Cardiovascular disease is the leading cause of death among persons with diabetes. Men with diabetes are 2 to 4 times more likely to die from a heart attack than men without diabetes. Women with diabetes are 5 to 8 times more likely to die from a heart attack than women without diabetes. Overall, cardiovascular disease is responsible for about 70% of all deaths in persons with diabetes. Strokes are responsible for 16% of all deaths in persons with diabetes.
High blood glucose values worsen the adverse effects of high cholesterol levels. Persons with diabetes have 2 to 3 times that rate of cardiovascular disease than persons without diabetes that have the same cholesterol levels. The high glucose levels cause the cholesterol to be more likely to buildup in the walls of the blood vessels leading to heart attacks and strokes. Because of this, cholesterol levels are treated to lower levels in persons with diabetes. If you are 40 or older and have diabetes, your cholesterol levels should be checked annually.
High blood pressure is also common in persons with diabetes and should be closely monitored and carefully controlled. Of course, persons with diabetes should not smoke as this doubles the risk of cardiovascular events.
The American Diabetes Association recommends that all adults with diabetes should have their 10-year risk of having a heart attack calculated. The American College of Cardiology has an online calculator you can use or ask your health care provider to use: tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/. Your provider will use the risk score to direct the goals of your therapy.
In December 2008, the Food and Drug Administration (FDA) began requiring drug developers to submit data on long-term cardiovascular outcome trials on all new diabetes medicines. All new diabetes medicines must show they do not cause an increase in cardiovascular disease. Members of two classes of drugs for the treatment of type 2 diabetes have actually shown to decrease cardiovascular deaths.
Glucagon-like peptide 1 (GLP-1) receptor agonists agents are injectable drugs that effectively lower blood glucose values and promote limited weight loss. Liraglutide (brand name Victoza – daily dosing) and semaglutide (brand name Ozempic – once weekly dosing) have both been demonstrated to have beneficial effects on reducing cardiovascular events. The liraglutide study results were so good that the FDA approved the use of liraglutide to reduce the risk of heart attacks, strokes and cardiovascular deaths in persons with type 2 diabetes and existing cardiovascular disease.
Sodium–glucose cotransporter 2 (SGLT2) inhibitors are oral medicines that lower blood glucose values by actively removing glucose from the body through the urine. Empagliflozin (brand name Jardiance) and Canagliflozin (brand name Invokana) both reduced cardiovascular events and hospitalizations for heart failure. Empagliflozin also has been shown to decrease cardiovascular mortality and all-cause mortality. SGLT2 medicines have also been shown to have beneficial effects on the kidneys in persons with diabetes.
Ask your healthcare provider if one of these medicines might be appropriate to include in your treatment regimen. Guard your heart for life.
Dr. Samuel Abbate is a local physician practicing in Wasilla at the Alaska Diabetes and Endocrinology Center.