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Diabetes & Heart Disease–Are They Separate? 4 Things to Know

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Diabetes and Heart disease.  Sounds like a stupid question, right?  One is the domain of a cardiologist and the other an endocrinologist.

Sure, the two are linked and having diabetes greatly increases your risk of having a heart attack.  To be a little more precise, 65% of diabetics die of heart disease or stroke.  That’s a pretty high number.  What this usually means in mainstream medicine, where specialists manage conditions and not patients, is that any person who is diabetic needs to make sure his or her blood pressure, cholesterol and triglycerides are under control.  And, by “under control,” we mean that the patient is taking his or her medication like a good little boy or girl.

The term is “comorbidities.”  This is a term used to describe two or more diseases that run alongside one another.  Like diabetes and heart disease.

But what if our view on this was entirely wrong??  What if, in reality, diabetes and heart disease are the same condition, just with different outward expressions?

Let’s boil it down to a common denominator: blood vessel health (although “vascular health” sounds much more trendy).  No one has a heart attack or stroke until he or she has a problem with the blood vessels feeding these organs.  Healthy blood vessels don’t get filled with plaque and throw off blood clots to clog smaller arteries.  And few things are more deadly for your blood vessels than the prediabetic and diabetic conditions.

This is why prediabetes is so incredibly bad for you as well–because your blood vessels are being destroyed in the process.  The links between heart disease and diabetes are already strong and undeniable, but I suggest that they are along the same continuum.  People who die of a heart attack just didn’t live long enough to get diabetes, but you can bet that almost all of them where prediabetic.

This also means that the prevention of these two conditions is the same.  I can’t think of one lifestyle change that would benefit diabetes and not heart disease and vice versa.  Which makes everything easier because you just have to focus on an anti-diabetic lifestyle and you get more bang for your buck.  Contrast this with medical therapy, where diabetes is managed with diabetic medications, but your heart disease risk is managed with blood pressure drugs, statins to lower cholesterol and aspirin or blood thinners to prevent clots from forming.  We still treat the two as separate conditions and manage them independently.

So why the long-winded discussion?  It relates to this particular study linking HbA1c levels and heart disease risk in non-diabetics with no prior history of cardiovascular events.

For those of you not familiar with HbA1c (also referred to as glycosylated hemoglobin, hemoglobin A1c or just plain A1c).  This number on your bloodwork tracks what your blood sugar levels have been doing over an average of about 3 months, using red blood cells (which live about 3 months).  Here’s how the numbers break down:

  • An ideal number is in the low 5’s.
  • Prediabetes is considered between 5.7 and 6.4%
  • Anything over 6.5% is consistent with diabetes.
  • For a medicated diabetic, under 7.0% is good–too much lower may kill you off faster.
  • However, for LIFESTYLE, there is no number too low for a diabetic.

With this in mind, you can understand just how bad the news from this study are.  Keep in mind that all the patients in this study had an HbA1c less than 6.5%:

  1. As HbA1c levels increased, there was an increase in the presence of heart disease and number of blood vessels involved.
  2. Those with higher HbA1c levels had a 280% higher chance of having heart disease.
  3. Those with both higher inflammation (as measured by hsCRP) and HbA1c levels closer to 6.5%, there was a 418% higher risk.
  4. The ideal cut-off value of HbA1c was below 5.6%.

That last bullet point, #4 above, pretty much means that 2/3 of the US alone is well on their way to heart disease.  It’s beyond time to get serious about this.  And getting back to my earlier point, this study basically uses a “diabetic” blood test to determine how much at risk someone is for developing heart disease.  Doesn’t get more closely associated than that.

 

Aspirin for the Heart May Be Unsafe for Low-Risk Individuals – (03-05-01)

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Aspirin for the Heart May Be Unsafe for Low-Risk Individuals

I come across many people in the community who have self-prescribed aspirin to protect against heart attacks. Many of them are unaware that the evidence is still weak for primary prevention (preventing the initial attack) and that, even if you lower your risk for heart attack you increase your risk for stroke. Care to pick? Personally–I would rather lower my heart disease risk with twenty lifestyles changes that don’t increase my risk of stroke (and will probably actually decrease it!).

Heart 2001;85:265-271 Dr. L. E. Ramsay and colleagues, from the Royal Hallamshire Hospital in Sheffield, UK, performed a meta-analysis of four randomized controlled trials that assessed the beneficial and harmful effects of aspirin as a preventive measure for coronary heart disease. From this, the researchers were able to determine the usefulness of aspirin therapy based on a person’s risk of a coronary event. For people with a 1.5% or greater coronary event risk per year, aspirin is a safe and worthwhile means of primary prevention, Dr. Ramsay’s group determined. In people with a 1% risk, aspirin is safe, they found, but it is unlikely to be of much therapeutic value. However, in people with a 0.5% coronary event risk per year, aspirin therapy is actually unsafe, according to the report. In this group, the bleeding risks of aspirin are likely to outweigh any beneficial effects. “Aspirin cannot be prescribed safely for primary prevention of coronary heart disease without formal estimation of coronary disease event risk of the individual,” the researchers emphasize. “Accurate risk estimation requires counting and weighing of major risk factors for coronary heart disease, using risk functions derived from epidemiologic studies such as Framingham.”

Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin – (12-31-01)

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Cyclooxygenase Inhibitors and the Antiplatelet Effects of Aspirin

This study finds that taking NSAIDs (specifically ibuprofen) and aspirin together can lower the potential blood thinning effects of aspirin. Considering that these two drugs are frequently taken together this does cause some concern. However, I still question the use of aspirin for both primary and secondary cardioprevention. Studies do indicate that risk of heart attacks may drop, but risk of stroke increases. I guess you need to decide which you would prefer. Personally, I would focus on some of the 10 or so other lifestyle factors that can lower risk of heart attack without increasing risk of other diseases.

NEJM — Abstracts: Catella-Lawson et al. 345 (25): 1809

Read entire article here

Manipulation of the neck and stroke: time for more rigorous evidence – (05-23-02)

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Manipulation of the neck and stroke: time for more rigorous evidence

I’m not sure how many people have managed to be exposed to this particular article as well as a recent one in Canada, but I thought I might address it anyway. These two articles suggest that the risk of stroke with cervical manipulation “occurs regularly.” I will address some issues, but be sure to read the editorial in this same journal ( eMJA: Manipulation of the neck and stroke: time for more rigorous evidence http://www.mja.com.au/public/issues/176_08_150402/bre10066_fm.html). First of all, by all standards there are no comparisons as to the safety of spinal manipulation (with possible exception of acupuncture). NSAIDs alone cause 16,000-19,000 deaths per year. Risk of vascular incidents with cervical manipulation is real, although the incidence has recently been cited to be as low as 1 in 5-6 million manipulations. And I firmly believe that the incidents that have been recorded in the medical literature (fewer than 100 in the recorded literature) are a matter of the DC being in the wrong place at the wrong time doing the wrong thing. The article firmly addresses other issues that show the poor methodology used in recent articles against cervical spinal manipulation. Incidentally, in my five years of practice I have given roughly 10,000 adjustments with no adverse effects (with exception of some post-treatment soreness).

eMJA: Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001

Read entire article here

Living Here as a Teen Ups Lifetime Risk of Stroke

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Lifestyle is all important. Period. But sometimes we have to admit that we can’t change everything, especially if it happened back when you were a teen.

I personally believe that chronic diseases like cancer, osteoporosis, heart disease and stroke have “critical periods” in our lives that pre-program us for or protect us from these diseases. Think this sounds strange? Here are some examples:

I’m sure you’re getting the idea. It is clear that the choices we make as a teenager follow us the rest of our lives. Pretty scary, huh?

While there isn’t anything you can do to turn back the hands of time and eat more broccoli, if you have children this information is critical. No longer can you accept that your teen’s Wonder bread, ubiquitous artificial sweetener intake and Monster energy drinks are just a phase. These choices WILL affect them 20, 30, 40 or even 50 years in the future.

Now that I’ve set the tone, it’s time to get to this particular article. The Stroke Belt is a region of the southeastern United States (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee) that has a higher risk of its residents suffering a stroke.

Basically, researchers looked at whether living in the Stroke Belt during certain age ranges led to a higher risk of stroke later in life. After teasing out other accepted risk factors for stroke (such as high blood pressure, obesity, smoking, etc..) the only time period that became important was the 13-18 year old range.

This group, if living in the Stroke Belt between the ages of 13 and 18, had a 17% higher overall lifetime risk of stroke. This is not chump change when it comes to an increased risk.

Of course, the question is whether lifestyles during the teenage years trip some kind of genetic switch (much like the studies noted above) or whether those living in the Stroke Belt during their teenage years pick up bad habits (smoking, sedentary lifestyles, down-home-Southern-cooking, etc…) that persist years later.

Either way, and regardless of whether you live or have lived in the Stroke Belt, you need to understand that your child’s current behaviors will likely affect his or her health for a lifetime. Help them choose wisely.

Serum potassium level and dietary intake as risk factors for stroke – (08-22-02)

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Serum potassium level and dietary intake as risk factors for stroke

While the fact that potassium lowers stroke risk is not a great shocker, what is surprising is the odds ratio (a marker for just how much of an increased risk in incurred) for patients currently taking diuretics and having a low serum potassium level at 2.5x the risk. This is quite a jump, especially considering that many diuretics result in loss of potassium from the kidneys…

Neurology — Abstracts: Green et al. 59 (3): 314 –

Read entire article here

Insulin resistance and risk for stroke – (09-26-02)

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Insulin resistance and risk for stroke

I’m sure that none of you who regularly read Updates had your eyes bulge wide on this one, this article does bother me a little. First, it is in a neurological journal, which is fine–all specialist should become familiar with the effect of increased insulin resistance because it truly cuts across all organ systems. However, I have a serious beef with the conclusion of this article that suggests that new drugs can be used to affect insulin resistance. Well, we know from several well designed studies that insulin sensitivity can be dramatically impacted through lifestyle changes (exercise, avoidance of refined grains for whole grains and intake of lots of fresh fruits and veggies). This article, which may be some neurologist’s first exposure to this concept, neglects to mention one of the most powerful tools to treat insulin resistance.

Neurology — Abstracts: Kernan et al. 59 (6): 809

Read entire article here

HRT and Associated Risk of Stroke in Postmenopausal Women – (09-26-02)

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HRT and Associated Risk of Stroke in Postmenopausal Women

Sorry…just felt the need to beat a dead bush (too much of an animal lover to beat a dead dog…). Still wondering why this stuff is even available, let alone prescribed…

Hormone Replacement Therapy and Associated Risk of Stroke in Postmenopausal Women

Read entire article here