February Blog: Diabetes Heart Connection

Guest Contributor: Amy Tuhlei

BJ, a 68-year-old male, has been living with diabetes for over 20 years.  Recently, BJ was caught off guard when he found out he had developed heart failure and established heart disease. He pondered, how could this have happened? He had been working hard to manage his diabetes and make healthier choices.  BJ is not alone out there.  

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Did you know that diabetes increases risk of developing heart disease? Heart disease is commonly caused by the buildup of cholesterol in the blood vessels that supply oxygen and nutrition to the heart. These cholesterol plaques can break apart or rupture, which the body will then try to repair the plaque by sending platelets to seal it up. However, the artery is small, so the platelets could possibly block the flow of blood and not allow for oxygen delivery and then a heart attack may develop. It could also result in not enough blood to the brain and cause a stroke, or not enough blood to the feet, hands, or arms causing peripheral vascular disease. High blood sugar from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels over time and the longer you have diabetes, the higher the chances for you to develop heart disease.

So what prevention steps can be taken? Remember, the major contributors to heart disease (heart attack and stroke) are high blood pressure, high cholesterol levels (particularly low-density lipoprotein (LDL) (or as I call it, lousy cholesterol), and blood clots. The following are recommended goals and medications for each of these contributors:

  1. Blood pressure management
    1. Goal BP <140/90 mmHg (ADA Guidelines)
    1. Common medications classes for that you may be on for high blood pressure: (don’t let the long names overwhelm you)
      1. Angiotensin Converting Enzyme Inhibitor (ACEI):
        1. i.e. Lisinopril (Zestril) or Enalapril (Vasotec)
      1. Angiotensin Receptor Blocker (ARB):
        1. i.e. Valsartan (Diovan) or Losartan (Cozaar)
      1. Thiazide Diuretic:
        1. i.e. Hydrochlorothiazide (Microzide) or Chlorothiazide (Diuril)
      1. Calcium Channel Blockers:
        1. i.e. Amlodipine (Norvasc) or Nifedipine (Procardia)
  • Controlling Bad Cholesterol, Low Density Lipoprotein (LDL or lousy cholesterol)
    • Goal LDL: if have established cardiovascular (heart) disease, goal LDL < 70 mg/dL
    • Primary medication class for you treating elevated LDL:
      • Statin: Atorvastatin (Lipitor)
      • These drugs lower bad cholesterol levels by blocking an enzyme that the liver uses to make cholesterol
  • Preventing Blood Clots 
    • Blood clots can form and break off and travel through the body and cause blockage of blood vessels
    • If a blockage happens in a blood vessel to the brain, it can result in a stroke
    • Medication to prevent blood clots:
      • Blood thinner: low-dose Aspirin (81mg)

I encourage you to talk with your health care professional if you have questions.

Diabetes medications, in particular some sodium glucose co-transporter 2 (SGLT-2 inhibitors and glucagon-like peptide 1 (GLP-1) agonists, have shown to have particular benefits in prevention of heart disease complications. Below you will find a table with the agents/drugs in class and their indication unique for heart disease.

Drug name                                        Benefits
Heart Failure (HF) (lower hospitalization risk for heart failure) Major adverse cardiovascular event (MACE) reduction (Ex. Heart attack and stroke)
Sodium Glucose Co-transporter 2 Inhibitors (SGLT2 inhibitors)
Canaglifozin (Invokana) X X
Dapagliflozin (Farxiga) X  
Empagliflozin (Jardiance) X X
Glucagon-Like Peptide 1 Agonists (GLP-1 Agonists)
Liraglutide (Victoza)   X
Dulaglutide (Trulicity)   X
Semaglutide (Ozempic)   X
Semaglutide (Rybelsus)   X
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Along with treatment, it is always important to implement non-drug treatment such as your diet, physical activity, and smoking cessation.

 For your diet, multiple options for healthy eating plans are described below and are proven to work for persons with diabetes.  Food is medicine, so what and how much we eat really matters.  

  • Dietary Approach to Stop Hypertension (DASH) diet:
    • Eating plan rich in fruits and vegetables, low-fat and nonfat dairy, whole grains, along with nuts, beans, and seeds
    • Also includes some
    • Cut back on foods high in saturated fat, such as fatty meats, full-fat dairy foods and tropical oils, as well as sugar-sweetened beverages and sweets
    • Limiting salt to less than 2,300 mg per day or less than 1,500 mg per day
  • Carbohydrate counting
    • Working with diabetes care and education specialist (formerly diabetes educator) learn how to count carbohydrates
    • Typically recommend 30 – 45 grams of carbohydrates per meal, and 15 grams of carbohydrates per snack
  • Healthy Eating Behaviors
    • Learning portion control
    • Plate Method: ½ plate nonstarchy veggies, ¼ plate protein, ¼ plate of starch (carbohydrate), diary product (i.e. milk or yogurt) and fruit
  • Mediterranean diet
    • High in vegetables, fruits, whole grains, beans, nuts, seeds, and olive oil
    • Plant based, not meat based
    • Main components:
      • Daily intake of vegetables, fruits, whole grains and healthy fats
      • Weekly intake of fish, poultry, beans and eggs
      • Moderate portions of dairy products
      • Limited intake of red met

Along with diet, moving your body each day is key for keeping the heart healthy.  The 2020 ADA Standards of Care Guidelines recommends at least 150 minutes a week, that’s less than 22 minutes each day, of moderate-intensity physical activity such as brisk walking. This will not only help you manage your weight, but also help lower your blood sugars, blood pressure, and cholesterol which will essentially help reduce your risk for heart disease and many other potential complications.

Last but not least, it is important to stop smoking. Smoking can lead to so many illnesses including lung cancer, chronic pulmonary disease (COPD) or progressive disease of the lungs, and atherosclerotic cardiovascular disease or Heart disease.

Lifestyle modifications along with your treatment therapy will help reduce your risk of heart disease and also improve your quality of life so you can live out the best possible life!

Back to BJ, he recently met with this primary care provider who placed him on empagliflozin (Jardiance) 25 mg once daily and semaglutide (Ozempic) 0.5 mg once weekly because he has diabetes, heart failure and heart disease.  He is relieved that his diabetes medications will help both manage his diabetes and protect his heart. 

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