Diabetes and Heart Disease

Diabetes is a disease that affects the body's ability to produce or respond to insulin. Typically, Type I diabetes occurs during childhood or adolescence, and is usually due to an inability of the pancreas to produce insulin. Type II diabetes typically occurs after the age of 25; commonly in obese, sedentary patients. It is caused by insulin resistance and an increasing insulin requirement. In recent years, as the epidemic of obesity in the United States continues, we are starting to see more Type II diabetes in younger adults, adolescents, and even children; due in large part to the increasing prevalence of obesity in young people. The number of people in the United States with diabetes has skyrocketed over the past several decades. If this trend continues, there will be enormous numbers of diabetics in the future; placing a great strain on the American healthcare system and the economy.

Cardiovascular Disease occurs in people with diabetes twice as often as in people without diabetes. Complications of atherosclerosis (hardening of the arteries) occurs at earlier ages and results in premature death. A person who is diagnosed with diabetes has the same risk as someone who has already had one heart attack.

The presence of abdominal obesity leads to insulin resistance. Abdominal obesity is defined as a waist to hip ratio of greater than 1. The distribution of fat, rather than overall obesity, determines risk. Abdominal obesity may be associated with the metabolic syndrome.

Metabolic syndrome is a clustering of cardiovascular risk factors that identify patients at high risk for coronary artery disease. Metabolic syndrome is defined by the presence of three out of five of the following criteria:

Waist circumference of greater than 40 inches in men and 35 inches in women
Elevated triglyceride level
Low HDL (good cholesterol)
High blood pressure
Elevated fasting glucose levels

The presence of metabolic syndrome in individuals corresponds to an increased risk of the development of diabetes and cardiovascular disease.

The treatment and prevention of diabetes involves lifestyle modification: namely weight reduction, increased exercise, dietary modification, smoking cessation, and when necessary, medication. Recently, a study was published which suggests that certain medications can actually prevent the development of Type II diabetes in high risk individuals. Recommended physical activity includes five hours a week or more of moderately strenuous exercise such as: walking, bicycle riding, swimming, etc. Eating a healthier diet with less fast food and lower fat intake will also help reduce the likelihood of developing obesity and Type II diabetes. Once diabetes has developed, lifestyle modification and various medications have been proven to be effective in reducing the risk of the complications of diabetes.

Typically, patients are concerned with complications associated with diabetes such as: blindness, kidney failure, and neuropathy. However, the more common complications of diabetes are heart disease and stroke. It is extremely important to aggressively modify all risk factors possible; including stopping smoking, keeping your cholesterol and blood pressure as low as possible, as well as exercise and diet. A regular physical exam by your physician is also an excellent way to monitor for the presence of diabetes.

For further information regarding diabetes and heart disease, please contact the American Diabetes Association or the American Heart Association.

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