Diabetes and Heart Disease: A Dangerous Combination

There is an important connection between diabetes and heart disease that many people are unaware of: If you’re living with diabetes, then you’re at heightened risk for heart and kidney disease.

Often, this is because many patients with diabetes also have one or more conditions, such as high blood pressure, that contribute to a higher risk of developing heart disease. In fact, 68% of adults 65 and older with diabetes die from heart disease, increasingly with related kidney disease complications.

Many people with diabetes actively manage their condition by following a glucose-lowering treatment plan, but they may pay less attention to protecting their heart and kidney health with preventive strategies.

A Widespread Problem

There are three groups of people in the United States who are at risk for heart disease related to diabetes. They are: people diagnosed with diabetes (about 29 million), people with undiagnosed diabetes (11 million) and people with pre-diabetes (115 million).

About 20% of people in the U.S. with diabetes are being treated for the condition and controlling it. About 45% are being treated but not controlling their disease. About 30% are unaware they have diabetes.

“We know that diabetes increases the risk of heart and kidney disease, yet 80% of American adults with diabetes are either uncontrolled, untreated or unaware of their condition,” says Ian J. Neeland, MD, Director of Cardiovascular Prevention and Co-Director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) at UH Harrington Heart & Vascular Institute. “This is a major public health problem.”

How Risk for Heart, Kidney and Eye Disease is Estimated

When you have diabetes, the likelihood of getting kidney disease, eye disease or heart disease can be calculated based on your A1C levels. Doctors order A1C blood tests to check your diabetes, diagnose diabetes or check how well you’re controlling your diabetes through medication.

The risk for getting heart, kidney or eye disease is assessed according to how well your diabetes is being managed, Dr. Neeland says. People with an A1C level of 10 are about twice as likely to get heart disease as someone with an A1C level of 5, and about 10 times as likely to get kidney and eye disease as someone with an A1C of 5.

“So it’s very important not only to know that you have diabetes, but to get it addressed and get it under control to reduce the risk of getting these diseases,” Dr. Neeland says. “What’s important to know is that heart disease is the leading cause of death in all patients with diabetes— much more than stroke, chronic obstructive pulmonary disease or lower respiratory infections.”

Fragmentation of Care

“One of the problems with diabetes is the fragmentation of care,” Dr. Neeland says. “It can be very confusing for patients. They go from specialist to specialist or from clinic to clinic receiving mixed messages and different instructions.”

Because diabetes involves so many different organs and systems in the body, patients need a multidisciplinary team consisting of a doctor, nurse, certified diabetes educator and pharmacist, as well as other people who can put the patient at the center of their treatment, Dr. Neeland says.

“They need to take a holistic approach and consider such questions as: what kinds of food do you eat or have access to, how is the family support network?” he says. “Also an abundant amount of resources are needed to support, advise, guide and help the patient so they are not left alone to try to fend for themselves, but have a support and care team with them every step of the way.”

New Therapies Available for Diabetes

Dr. Neeland says the good news is that the future is bright for people with diabetes. “We have many new avenues of treatment and care for diabetes,” he says. One of the most exciting is two new classes of medication to treat diabetes: SGLT2 inhibitors and GLP-1 medications.

“In the past several years, we have seen these medications do something that no other diabetes medication has done before, and that’s reduce your risk of heart disease,” Dr. Neeland says. “Insulin and the other medications for diabetes do not change your risk for heart disease. They help lower your blood sugar, but they’re much less effective for preventing heart disease.”

Dr. Neeland says these two medications can do many things:

• Prevent heart attacks.
• Prevent death from heart disease.
• Prevent hospitalizations for heart failure.
• Prevent worsening kidney disease.

“These newer medications are a completely different ballgame, because even if sugar is controlled and your eyes are fine, heart disease is lurking in the background,” he says. “Another newer therapy is non-steroidal MRAs,” says Dr. Neeland. Non-steroidal MRAs (mineralocorticoid receptor antagonists) can help reduce heart and kidney complications in people with diabetes, with fewer side effects than steroid medications. “They also treat heart failure, and reduce hospitalizations and death from heart failure.”

It’s important to see a cardiologist who understands diabetes, as well as heart disease, and can integrate comprehensive care and treatment, Dr. Neeland says.

Related Links

UH Harrington Heart & Vascular Institute’s Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) brings together multiple specialists to advance the treatment of the cardiac and vascular complications of metabolic disease.