Debbie Belknap, RN - Diabetes and Heart Disease
Debbie Belknap is an RN, certified diabetes educator, and current chair of the ECC committee for the State of Washington.
Most people who have diabetes know there is a strong connection between the disease and cardiovascular disease. However what most do not realize is that the statistics between the two are truly staggering. According to the National Institutes of Health, approximately 65% of people living with diabetes actually die of heart disease or stroke. In fact someone living with diabetes has twice the likely hood of developing cardiovascular disease as someone with no diabetes. Also people with diabetes tend to develop cardiovascular disease at a younger age than those without diabetes. According to the American Heart Association, at least 65% of people, 65 and over, with diabetes die from heart disease and 16% die from stroke. In fact, people with diabetes also tend to develop CV disease at a younger age than those without diabetes.
To grasp the true scope of the problem you only have to look at the statistics. According to the CDC 30.3 million people in the United States have diabetes. That is 9.4% of our population. The CDC says 23.1 million people in the US have DIAGNOSED diabetes BUT 7.2 million are undiagnosed. That is 23.8% of people living in the US who have diabetes but do not know it. The numbers are staggering and continue to grow. In my home State of Washington in the year 2000, 5% of the population had diagnosed diabetes. In 2015 it was 7.7% of our state population.
So how are diabetes and CV disease connected? It starts with high blood sugars or even blood sugars that are just above normal. Over time high sugars damage the arteries causing them to become hard and stiff. When the arteries are stiff they do not expand or contract as well which can make blood platelets stickier and much more likely to form a clot. Diabetes also causes chronic inflammation which also further injures the walls of the arteries. Lastly diabetes can also cause scar tissue to form on the heart muscle furthering the damage. Even people with insulin resistance or pre-diabetes with one or more risk factors are at greater risk of developing CV disease. The longer you have diabetes the greater your risk. There is some good news. The steps someone with diabetes takes to manage their disease also helps to lower their risk of heart disease and stroke.
So what are the steps a person can make to manage their diabetes but also to help prevent CV disease? In a word LIFESTYLE. What are these therapeutic lifestyle changes? ;
- BE active-move more sit less. Recent research in Circulation 2011 found improved fitness lowered risk for CV disease
- Possible low dose aspirin
- Lose weight or maintain a healthy weight
- Eat a heart-healthy diet. One of the best weapons to fight CV disease
- Control your BP, cholesterol and blood sugars
- Quit smoking!!!
- Take meds as prescribed- BP meds, cholesterol, DM meds
It sounds so simple and easy on paper but as we all know it is not. To start ,focus on one small change that you know will be doable than build on from that. It is not an all or nothing goal. Small steps and changes can equal BIG rewards. You take it one day at a time, one small goal at a time.
Lastly joining the arsenal of medications to control diabetes are a new classification of drugs called SGLT2 inhibitors (sodium- glucose co-transporter 2 inhibitors). These new drugs block the re-absorption of sugar by the kidneys and allow them to excrete more sugar in the urine. This helps lower blood sugars. These medications do not increase risk for low blood sugar by themselves. They also promote weight loss and can lower blood pressure. The 3 medications currently on the market are: Invokana, Farxiga and Jardiance. Because of FDA mandates that all new diabetes medications do more extensive research on cardiovascular effects and outcomes, these classification of drugs have been shown to decrease a person’s risk of cardiovascular death . Two recent and important drug studies have shown a decrease in mortality from CV disease and a decrease in MI and Stroke.
The FDA has also approved a GLP1 Analog as a treatment to reduce the risk of 3 major cardiovascular diseases in patients with type 2 diabetes. This GLP1 has been shown to significantly reduce the risk of cardiovascular death, non-fatal heart GLP1 analogs work by helping to improve gut hormone levels. These medications work when sugars are high. They also improve actions of insulin, inhibits glucose from the liver, and allows stomach from emptying to quickly thus reducing food intake.
So, it is not all doom and gloom. We can prevent or lower the risk for cardiovascular disease in diabetes. By doing so we increase survival rates AND the cost savings would be in the billions. Current costs of cardiovascular disease, according to the AHA is 237 billion dollars a year with a projected cost by 2035 of 368 billion dollars. Taking care of your diabetes is very important to help you take care of your heart and brain. It is possible, it is attainable but it does require some work.
Debbie Belknap RN, BSN, CDE, CPT
Washington Association of Diabetes Educators Coordinating Body Chair
2013 WADE Diabetes Educator of the year