Cardiovascular Disease and Type 2 Diabetes

Condition

What causes cardiovascular disease and Type 2 Diabetes?

Cardiovascular disease and type 2 diabetes are chronic metabolic conditions that are caused by a combination of genetic risk, environmental and lifestyle factors. Risks associated with lifestyle include tobacco use, intake of high calorie, poor nutrient foods, and sedentary behavior with low levels of physical activity. Other risk factors for type 2 diabetes are not modifiable, such as age, ethnic origin, family history of diabetes, and some genetic markers.

How are cardiovascular disease and type 2 diabetes diagnosed?

Type 2 diabetes is diagnosed by measuring the levels of sugar (glucose) in your blood, or some blood markers (hemoglobin A1c) reflecting the levels of glucose in circulation.

Cardiovascular disease can be diagnosed based on symptoms such as chest pain called angina, leg pain while walking, and weakness or neurological symptoms typical of stroke. These symptoms are caused by narrowing or blockage of vessels in your heart, in your brain, or elsewhere in your body. Your doctor can also detect or screen for presence of narrowing of vessels by imaging tests.

What are the signs & symptoms suggestive of Type 2 diabetes and cardiovascular disease?

You can reduce your risk of getting heart disease and diabetes with healthy food choices and exercise. Your doctor can help identify your risk by checking your waist circumference, blood pressure, lipid profile, and blood glucose. Medications can be added for improvement of these risk factors if your diet and behavior efforts are not able to reach the appropriate targets

When blood sugars get very high, people can have excessive thirst, increase urination, and weight loss. High blood sugars can also lead to a narrowing or blockage of vessels in your heart can lead to chest pain called angina, or myocardial infarction that people often called ‘heart attack’. Blockage of vessels in your brain is called stroke and can lead to weakness or tingling in parts of your body, difficulty speaking, and many other neurological symptoms. Narrowing of vessels in your legs can lead to leg pain when you walk, and if severe it may even require amputation.

Terms you should know

High Metabolic Risk: a cluster of diseases that develop as a result of poor lifestyle behaviors, genetic factors or a mismanagedTop 5 things to know about CVD and T2D condition.

Cardiovascular Disease: also known as heart disease, a disease that narrows or blocks the valves in the heart.

Prediabetes: occurs when blood glucose levels are higher than normal, but not high enough for a diabetes diagnosis.

Metabolic Syndrome: clustered risk factors, which include obesity, high blood pressure, elevated triglycerides, low high-density lipoprotein-cholesterol (HDL) “good” cholesterol, and abnormal elevation of blood sugar.

Hypertension: also known as high blood pressure this condition often has no symptoms and is the leading cause of cardiovascular disease.

High-Density Lipoprotein (HDL): also known as “good cholesterol” because it helps to remove other cholesterol from the blood stream.

Low-Density Lipoprotein (LDL): also known as “bad cholesterol” makes up most of your body’s cholesterol and can increase your risk for heart disease and stroke.

About one third of all US adults are considered at high metabolic risk.

Common metabolic and diabetes risk factors include:

  • elevations of triglycerides (TGLs)
  • reduced levels of high-density lipoprotein-cholesterol (HDL)
  • increased plasma glucose levels
  • systemic hypertension (high blood pressure)
  • enlarged waist circumference due to large amount of abdominal body fat
  • a prothrombotic state (increased risk of blood clots in the blood vessels)
  • a proinflammatory state (increased risk of inflammation)

Type 2 Diabetes

People who have been identified as having prediabetes should be tested annually for type 2 diabetes.

For someone with high metabolic risk, especially with prediabetes, the best way to lower the risk of progressing towards type 2 diabetes is to adopt lifestyle changes

Risk factors that increases your risk of developing type 2 diabetes include: excess weight (especially around the waist), food intake rich in calories and simple sugars, low level of physical activity, high amount of sedentary time (sitting or lying down), tobacco use, and some medications. Other markers can also indicate higher risk of developing diabetes such as different types of blood cholesterol levels (high triglycerides and low HDL) and high blood pressure.

Management & Prevention

For individuals at high metabolic risk, the first line of therapy is lifestyle changes. Most successful lifestyle interventions are comprehensive programs led by trained health professionals which support the adoption of healthy lifestyles, including diet and physical activity, aiming for moderate but sustained weight loss.

For individuals at metabolic risk with excess weight, comprehensive programs to support the adoption of a healthy lifestyle should aim to achieve weight loss of at least 5% of initial body weight.

All individuals at high metabolic risk should adopt a cardiovascular-healthy diet that includes high amount of vegetables, fruits, whole grains, nuts, legumes, unsaturated oils, low-fat dairy, poultry, and fish; and low amount of sodium, red and processed meat, high-fat dairy, and sugar-sweetened foods and drinks. Caloric reduction is often part of weight loss programs.

All individuals at high metabolic risk should aim to limit their amount of sedentary time and to be physical active on a daily basis. Walking is a great way to be active and is safe for most people. Structured activity programs may be appropriate for some individuals.

Lifestyle interventions should also address factors such as tobacco cessation, stress management, and sleep hygiene

In individuals with prediabetes, if lifestyle intervention is not possible or not successful, some medications may be needed to slow down the progression towards type 2 diabetes.

For individuals at high metabolic risk, the blood pressure goal should be less than 130/80 mm Hg. Lifestyle approaches including sodium reduction, cardiovascular healthy diet, regular physical activity, and weight loss lead to significant improvement in blood pressure. Blood pressure medications should be added if lifestyle changes are not successful or insufficient to reach pressure less than 130/80 mm Hg.

Depending on your risk of developing cardiovascular disease and your level of “bad cholesterol” some medications such as statins may be needed to prevent “heart attack” or stroke.

Type 2 Diabetes is preventable! The longer you have diabetes, the higher the chances of developing heart disease. Over time, high blood glucose can damage your blood vessels that control your heart. Lifestyle behaviors including cardiovascular-healthy diet, daily physical activity, and avoiding tobacco is the best way to prevent type 2 diabetes and cardiovascular diseases.

Questions to ask your healthcare team

Both type 2 diabetes and cardiovascular diseases can progress over many years without symptoms, which is why it’s important to talk about it with your doctor about what screenings or tests are appropriate for you.

  • Should I have my blood glucose, and cholesterol levels checked?
  • Should my waist circumference be measured?
  • Is my blood pressure at a healthy level?
  • What are the programs available to help me adopt a healthy lifestyle?
  • Should I see an endocrinologist or diabetes educator?
DEVELOPED FOR PATIENTS BASED ON Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: AN ENDOCRINE SOCIETY CLINICAL PRACTICE GUIDELINE
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