Heart Disease: A Diabetic's Biggest Health Threat

Yet too few people with the disease are aware of the risk, experts say

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HealthDay Reporter

WEDNESDAY, March 24, 2004 (HealthDayNews) -- People with diabetes know all too well their disease puts them at risk for devastating health problems, including blindness, kidney failure and amputations.

Yet too few realize heart disease is the leading cause of premature death among diabetics, claiming the lives of two out of every three people with the blood sugar disease, experts say.

"People with diabetes have a two-to-four times greater risk of heart attacks, at an earlier age, and with earlier deaths than non-diabetics. But two-thirds of people with diabetes don't think of heart disease as a problem," says Dr. Nathaniel G. Clark, national vice president of the American Diabetes Association.

"In fact, the risk of heart disease is going down in the regular population, but is going up in the diabetic population," he adds. "People aren't aware of this. There is a serious knowledge gap between the facts and the perception of the risks of heart disease and diabetes."

Clark's comments came at a March 23 conference in New York City sponsored by the American Diabetes Association, the American College of Cardiology and the National Diabetes Education Program. The session was held to spotlight the strong link between diabetes and an increased risk for heart disease, and to introduce a program to lower the incidence of heart disease among diabetics.

Approximately 18.2 million Americans have diabetes, and it's the sixth leading cause of death, according to the American Diabetes Association.

More worrisome, diabetes -- much of it fueled by the obesity epidemic -- is rising at an alarming rate. From 1990 to 1998, the prevalence of the disease in the United States rose by a third, a recent study in Diabetes Care found. Currently, one out of five adults aged 65 or older have the more common type 2 diabetes, which is often caused by poor eating habits and lack of exercise, according to the U.S. Centers for Disease Control and Prevention.

"Being a diabetic is considered a risk equivalent for heart disease or a heart attack at the same risk level as someone who has already had a heart attack," says Dr. Noel Bairey Merz, director of the Preventative and Rehabilitative Cardiac Center at the Cedars-Sinai Medical Center in Los Angeles. She was another conference participant.

Bairey Merz conducted a recent study of 2,008 diabetics that appeared in the Journal of the American College of Cardiology. She found 65 percent were aware that complications from diabetes could cause blindness, and 36 percent understood the link between the disease and amputation of a limb. But only 17 percent were aware of the increased risk of heart attacks, and only 5 percent knew they were at greater risk of stroke.

The risk for women with diabetes is particularly high, five times that of women without the disease, Bairey Merz adds, most likely because women with diabetes have lower estrogen levels than women without the disease. Lower estrogen levels are a known risk for heart disease among postmenopausal women, she says.

So how to bridge this knowledge gap?

The key is to make people with diabetes aware they should ask their doctors to regularly test their blood pressure and cholesterol, both indicators of heart disease risk.

If the tests show they're at risk for heart disease, they should ask their doctors for help in drawing up a plan to manage their risk, including lifestyle changes -- such as better nutrition and more exercise -- and possibly medication.

In addition, the three groups that sponsored the conference have introduced a program called The ABCs of Diabetes, to alert diabetics to ask their doctors for three tests to assess their cardiovascular health.

"A" stands for a glucose test that's called A1C, does not require fasting and can be done in the doctor's office. "B" is a blood pressure test, and "C" is a cholesterol test. The three groups recommend that the glucose test result be 7 percent or less; the blood pressure be no higher than 130/80 mmHg; and the combined cholesterol number not exceed 200 mg/dl.

"Patients should routinely ask, 'What are my A1C, blood pressure and cholesterol readings?' 'What are my treatment goals?' And 'What do I do to achieve them?'" says Dr. James R. Gavin III, another speaker at the conference who is chairman of the National Diabetes Education Program.

"This will be incredibly useful in making a better connection between risk and action and empower the patient to ask questions," he says.

Another conference participant, Linda Rooks-Dimps, an assistant with the Washington, D.C., public library system, was diagnosed with diabetes seven years ago when she was 43. But she didn't realize her risk for heart disease until a year ago, when she adopted the ABC program.

She now exercises three times a week, has lost 38 pounds and her tests are within the ABC guidelines.

"My doctor has reduced my medicines by half," she says. "I'm thrilled."

More information

You can assess your risk for diabetes by taking a test at the American Diabetes Association. More information about the ABC program, visit the National Diabetes Education Program.

SOURCES: Nathaniel G. Clark, M.D., M.S., R.D., national vice president, American Diabetes Association, Alexandria, Va.; Noel Bairey Merz, M.D., director, Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Medical Center, Los Angeles; James R. Gavin III, M.D., chairman, National Diabetes Education Program, and president, Morehouse School of Medicine, Atlanta; Linda Rooks-Dimps, assistant, Lifelong Learning program, Martin Luther King Jr. Memorial Public Library, Washington, D.C.; March 23, 2004, conference sponsored by the American Diabetes Association, the American College of Cardiology and the National Diabetes Education Program, New York City

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