Vascular disease

Vascular disease is two to four times more common in people with Diabetes. It is caused by stiffening and clogging of arteries (atherosclerosis). In Diabetes, when the blood glucose is chronically high, excessive amounts of glucose attach to the inner walls of the blood vessels, decreasing their elasticity. Elevated blood glucose also cause atherosclerosis by promoting plaque formation. High blood pressure, high cholesterol and triglycerides, and smoking further increase this risk. Even mildly increased blood glucose (as in Prediabetes) increases heart disease risk.

Often heart disease is silent in people with Diabetes. In other words, there are no symptoms sometimes even during a heart attack.

Heart disease and stroke

Studies show that a person with Diabetes has the same chance of having a heart attack or stroke as someone has already had a heart attack or a stroke. Most people with Diabetes are unaware of their greatly increased risk of cardiovascular disease. This means people with Diabetes should not smoke, and need to be very diligent in minimizing the risks for cardiovascular disease (managing their blood glucose, cholesterol and triglycerides, blood pressure, and taking aspirin), even more so than the general population.

Medicines to lower lipids

Medications that lower lipid levels are important for lowering the risk of cardiovascular disease. Statins are the most commonly used medications for this purpose. Other medications may be used if statins are not effective enough to reach your lipid goals or if you cannot take them due to an adverse reaction.

Here is a list of several lipid lowering medications:

• Statins- also known as HMG-CoA-Reductase inhibitors, statins mainly lower blood levels of LDL and total cholesterol. They have been shown to signficantly lower the risk of heart attack and stroke. They can raise insulin resistance slightly but this side effect is outweighed by their life-saving benefits.
• Fibrates- these medications may lower blood levels of triglycerides and have other favorable effects on cholesterol. 
• Omega-3 fatty acids- these are obtained either prescription or over-the-counter (e.g., fish oil supplements) and help to lower triglycerides levels and modestly raise HDL levels in the blood.
• Ezetimibe- this medication works by blocking the intestinal absorption of cholesterol and lowers blood levels of LDL and total cholesterol.
• PCSK-9 inhibitors- these medications block the degradation of LDL receptors in the liver. This helps to remove LDL from the bloodstream, lowering LDL levels.
• Bempedoic acid: this medication lowers cholesterol production in the body and increases LDL uptake by the liver, lowering the blood level of LDL.

Medicines for the treatment of high blood pressure

Maintaining a healthy blood pressure is critical for keeping many organs healthy including the heart, brain, eyes and kidneys. Your healthcare provider may recommend a blood pressure lowering medication to help reach your blood pressure goals. 

Reproduced from “Diabetes DeMystified” by Umesh Masharani, McGraw-Hill 2007

Individuals with Diabetes are at higher risk for heart disease and stroke.