Diabetes is mother of heart disease: Top Diabetologist

Dr Anoop Misra of Fortis gives solutions to handle the twin risks of diabetes & heart diseases.

Diabetes is largely held responsible by scientists for the incidence of heart disease in people. While an unhealthy lifestyle partly shares the blame, managing the silent killer can to a great extent lower the chances of developing the life threatening condition.

In conversation with Smita Mishra of Zeenews.com, Dr Anoop Misra, Director Department of Diabetes and Metabolic Disease, Fortis Hospital, gives concrete solutions to handle the twin risk factors and elaborates upon the lifestyle changes that can actually bring about significant changes in a person’s quality of life. What is the connection between diabetes, heart disease, and stroke?

Diabetes could be called the ‘mother’ of heart disease and stroke. Although other factors such as smoking and hypertension contribute significantly to heart attacks and stroke, by far diabetes contributes maximally. Further, those patients with diabetes who are poorly controlled (blood sugar remains high), fare poorly to any therapy given subsequent to heart attack and stroke.

What types of heart and blood vessel diseases occur in people with diabetes?

Patients with diabetes mostly have disease in all the blood vessels which supply heart and brain. Vessel obstruction due to diabetes is more severe, and causes more damage. There are more chances of incapacitation and death following heart attack and stroke in poorly controlled diabetic patient. Results of intervention (stent) and surgery may not be optimal in patients with diabetes and heart attack.

As a doctor, what do you think are the risk factors for heart disease and stroke in people with diabetes?

High blood sugar itself is a strong risk factor for these diseases. In addition, a number of other risk factors exist simultaneously in diabetic patients; hypertension, high cholesterol, obesity etc. Importantly, blood of patients with diabetes is thicker, and more likely to form clot, which may obstruct arteries in heart, brain, or legs. Some scientists believe that any patient with diabetes above 40 years of age is should be presumed to have significant degree of heart disease risk. What steps do you think can be taken to prevent or delay heart disease and stroke in diabetics?

The following are most important

1. Regular physical activity
2. Maintenance of normal body weight
3. Proper diet under supervision of a nutritionist
4. Good control of blood sugar under constant monitoring of a diabetologist
5. Good control of blood pressure and cholesterol
6. Stress management
7. Aspirin (under physician’s advice)

What are the treatment options for diabetics with heart disease?

Treatment options remain the same as for non-diabetics. However, early and aggressive detection and management of heart disease and constant monitoring is more important in diabetic patients than non-diabetics. Control of blood sugar and cholesterol is stricter in diabetes patients than non-diabetics

Is stenting difficult in diabetics? Does it really work in their case?

Multiple studies have shown that diabetes is a strong risk factor for re-obstruction following successful stenting, with greater need for repeat procedures and inferior clinical outcomes. Recent data suggest that new drug eluting stents reduce re-obstruction rates and the need for repeat revascularization irrespective of the diabetic state.

What is metabolic syndrome and how is it linked to heart disease?

The metabolic syndrome is a cluster of risk factors occurring in the same individual. This cluster includes; high blood pressure, high waist circumference, high blood sugar, low levels of HDL (good cholesterol) and high levels of triglycerides (ugly cholesterol). Three out of these five factors must be present to diagnose the metabolic syndrome; however, the most important factor remains abdominal obesity. Presence of metabolic syndrome in any individual signifies high risk for heart disease. The highest risk is conferred if all five factors are present in the same individual. Smoking and family history of heart disease only adds to the risk further.

Does diet help in delaying heart disease in diabetics?

Diet has a crucial role to play in causation of diabetes and heart disease. Those with family history of diabetes should pay attention to diet from an early age. Diet should be individualized depending on weight and activity of the individual. In general, diets should include high fibre, low saturated fat, and high omega-3 fatty acids. In particular, trans fatty acids [in cakes, pastries, French fries, and anything cooked in vanaspati (which means most of the commercially sold foods by vendors and restaurants)]. For translating these nutrients in everyday diet, a consultation with nutritionist is required.

As a doctor what steps do you think a diabetic suffering from heart disease can take to lead a long and healthy life?

A positive attitude is a must. With such state of mind, discipline in diet, exercise, following physicians’ advice and avoidance of smoking, a useful and productive life is assured.