Heart Attack Risk Factors Have A Bigger Impact On Risk In Women Than In Men

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Diabetes, heart disease share risk factors best managed early

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Dr. Abraham Thomas is an endocrinologist and chair of medicine at Baystate Health as well as at UMass Medical School-Baystate.
Dr. Abraham Thomas is an endocrinologist and chair of medicine at Baystate Health as well as at UMass Medical School-Baystate. (Anne-Gerard Flynn photo)

By Anne-Gerard Flynn

agflynn413@gmail.com

Special to The Republican

The country's high rate of obesity in recent years has highlighted the condition's correlation in the media with the onset of type 2 diabetes.

Less highlighted is the fact that many of the factors that cause diabetes also contribute to heart disease.

One veteran Western Massachusetts endocrinologist likes to highlight the importance of heading off both chronic diseases - or at least minimizing their impact - by earlier identification and better management of risk factors.

"When I was in training it was not uncommon for people with diabetes to have an amputation or lose their eye sight, but we don't see as much of that now," said Dr. Abraham Thomas, who received his medical degree from New York's Columbia University and his master's in public health from Harvard.

"We can make a huge difference if we are following all the things that we should."

This, Thomas said, means taking the better medications that can be prescribed today if needed, keeping current with recommended screenings and visits to health care providers and adhering to a healthy lifestyle.

Chair of Baystate Health's department of medicine, Thomas talked about diabetes and heart disease as a participant in Baystate's annual February series on heart and vascular health.

"Many of the risk factors for heart disease usually exist in people with type 2 diabetes. For example high blood pressure," said Thomas in a recent interview.

"Many people with diabetes have high blood pressure. People with diabetes have abnormal cholesterol patterns." 

He added smoking and obesity are traditional risk factors for heart disease that many people "with type 2 types already have."

"There is also damage from the high glucoses that affect blood vessels both large and small. Some of it impacts the heart. Some of it impacts vessels in other parts of the body," said Thomas of the impact of type 2 diabetes on blood sugar levels and the ability of the hormone insulin to regulate these levels by getting cells to absorb the glucose or sugar that is stored for energy.

Statistically, people with diabetes are said to be at twice the risk for ischemic stroke, that is, developing a blockage within a blood vessel supplying blood to the brain, than those without diabetes and to have a higher risk factor for heart disease at a younger age.

Treatment, Thomas said, is key.

"There are some features of heart disease that may be a little bit different in people with diabetes but in many ways, we do the same types of treatment," Thomas said.

"For example, the risk for heart disease goes up for women, compared to men, after menopause but if you have diabetes that risk is earlier in life and that earlier risk is true also for men with diabetes."

He added, "However, for the most part, if we want to avoid heart disease in people with diabetes, we want to modify the risk factors.

He cited the importance of the management of blood cholesterol levels with medications in people with diabetes as abnormal levels can cause blocked arteries and lead to cardiovascular disease.

He added other risk factors include being insulin resistant, a condition common with obesity.

"We look at risk factor modification - things we can change," Thomas said.

"If patients have high blood pressure, can we get their blood pressure to a target. For those with diabetes, the recommendation is usually 130/80. If they have abnormal cholesterol, we treat them even before they have their diabetes. If they are smoking, we have them stop smoking. If they are sedentary, can we get them to change their activity level."

Thomas added that with type 1 diabetes the "likelihood of having heart disease is much earlier" and "higher than the average person."

"This is because most people with type 1 diabetes start with the disease much younger in life," said Thomas, adding that type 1 is an autoimmune disease that attacks the cells of the pancreas that make insulin and as a result the pancreas produces little or no insulin.

"We also do the risk factor modification for heart disease for people with type 1. So, if they have high blood pressure, we want to treat that, if their weight goes up, which can be more common in people with type 1 diabetes, we make sure they have a healthy lifestyle and address their cholesterol."

Thomas added statin drugs are used to lower blood cholesterol levels, and that angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are often used to treat high blood pressure in people who are diabetic.

Thomas was asked about the estimate that at least 68 percent of people age 65 or older with diabetes die from some form of heart disease and 16 percent die of stroke could be attributed to the body's aging process.

"There is greater impact with diabetes. If you have diabetes you are more likely to have a heart attack or stroke and then if you have one, your risk of having another is higher," Thomas said.

"The average life span is about 78 years and diabetes shortens that life span in men and women by seven- to eight-and-a-half years. It is more than just the aging. Aging makes it worse. It is the combination."

While people with type 1 diabetes have to take insulin since their bodies do not make it or enough of it to regulate the body's blood sugar levels, Thomas said "not everyone needs to be on insulin" with type 2 diabetes and that there are "many more medical options in treating type 2 diabetes in recent years."

The American Diabetes Association's 2018 "Standards of Medical Care in Diabetes" was released with new recommendations for people with cardiovascular disease and diabetes.

The lengthy document discusses how the complex disease is diagnosed and treated and how this sometimes includes addressing behavioral health issues. Medical therapy for type 2 often starts with addressing blood glucose levels, as well as self-management.

"The recommendation now is that if you are diagnosed with diabetes that you start with medication as well as lifestyle. It used to be you were just treated for lifestyle at the beginning depending on the severity of your diabetes when they found it out," Thomas said.

"Not everyone is successful with lifestyle and they did not want to wait six months to a year before putting someone on a medication. That has been my recommendation for quite a while now. "

He added, "If we treat it, we lower the risk of something happening."

"As an endocrinologist - and for all physicians who take care of people with diabetes - when we talk about treating diabetes as well as heart disease prevention we are talking about taking care of the ABC's," said Thomas of the phrase popularized a few years ago by American Diabetes Association and the American College of Cardiology that refers to A1C (blood sugar level), blood pressure and cholesterol.

"You have to treat those as well as all the risk factors."

He added, "There are lots more medications than ever before to treat diabetes, and good medications to treat blood pressure and cholesterol."

"If you have diabetes and you can modify your risks you can actually live your full life and not have to have your heart attack or stroke," said Thomas, referring to such statistics as that from the American Heart Association that adults with type 2 diabetes are about twice as likely to die from heart disease as adults who do not have diabetes.

"You can make a big difference taking care of yourself and working with your health care provider."

Other speakers in Baystate's heart and vascular health series, held this month from noon to 2 p.m. at the Baystate Health Education Center, 361 Whitney Ave., Holyoke, include "Advances in Stroke Treatment," presented today, Feb. 17, by Dr. E. Jesus Duffis, director of Baystate's neurointerventional surgery division.

The talk will focus on the warning signs of strokes as well as what is being done to enhance recovery.

Also, "Surgical Treatment of Coronary Artery Disease 2019: Modern Treatment for an Age-Old Disease," to be presented Feb. 24 by Dr. Thomas Schwann, Baystate's chief of cardiac surgery, will focus on coronary artery bypass graft surgery and who qualifies for it.

Registration is required for each session and can be done online or call (413) 794-5200.

The lecture series is sponsored by Health New England.

Source : https://www.masslive.com/living/index.ssf/2019/02/diabetes_heart_disease_share_risk_factors_best_managed_early.html

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