Managing the diabetes-related risks of heart disease and stroke
If you have type 2 diabetes, you are more likely to develop heart disease, and you have a greater chance of having a heart attack or a stroke.
High blood glucose (sugar) levels can damage your blood vessels in various ways: “microvascular” or damage to smaller vessels can lead to vision loss or kidney disease, while “macrovascular” complications occur when the larger blood vessels in the heart or brain are affected – thus elevating the heart disease and stroke risks.
The connection between diabetes and heart disease and stroke has been established for several decades, providing health-care professionals with extensive evidence about how to reduce the risks for patients with diabetes.
“People with type 2 diabetes should be aware that they are at significantly increased risk for cardiovascular disease (CVD) and should have all of their risk factors assessed by their physician and managed accordingly,” says Dr. Milan Gupta, associate clinical professor, Department of Medicine, McMaster University in Hamilton, Ontario, and medical director of the Canadian Collaborative Research Network in Brampton, Ontario.
“This includes keeping your blood pressure and cholesterol at healthy levels, avoiding smoking and maintaining a healthy body weight, and working with your health-care team to ensure your A1C is as close to target as possible.”
A1C is a blood test that measures your level of diabetes control over the previous three months. Every patient diagnosed with diabetes has an individualized target, but most are advised to aim for an A1C of less than seven per cent. Achieving the A1C target is very important, given the damage caused to blood vessels by uncontrolled, elevated blood sugars.
Diabetes medications are also available to further help patients control their blood sugar levels. According to Dr. Gupta, the drugs that have been used for many years to control blood sugar have limitations in terms of protecting against heart attacks and stroke.
“The historical medications used for diabetes management are very effective for lowering blood glucose and are generally shown to help prevent microvascular disease,” he says. “However, these drugs have not shown the macrovascular benefits we would like to see.”
However, some of these limitations have been overcome with the recent introduction of new types of diabetes medications, says Dr. Gupta. “We have new classes of drugs for diabetes control that can lower the risk of a heart attack or stroke in patients with diabetes who have cardiovascular disease. We advise people in this category to discuss the options with their health-care team.”
The two categories of heart-beneficial drugs are GLP-1 receptor agonists and SGLT2 inhibitors.
These new drugs have significantly changed the treatment landscape for people who have type 2 diabetes and CVD, Dr. Gupta says, and could help reduce rates of disability and death.
“Cardiovascular disease is the leading cause of death in patients with diabetes and although we have made inroads in reducing mortality due to CVD in patients with diabetes, there is still a long way to go,” he says.
“These new classes of drugs represent a major step forward in further lowering that risk, such that they have been practice-changing. The Diabetes Canada Clinical Practice Guidelines and other guidelines around the world now recommend these medications for diabetes patients who meet the criteria.
“We are quite hopeful that adoption of this new evidence in treating people with diabetes, specifically those with CVD, will prolong survival.”
This article was sponsored by Novo Nordisk Canada.