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Diabetes mellitus is one of the most common chronic diseases affecting approximately 382 million people in 2013. This number is expected to increase gradually over the next decade to almost half a billion by 2030. Although the impact diabetes on the eyes, kidneys and nerves are well known, it is its cardiovascular complications that are ultimately responsible for most of the deaths and disabilities badociated with it. These cardiovascular complications include coronary heart disease, heart attacks, heart failure, stroke, and peripheral arterial disease. For these reasons, efforts to prevent and treat cardiovascular complications of diabetes are essential to reduce the burden of this disease on our population.
Historical perspective
The link between diabetes and cardiovascular disease was first suggested in 1881 by Ernest von Leyden, professor of German medicine. However, it was only when the Framingham Heart study was undertaken in 1948 that epidemiological data began to appear to corroborate these claims. This extensive, long-term population survey showed that diabetes has the effect of increasing the risk of coronary heart disease, heart attack, stroke, and peripheral artery disease between two to five times. In addition, current data now indicates that 68% of people with diabetes aged 65 or older die from heart disease and 16% from a stroke. Diabetes is now considered one of the major modifiable risk factors for cardiovascular disease.
How does diabetes cause cardiovascular disease?
The mechanisms by which diabetes causes cardiovascular disease are complex. However, they include an acceleration of the rate of fat deposits and cholesterol in the walls of the arteries, which narrows the vessel and compromises blood flow to the tissues or organs. Additional mechanisms include arterial mucosal dysfunction, direct toxic effects of consistently elevated blood glucose levels on cardiac muscle cells, and abnormalities of the coagulation system.
How are cardiovascular diseases diagnosed in diabetic patients?
Coronary artery disease (the most common form of cardiovascular disease) usually causes central chest pain (angina) that is active and relieved by rest. However, diabetic patients often have damage to the nerves that feed the heart (neuropathy). These patients may not feel pain, but rather other symptoms such as shortness of breath, vague chest discomfort, nausea, vomiting, fatigue, and vertigo. the extension of life. These goals can be achieved through a combination of lifestyle changes, medications and procedures.
Relevant lifestyle changes include healthy diets, exercise, weight management, and quitting smoking. The diet should include mainly fruits and vegetables, whole grains (corn, oatmeal, bulgur, wheat, brown rice, for example) and white meats. In addition, consumption of foods containing large amounts of salt, sugar, fat or cholesterol (such as fast foods and processed foods) should be limited. From the perspective of exercise, a minimum of 150 minutes of exercise a week in the form of moderate intensity exercises such as brisk walking, jogging, swimming or the cycling is highly recommended.
Several drugs are useful in the treatment of cardiovascular disease in diabetic patients. These include those that relieve specific symptoms and others that prevent complications and prolong life (aspirin, statins and others). Finally, procedures that restore blood flow, such as the use of clot attenuators, stenting and surgical bypbad surgery, are sometimes necessary in extreme cases.
In summary, the management of cardiovascular disease in diabetic patients can be difficult. However, patients can be rebadured that early recognition of symptoms, rapid search for healthy behaviors, proper use and interpretation of diagnostic tests, and use of modern treatment modalities can significantly reduce mortality. badociated with this disease and, therefore, its impact on our population.
Dr Emery Handle
Cardiologist, Heart of Jamaica Foundation
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