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Even well-treated diabetes can significantly increase a patient’s risk for developing some form of cardiovascular disease, through various mechanisms involving the dual impact of inflammation, oxidative stress, and more.
While it may be convenient to put each health concern in a box, focusing on one treatment at a time, the diabetes and cardiovascular disease (CVD) connection provides an important lesson: the human body doesn’t work that way.
Much of this connection is still unexplored, but its strength has been confirmed well beyond doubt.
Before we dive into the specifics, a look at the trajectory of both of these epidemic-level diseases will demonstrate just how important these issues are.
An article on the epidemiology of diabetes and cardiovascular disease by the University of Colorado School of Medicine provides a few searing insights not only on the current prevalence level of diabetes and heart disease, but how quickly the world has arrived at this state.
For example, per the article, the “global burden of DM (diabetes mellitus)” ballooned from 30 million patients in 1985 to 382 million in 2014.
Regarding the diabetes and CVD connection, CVD-related deaths are 1.7 times more frequent in US adults with diabetes than in the non-diabetic population.
Tellingly, the most common cause of death among diabetics is a CVD-related event, i.e., a heart attack or stroke.
In other words, the link between CVD and diabetes is very strong, and the prevalence of both issues is on an explosive trajectory.
To quickly clarify on the umbrella term that is cardiovascular disease, this class of diseases includes many problems affecting the heart and blood vessels, including:
These are just a few of the most common diseases among more than a dozen that exist under the definition of CVD.
Now that we’ve nailed down the context, let’s see what the research says about the links between diabetes and cardiovascular disease.
Both directly and indirectly, diabetes can influence many factors that contribute to CVD, including systemic inflammation, lipoprotein profile, oxidative stress, and more.
This finding from the State University of Rio de Janeiro points to several cases (contemporary studies) in which the early and intensive treatment of elevated blood sugar (hyperglycemia) led to a relative decrease in cardiovascular health concerns later in life.
Conversely, diabetic patients who underwent intensive treatment more than five years after their diagnosis did not show any decrease in cardiovascular disease incidence.
The term that many experts are using to refer to this phenomenon is metabolic memory, an idea that tissues “remember” the effects of this treatment (or lack thereof) and carry them into the future.
Whether the theory holds or not, this connection between blood glucose management and cardiovascular health is especially important for all diabetics, considering it involves the hallmark diabetes symptom.
Few issues can accelerate health decline more rapidly in the case of diabetes/heart disease (and so many others) than obesity.
Obesity exacerbates both conditions, each exacerbated condition worsens the other, and down the spiral goes.
Specifically, an excess of visceral (abdominal) fat worsens diabetes by creating an overabundance of pro-diabetes inflammatory substances called cytokines.
Moreover, obesity has long been correlated with a much higher incidence of CVD-related mortality.
It’s difficult to pinpoint the single most important risk factor in the diabetes-CVD continuum, but obesity is definitely up there.
The scientific community is slowly inching away from the “good cholesterol versus bad cholesterol” mentality (because it’s flawed), but it’s still true that an excess of low-density lipoproteins (bad) and a shortage of high-density lipoproteins (good) is dangerous.
In some cases, diabetes patients see this exact shift in their cholesterol profile, which increases the risk for atherosclerosis.
Atherosclerosis is characterized by the formation of plaques within arterial walls, which hardens these blood vessels while hampering blood flow.
The more occluded an artery becomes by these fatty plaques, the higher the risk of heart attack or stroke.
According to the American Heart Association (AHA), many diabetics experience high blood pressure as a symptom related to insulin resistance.
This presents another highly relevant connection to CVD, as high blood pressure significantly increases one’s risk of developing some form of cardiovascular disease.
In fact, the AHA reports that CVD risk is doubled for diabetics with high blood pressure.
The reason antioxidant-rich foods like blueberries are so important today is because they protect against oxidative stress, which can be brought on by many sources (not just unhealthy food).
Actually, it’s healthy to maintain a certain level of free radicals, which are one type of “reactive oxygen species” that antioxidants counteract, but with an abundance (and a lack of antioxidants), oxidative stress can occur.
Once again, this issue provides a direct throughway between diabetes and CVD.
Per the Rio de Janeiro study, “Increased intracellular glucose concentrations result in the activation of alternative pathways of metabolism…these pathways trigger an increased production of reactive oxygen species (ROS).”
In other words, diabetes increases free radical production, and an excess of free radicals can wreak havoc on the cardiovascular system, killing off vital tissue and interfering with the heart’s healthy functioning in many ways.
As always, it’s important to defer to your primary care physician when arranging treatment for your diabetes and/or CVD diagnoses, but diet, exercise, and lifestyle modification are almost always a major part of said treatment.
Exercise will increase glucose tolerance, decrease systemic inflammation, strengthen the heart, and much more.
Dietary changes can shore up your defense against diabetes and CVD to similar effect, keeping blood glucose at a healthy level, preventing excessive weight gain, and more.
Finally, aside from the treatments recommended by your care team, smoking and alcohol cessation are crucial to lowering risk factors for cardiovascular events and other issues.
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