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Diabetics Miss the Point About Heart Risk

Survey finds 68% unaware of disease's deadliest complication

TUESDAY, Feb. 19, 2002 (HealthDayNews) -- The vast majority of diabetics are in the dark about the darkest complication of their disease.

Almost seven out of 10 people with diabetes don't consider cardiovascular problems to be a significant complication of their underlying disease, even though two-thirds of them will die of a heart attack, stroke or other vessel ailment.

So says a new survey by the American Diabetes Association and the American College of Cardiology, which shows that although patients generally understand that their diabetes can lead to blindness and amputations, they're woefully unaware of how unhealthy blood sugar can jeopardize their heart and vessels.

The survey found that three-quarters also had risk factors for heart attacks and strokes -- such as high blood pressure and elevated cholesterol -- but don't associate them with their sugar trouble.

"More than 16 million Americans have diabetes, and that figure is growing at an alarming rate," Health and Human Services Secretary Tommy Thompson said at a briefing today to announce the results of the survey. "Sixty-five percent of people with diabetes in the United States die from heart attacks or strokes. Unfortunately, most of them are not aware of the link between diabetes and heart disease and the things they can do to reduce their risks."

Blindness, kidney failure, and amputations "are, indeed, very serious complications," Dr. Christopher Saudek, president of the American Diabetes Association said in a statement. However, Saudek added, "The harsh reality is that if you have diabetes, you have a two-to-four-times greater likelihood of having a heart attack than if you do not have diabetes."

Heart attacks tend to occur earlier and more severely in diabetics than in people without the blood glucose condition. Diabetics are also more prone to multiple heart attacks and strokes.

The survey, of 2,008 men and women nationwide, shows that 68 percent failed to grasp the connection between blood sugar imbalance and cardiovascular health. Older adults and Hispanics with the disease were even less likely to make the link. Three-quarters of patients in these groups couldn't identify any heart or vessel condition that was a complication of their disorder.

Almost two-thirds of the people surveyed said they knew diabetes could cause blindness, and 36 percent said it could lead to amputations, the result of nerve damage and infections in the feet and extremities. But far fewer said they believed diabetes could also lead to immediately deadly problems. Only 17 percent, for example, said they thought diabetes could cause heart disease, 14 percent believed it increased their risk for heart attacks, and just 5 percent said they knew it was linked to stroke.

Although 60 percent of patients have high blood pressure, and virtually all have at least somewhat abnormal cholesterol, 60 percent of those surveyed didn't believe they were at risk for either.

"People with diabetes know how important it is to control their blood glucose, but too little attention is paid to the role of cholesterol and blood pressure," Dr. Allen M. Spiegel, director of the National Institute of Diabetes and Digestive and Kidney Diseases, said in a statement about the survey. "Research shows that this new approach, aggressively treating these three risk factors, can save lives."

Dr. Dace Trence, a University of Washington diabetes specialist, says one reason for the missing link is that doctors don't screen patients for cardiovascular problems as aggressively as they test for more acute conditions like eye and nerve damage.

"We seem to have a much better handle for the person without diabetes" when it comes to cholesterol and blood pressure, Trence says. For diabetics, "we don't know if they need even more aggressive blood pressure and cholesterol control" than the otherwise healthy patients.

In addition, Trence says, relatively recent advances in the management of diabetes and its acute complications, including kidney failure, in particular, mean that more patients are living longer with the disease -- and suffering long-term problems associated with decades of unhealthy blood sugar.

The survey did find a bright spot: 75 percent of patients said they talked with their health care providers about how to manage their condition. However, only 53 percent said those discussions involved ways to cut the risk of heart disease and stroke by reducing blood pressure, while 45 percent said they were told about the importance of lowering cholesterol. More than a third of smokers in the survey said their provider didn't discuss quitting smoking.

What To Do

Although the link between diabetes and cardiovascular illness is absolute, it's not inevitable, experts say.

Keeping weight down and getting regular exercise can reduce the risk of heart and vessel trouble. So can taking daily doses of low-dose aspirin, as well as drugs that control blood pressure and cholesterol. Taken together, these therapies comprise the "ABCs" of diabetes care: A stands for A1C, a measure of average blood sugar over a three-month period; B stands for blood pressure; and C is for cholesterol.

And for diabetics who continue to smoke, the message is simple: quit.

To learn more about diabetes, try the Ameican Diabetes Association. You can also visit MyDiabetes, a site devoted to the condition, or the Centers for Disease Control and Prevention.

To find out more about cardiovascular health, visit the American Heart Association.

SOURCES: Interview with Dace Trence, M.D., assistant professor of medicine, University of Washington, Seattle; American Diabetes Association/American College of Cardiology survey, Feb. 19, 2002; statements from Tommy Thompson, Secretary of Health and Human Services, Christopher Saudek, M.D., president, American Diabetes Association and director, Johns Hopkins Comprehensive Diabetes Center, Baltimore, and Allen M. Spiegel, M.D., director, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.
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