for an evaluation as soon as possible, especially people with risk factors for heart attack, like Diabetes, high blood pressure, smoking, family history of heart attack and others.The associated symptoms that will point towards heart attack are:Uncomfortable pressure, squeezing, fullness, burning, tightness, or pain in the centre of the chestPain, numbness, pinching, prickling, or other uncomfortable sensations in one or both arms, the back, neck, jaw, or stomachShortness of breathSudden nausea or vomitingLight-headedness or dizzinessUnusual fatigueHeat/flushing or a cold sweatSudden heaviness, weakness, or aching in one or both arms.Symptoms of a heart attack vary from person to person. Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest.However, the more signs and symptoms you have, the greater the likelihood of having heart attacks. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest.As with men, the most common heart attack symptoms in women are chest pain or discomfort. But women are somewhat more likely to experience some of the other common symptoms than men, particularly shortness of breath, nausea/vomiting and back or jaw pain. The pain may radiate to both arms instead of only the left arm, as commonly seen in men. Unusual fatigue is also a common symptom in women. In view of atypical symptoms, women tend to delay seeking medical attention.Heart attacks can be silent without obvious symptoms. It is discovered days, weeks, or months later with an electrocardiogram test, used to diagnose a heart problem. Silent heart attack:is more common in women than in mencan happen to women younger than 65 years. Younger women who have silent heart attacks without chest pain are more likely to die compared to younger men who have silent heart attacks without chest pain.is more likely to happen in women with Diabetes. Diabetes can change how you sense pain, making you less likely to notice heart attack symptoms.If you think you or someone else may be having a heart attack, call emergency medical services for an ambulance right away. Do not drive yourself to the hospital. You may need medical help on the way to the hospital. Ambulance workers are trained to provide necessary medical help on the way to the emergency room.Getting to the hospital quickly is important. Treatments for opening clogged arteries work best within the first hour after a heart attack starts. The best treatment for a heart attack is primary angioplasty where a balloon catheter is passed across the occluded artery and the balloon inflated to open the closed segment so that the blood circulation is re-established. A stent, which is a metallic scaffold, is placed to maintain the opening created in the artery..Lower risk of heart failurePeople with Diabetes are advised to undergo annual tests like ECG, stress test and 2-D Echo to ensure timely medical intervention to avoid heart failure, if required. In case people with Diabetes are detected to have blockages in their blood vessels, relieving them via surgery may also protect their heart. It is possible to lower your risk of heart disease and circulation problems by:Keeping your blood glucose levels under control,Stopping smoking,Losing weight if you are overweight,Keeping your blood pressure in the proper range,Getting regular physical activity andKeeping your blood fats and cholesterol levels in a healthy range.Abstaining or limiting alcohol intakeReducing salt and fat in dietExercising regularly.ManagementThere are various steps to manage CAD. It is important to quit smoking. Passive smoking or breathing in a smoke-filled environment can also cause heart attacks. It is advisable to check blood sugar levels regularly. Many people with atherosclerotic disease either have glucose intolerance or have Diabetes. This may affect the blood vessels in the long run. If you have blocked arteries, you may be recommended coronary angiography to look for the blockages. It helps to understand whether the blockages can be dilated, or they require bypass surgery for removal..MedicationA person with established coronary artery disease is recommended aspirin because aspirin reduces the risk of blood clots. They are almost always recommended statins to lower bad cholesterol (LDL-C) levels. Many people with coronary artery disease also have high blood pressure. They are recommended anti-hypertensive drugs and for people who have Diabetes, anti-diabetic drugs are prescribed.Coronary angioplasty and coronary artery bypass graft surgery Surgical options such as bypass surgery can help to control the damage caused by CAD. One in three people who have CAD undergo coronary angioplasty and stenting. A catheter is used to displace the plaque attached to the artery walls and improve blood flow. Another technique involves removing the plaque by cutting it away.Stenting involves inserting a wire mesh into the artery which supports the damaged artery walls. This reduces the chance of the artery wall closing and cutting of blood flow. Coronary artery bypass graft (CABG) is performed when angioplasty is not possible and when the artery is too small or there are multiple blockages in the artery.10 per cent people who have CAD will undergo CABG surgery. People who have multiple blockages need to have bypass surgery. A healthy artery or vein from the leg or arm is used to create path to bypass the blockages.Lifestyle modificationDietA person with Diabetes and coronary artery disease can eat just about the same as everyone. It is important to be careful of what you eat, how much you eat and how often do you eat. Do not eat too much too often. Watch your weight and do not put on excess weight. Avoid sugar and excess carbohydrates. Eat a variety of foods with lots of fruit and vegetables. Choose lean cuts of meat and fish and eat modestly.ExerciseThe best combination of exercise for people with Diabetes and coronary artery disease is combining aerobics and high intensity exercises such as swimming, running or brisk walking with static exercises such as lifting weights and stretching. Aerobics and high intensity exercises increases oxygen intake and static exercise help improve muscle strength. It is important to remain active and move around for at least three to four hours a day. Exercises such as swimming and bicycling activate a large group of muscles.Consult your doctor before starting or modifying your exercise routine.The American Sports Medicine guidelines suggest a heart check-up if:You are not normally activeYou have had any heart problems or any other health condition that may predispose heart problems like diabetic neuropathy or hypertension or kidney disease or lung problem.You will be participating in a high intensity activity.If you answer yes to any of these then it may be necessary to consider a heart check-up as you may be at a higher risk of having a cardiac event during exercise. This check-up would include blood pressure measurement, pulse rate, body mass index and treadmill test.It is also necessary to get medical help if you experience any of these symptoms while you are exercising or notExcessive shortness of breathChest painPalpitationDizzinessNear syncope (loss of consciousness and muscle strength characterised by a fast onset, short duration, and spontaneous recovery)Significant swelling on your legsThe overall risk to cardiac event during exercise is low. You should always start slowly with warm-up. Do not build up too fast on intensity and length of time. People who don't exercise are almost twice as likely to get heart disease as people who are active. Regular exercise can help you -Burn caloriesLower blood pressureLower LDL (bad cholesterol)Increase HDL (good cholesterol)Dr Abhay Khode is Consulting Cardiologist in Pune.
