The nexus between diabetes and CVD

Dr Ajit Menon, Sr Interventional Cardiologist attached with Lilavati Hospital, Breach Candy Hospital and Wockhardt Hospitals, explains about the axis between diabetes and CVD while giving pointers on how to handle CVD patients with diabetes

Very innocuous chest pain caused by exertion, led 42 year old Raman to consult a cardiologist. His cardiologist asked him to undergo various investigations, the results of which came as a bit of a shock to him. His blood glucose levels were high and the stress test was positive. Further tests including coronary angiography revealed that two of his major arteries had severe disease and he had to undergo a multi vessel angioplasty which he chose as a treatment option. He was one of the many patients who suffered with a cardiovascular patient along with Type 2 Diabetes Mellitus.

Post a successful angioplasty, Raman now leads a normal healthy life.

Cardiovascular disease (CVD) is currently the leading cause of death globally. The ubiquity of smoking, obesity, diabetes, and hypertension has been gradually escalating, and is thought to be the driving influence behind the epidemic of heart disease faced today. India has the second highest number of diabetic patients in the world – a staggering figure of 67 million with another 30 million in pre-diabetes group and this is projected to increase further by the year 2030 positioning India on the number one pedestal. Indians tend to be diabetic at a relatively young age of 45 years which is about 10 years earlier than in West. There are an estimated 55 million patients of coronary artery disease in India. An increasing number of young Indians are falling prey to coronary artery disease. With millions hooked to a roller-coaster lifestyle, the future looks even grimmer. One fifth of the deaths in India are from coronary heart disease. By the year 2020, it will account for one third of all deaths. Sadly, many of these Indians will be dying young.

CVD, one of the most common non-communicable diseases, have become a major health concern in many developing countries including India. It affects many people at midlife, as well as in old age. It can also happen to those who “feel fine.”

The majority of CVD is caused by risk factors that can be controlled, treated or modified, such as high blood pressure, cholesterol, overweight/ obesity, tobacco use, lack of physical activity and diabetes. And every risk factor counts. Research shows that each individual risk factor greatly increases the chances of developing heart disease. Moreover, the worse a particular risk factor is, the more likely you are to develop heart disease. For example, if you have diabetes, the higher it is, the greater your chances are of developing heart disease, including its many serious consequences. According to statistics CVD is a major complication of diabetes and the leading cause of early death among people with diabetes. Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes and about 65 per cent people with diabetes die from heart disease and stroke. Indians have an increased susceptibility to diabetes which can be attributed to genetic factors as well as environmental factors. In addition to several features of urban life such as physical inactivity and unhealthy dietary practices, outdoor and indoor air pollution tend to increase the prevalence of diabetes and CVD also in urban India. The association between physical inactivity and obesity and the prevalence of diabetes has been established.

Despite these statistics, nearly 70 per cent of the people living with diabetes aren’t aware that they are at an increased risk of heart attack and stroke. Further, there are several misconceptions about the “diabetes – CVD” connect that increases ones risk of heart disease manifolds. One such misconception is “Diabetes won’t threaten my heart as long as I take medication”. But the truth is that treating diabetes can help reduce your risk for or delay the development of cardiovascular diseases. But even when blood sugar levels are under control, it can still increase your risk for heart disease and stroke. That’s because the risk factors that contribute to diabetes onset also make one more likely to develop cardiovascular disease. These overlapping risk factors include high blood pressure, overweight and obesity, physical inactivity and smoking.

To further add to the complications, the risk of death due to myocardial infarction is three times higher in diabetics as compared with non-diabetics. Adult diabetics are two to four times more likely to have heart disease or suffer a stroke than people without diabetes. About 65per cent people with diabetes die from heart disease and stroke. This occurs because of damage to the circulatory system from elevated blood sugars along with high blood pressure and abnormal blood cholesterol and fat metabolism.

Diabetics have multiple co-morbidities. The cardiovascular disease patterns are different in them. They have much more long vessel disease, diffuse disease and smaller arteries. The result of this is difficult treatment options and more often than not, angioplasty has a very high rate of recurrence/ failures.

But with the advent of newer drug eluting stent, especially the Resolute Integrity, the first and only FDA approved drug eluting stent for use in diabetics; angioplasty has become a preferred choice of treatment for many diabetics. As diabetic patients have special needs since the vascular anatomy is different, Resolute Integrity has come across as a boon to these patients in terms of granting them excellent long-term results.

Resolute Integrity is exceptionally easy to navigate through the coronary vasculature to the narrowed arterial segment that requires treatment, as already mentioned the arteries of the diabetics may be more tortuous and smaller and therefore difficult to navigate through for the operating surgeon. Also it is biocompatible biolinx polymer, which is used to bind the drug to the stent achieves an extended 180 day drug elution, thereby meeting the longer healing time requirements of the diabetic patients. Resolute Integrity, because of its continuous sinusoidal technology is very flexible and more deliverable as compare to many other drug stent available.

Diabetes and CVDs share an evil axis and the only way to control this is by understanding the complications and making healthy choices.

Whatever the age or current state of health, it’s never too late for people to take steps to protect their heart. It’s also never too early. The sooner you act the better. So, people should find out more about the state of their heart, learn about heart healthy living, and start taking action to improve their heart health today.