Diabetes & Heart Disease: Why Is the Risk High?

By: dr. Novita Sitorus, Sp.JP(K), FIHA

Diabetes isn't just about high blood sugar; in the long term, diabetes accelerates damage to blood vessels throughout the body, including the blood vessels of the heart, brain, and kidneys. This is why many patients with heart attacks or strokes also have a history of diabetes, or long-standing high blood sugar. The good news is, this risk can be reduced if diabetes is well managed: with regular heart screenings, medications that protect the heart and kidneys, and a consistent healthy lifestyle.

Why is the Heart Risk Higher in Patients with Diabetes?

In patients with diabetes, high, uncontrolled blood sugar levels over the long term can cause:

• Damage to blood vessel walls
• Fat buildup in blood vessels is faster than in people without diabetes.
• Lipid profile disorders
• Nerve damage

The result: the risk of coronary heart disease, heart attack, stroke, and heart failure doubles compared to people without diabetes, especially when accompanied by other factors such as smoking, high blood pressure, and high cholesterol.

Cardiac Screenings to Consider

For patients with diabetes, especially those with long-standing diabetes and/or other risk factors, doctors often recommend cardiac screening to detect problems early. Some common forms of screening include:

• Interview and physical examination
  Assess symptoms: chest pain, shortness of breath, fatigue, palpitations, leg swelling.
  Measure blood pressure, pulse, weight, and abdominal circumference.
• Electrocardiogram (ECG)
  Examines the electrical activity of the heart, looking for signs of reduced blood flow or rhythm disturbances.
• Echocardiography (cardiac ultrasound)
  Assesses the structure and function of the heart pump, valves, and pressure within the heart.
• Other tests as indicated
  For example, a treadmill test, coronary CT scan, or cardiac catheterization if significant narrowing is suspected.

The goal is to detect problems before a heart attack or severe heart failure occurs, so that a treatment plan can be formulated early.

Protective Medication: Not Just Sugar Medication

Proper diabetes management not only lowers blood sugar but also protects the heart and kidneys. Doctors consider:

• Blood sugar-lowering medications with heart/kidney benefits
• Blood pressure medications
• Cholesterol-lowering medications
• Blood thinners

Lifestyle: The Foundation of Diabetes Management & Heart Protection

Without a healthy lifestyle, medication alone is often insufficient. Important points to note:

• Diet: Control carbohydrate portions to avoid excess; choose complex carbohydrates whenever possible.
• Reduce sugary foods.
• Limit fried foods, saturated fats, and fast foods to help control cholesterol and weight.
• Increase fruit and vegetables as recommended by your doctor/nutritionist.
• Physical activity: General target: 150 minutes per week of light to moderate intensity aerobic activity such as brisk walking and leisurely cycling.
• Start slowly, according to your ability and heart condition.
• Weight & waist circumference: Losing excess weight can improve blood sugar, blood pressure, and blood lipids simultaneously.
• Quit smoking: Smoking + diabetes = a very dangerous combination for blood vessels.
• Sleep & stress management: Try to get enough sleep and manage stress, as chronic stress can worsen blood sugar and blood pressure.

Managing diabetes also means protecting your heart. The earlier preventive measures are taken, the greater the chance of a healthier, more active, and more complication-free life in the future.

FAQ

1. I just found out I have diabetes. Will I definitely develop heart disease?
   Not necessarily, but the risk is higher. With good control of blood sugar, blood pressure, and cholesterol, and a healthy lifestyle, the risk can be significantly reduced.
2. Do I need routine heart screenings if I have diabetes but no other symptoms?
   This is often worth considering, especially if you have had diabetes for a long time or have other risk factors (smoking, hypertension, high cholesterol, family history). The type and frequency of screenings will be decided by your doctor.
3. I already have a lot of diabetes medication, so why do I need to add cholesterol or blood pressure medication?
   The goal of therapy is not just to lower blood sugar, but to protect blood vessels. The right cholesterol and blood pressure medication can significantly reduce the risk of heart attack and stroke in diabetes patients.
4. If your blood sugar is "normal," can you stop your diabetes medication?
   Don't stop your medication without consulting your doctor. Appearing normal blood sugar is often the result of a combination of medication and lifestyle. If you need to reduce your medication, your doctor will do so slowly while monitoring you.

5. Do all diabetes patients have to have a very strict diet?
   A diabetes diet doesn't have to be torturous. The point is to regulate the types and portions of food, not to abstain from eating anything. A doctor or nutritionist can help you develop a realistic eating plan that fits your habits.

    

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