Diabetes is a ‘silent driver’ of heart disease, heart attacks: Experts

Dr. Ashwin Mehta, Director of the Heart Failure Programme in Cardiology at Sir Ganga Ram Hospital, explained that the mechanism behind this connection is complex. He noted that prolonged high blood sugar leads to a condition known as hyperglycemia, which triggers several destructive processes.

Key factors contributing to heart damage include:

• Endothelial Dysfunction: High sugar levels (glucotoxicity) and the loss of nitric oxide damage the delicate lining of the blood vessels.
• Lipid Imbalance: Diabetes is frequently accompanied by elevated cholesterol and triglyceride levels.
• Plaque Deposition: These increased lipid levels make blood vessels far more vulnerable to the buildup of plaque, which can block blood flow.
• Clustering Risks: Diabetes often occurs alongside hypertension, further compounding the risk of a cardiac event.

Dr. Mehta emphasized that the risk is so profound that medical professionals often treat diabetic patients as if they already have coronary artery disease. "We call this a myocardial risk equivalent," he stated, noting that the long-term complications are significantly higher than in the general population.

The "Failed Alarm System"

One of the most terrifying aspects of diabetes is its ability to mask the warning signs of a heart attack. Dr. Naresh Trehan, Chairman and Managing Director of Medanta, highlighted a phenomenon involving nerve damage that can leave patients oblivious to their condition.

"People who have diabetes, the nerve endings that give the pain from the heart are damaged, so their alarm system has failed," Dr. Trehan explained. He warned that because these nerve endings are compromised, patients may not experience the classic chest pain typically associated with a heart attack. This means the heart can suffer continuous, silent damage without the patient ever realizing they are in danger.

A Cautionary Tale: The Case of the "Gas" Discomfort

To illustrate the suddenness of these events, Dr. Mehta shared the case of a 45-year-old man who had lived with diabetes for a decade. The patient presented to the emergency department complaining of what he believed was simple gastric discomfort caused by spicy or fatty food.

Despite having no history of hypertension or previous heart attacks, his ECG revealed alarming changes. An angiography later showed that all three of his coronary arteries were completely blocked, with blood flow barely trickling through a tiny channel in one artery. The patient, who had been taking his diabetes medication irregularly, required immediate bypass surgery.

"He was worried that he had no symptoms and wondered how he could have a sudden onset of so many problems," Dr. Mehta said. "This is not sudden; it is more common in diabetics."

Preventative Measures and Recommendations

Given the silent nature of these complications, experts are urging a proactive approach to cardiac health for anyone managing diabetes. Medical professionals are advised to ensure that diabetic patients undergo regular cardiac evaluations.

Expert advice for those with diabetes includes:

1. Annual Heart Check-ups: Regular echocardiograms or heart evaluations are essential to monitor vessel health.
2. Strict Medication Adherence: Consistent management of blood sugar is vital to prevent glucotoxicity.
3. Monitoring Lipids: Keeping a close eye on cholesterol and triglyceride levels to prevent plaque buildup.