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What Every Diabetic Should Know About Heart Disease

It's the leading killer of people with the blood sugar disease

SATURDAY, May 22, 2004 (HealthDayNews) -- Most people with diabetes are keenly aware they have to worry about the threat of kidney problems, nerve damage that can lead to amputation, and blindness.

But most don't know their disease also dramatically raises their risk of heart disease or stroke.

"Two out of three people with diabetes die from cardiovascular disease, not from other related complications," said Joann Gallivan, director of the National Institutes of Health's National Diabetes Education Program.

Yet two-thirds of those diagnosed with diabetes don't think of heart disease as a serious problem, she added.

This, despite a spate of recent attention paid to the problem, including guidelines issued last April by the American College of Physicians. They recommend that diabetics over the age of 55, or those with diabetes under that age with risk factors such as smoking or high blood pressure, start taking cholesterol-fighting drugs called statins.

This knowledge gap could be partly due to the fact that only in the last few years has research begun to establish the diabetes-heart disease link. Even many doctors have only recently become aware of the high risk of heart disease among diabetic patients, Gallivan said.

"In the past we've focused on diabetes-management issues like blindness, kidney problems and nerve damage and didn't emphasize enough the cardiovascular disease risk," said Dr. Nathaniel G. Clark, national vice president of the American Diabetes Association.

But even when doctors discuss cardiovascular risks with their patients with diabetes, the patients aren't always grasping the new information, he said.

"In surveys we did of doctors and patients, we found that diabetes patients were being managed correctly by doctors. But when we interviewed the patients, they said their doctors hadn't told them that heart disease and diabetes are linked," he said.

Those patients include Linda Rooks-Dimps, a 50-year-old librarian with the Washington, D.C., public library system, who has had diabetes for seven years. She credits her doctor with regular warnings about her heightened risk for kidney disease, enough so that she began several years ago to exercise regularly diet, and eat more healthfully. To date, she's lost 38 pounds.

But she had no idea diabetes dramatically increased her risk for heart disease until she attended a recent health conference.

"My doctor never said anything about heart disease and stroke, and I didn't realize what a big effect diabetes has on the heart," she said.

People with diabetes run the same risk of heart disease or a heart attack as someone who has already had a heart attack, Clark said.

To focus attention on the link between diabetes and heart disease, the American Diabetes Association, the American College of Cardiology and the National Diabetes Education Program have created a program called Be Smart About Your Heart: Control the ABCs of Diabetes. It encourages diabetes patients to ask their doctors to test them not just for blood sugar levels, but for blood pressure and cholesterol as well.

The "A" stands for a glucose test called A1C, which doesn't require fasting and can be done in the doctor's office. "B" stands for a blood-pressure test, and the "C" represents a cholesterol test.

The three groups behind the Control the ABCs of Diabetes campaign recommend that the glucose test result be 7 percent or less; the blood pressure reading be no higher than 130/80 mmHg; and the combined cholesterol number not exceed 200 mg/dl.

"If a person has diabetes, it becomes crucial that these targets, which have been determined by clinical trials, be met," said Dr. James R. Gavin III, chairman of the National Diabetes Education Program and president of the Morehouse School of Medicine in Atlanta.

Gavin recommends patients and their doctors establish a treatment plan that includes lifestyle changes, such as more exercise and a better diet, and, when necessary, medication.

There are approximately 18.2 million Americans with diabetes, and it is the sixth-leading cause of death in the United States, according to the American Diabetes Association.

What's more, the disease is on the rise -- from 1990 to 1998 its prevalence increased by one-third among Americans, according to a recent study in Diabetes Care. One out of five adults aged 65 or older has the more common type 2 diabetes, according to the U.S. Centers for Disease Control and Prevention.

Just last week, U.S. health officials announced that 41 million Americans have blood sugar levels high enough to put them at risk of developing diabetes -- more than twice the previous estimate.

The new number means two of every five adults aged 40 to 74 is now considered to have "pre-diabetes," the U.S. Department of Health and Human Services reported.

More information

For a comprehensive look at Be Smart About Your Heart: Control the ABCs of Diabetes program, visit the National Institutes of Health. The American Heart Association offers a thorough explanation of what cholesterol is and recommended levels.

SOURCES: Joann Gallivan, R.D., director, National Diabetes Education Program, National Institutes of Health, Bethesda, Md.; Nathaniel G. Clark, M.D., national vice president, American Diabetes Association, Alexandria, Va.; Linda Rooks-Dimps, diabetes patient and librarian, Washington, D.C., public library system; James R. Gavin III, M.D., chairman, National Diabetes Education Program, and president, Morehouse School of Medicine, Atlanta
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