A person who has diabetes has a significantly higher risk of developing heart disease or having a stroke – and at a younger age – than an individual without the disease.
“In training, physicians are taught that having diabetes puts someone at the same risk for a heart attack, as a person without diabetes who has already had one heart attack,” says Dr. Amel Arnaout, clinical director of the University of Ottawa Heart Institute Diabetes Program.
Cardiovascular disease (CVD) includes heart disease, stroke and peripheral vascular disease. “We expect CVD to occur up to 15 years earlier in people with diabetes and at least 50 per cent of premature deaths of people with diabetes are related to cardiovascular causes,” says Dr. Arnaout.
High blood sugar levels raise the risk for heart attack and stroke, and people with diabetes often have other risk factors, as well, including high blood pressure, high cholesterol and excess weight. Individuals with both type 1 and type 2 diabetes face increased cardiovascular disease risks.
Ensuring that cardiovascular risks are managed in people with diabetes is critical and the individual plays an important role. “The good news is that people with diabetes can lower their risk of heart disease and stroke considerably by paying careful attention to all of their risk factors,” says Dr. Jan Hux, chief science officer at Diabetes Canada.
An important part of reducing CVD risks for the person with diabetes is achieving control of their blood glucose, which helps prevent harmful vascular damage.
Certain medications that help people with type 2 diabetes control their blood sugar levels also provide additional benefits by lowering the risk cardiovascular disease. Some medications in the class of drugs called glucagon-like peptide 1 (GLP-1) reduce the risk of major cardio events for high-risk patients and achieve a major reduction in the risk of stroke.
Therapies that tackle other risks that contribute to CVD, such as high cholesterol, also yield significant benefits, Dr. Arnaout says.
“Studies have shown that treatment to lower LDL or ‘bad’ cholesterol levels in people with diabetes who don’t have CVD help prevent heart attacks and stroke – regardless of what they’re doing for their diabetes control.”
Both Diabetes Canada and Heart & Stroke put a high priority on educating Canadians about the links between diabetes and cardiovascular disease.
“Our goal is to lower the number of Canadians with heart disease and stroke, and part of that is raising awareness about the connections between different diseases, as well as risk factors and healthy behaviours,” says Eden Klein, Associate Manager, Research, Ontario, with Heart & Stroke.
“We want to increase knowledge about risks while informing Canadians how to manage their risk factors to make a difference in their health. For example, we know that being physically active is extremely important, especially for people with diabetes. Exercise can improve blood sugar control by 10 per cent,” says Ms. Klein.
Heart & Stroke is also funding research projects to expand knowledge about CVD and diabetes. “There has been progress, but there are still some aspects we don’t fully understand about the connections,” she says. “Funding research is the best way to expand knowledge and ensure we are properly supporting people with diabetes.”
One funded project is led by Geoff Werstuck from Hamilton’s McMaster University, who is studying the mechanisms by which high blood sugar promotes development of atherosclerosis, the clogged arteries that can lead to heart attack or other heart issues.
Diabetes Canada has also funded research by Mr. Werstuck. The long-term goal is to develop drugs that can better protect people with diabetes from heart disease.
“One important message for Canadians is, ‘You are never too young and it’s never too late to manage your CVD risks, including when you have diabetes,’” says Ms. Klein.
“It’s very important to make those changes in your lifestyle and work with your physician to manage your risk factors. Anything we can do to reduce the risks will definitely make a difference for Canadians.”