Diabetes is a leading risk factor for cardiovascular disease, and Consultant Cardiologist, Dr Low Lip Ping, explains how early intervention can help prevent premature death.

Cardiovascular disease (CVD) claims 23 Singaporean lives daily, with heart disease and cerebrovascular disease (stroke) ranking as the third and fourth leading cause of mortality in Singapore.

While multiple factors contribute to CVD, diabetes mellitus remains a prominent risk factor for the condition. In individuals with diabetes, CVD has been identified as the primary cause of death, responsible for two-thirds of fatalities in this group.

We speak to Consultant Cardiologist and Chairman Emeritus of the Singapore Heart Foundation, Dr Low Lip Ping, about the deadly link between diabetes and CVD, and how early intervention can reduce the risk of heart disease-related deaths.

For Life (FL): What are the most common risk factors for CVD? How prevalent is CVD among diabetics and how does diabetes cause CVD?

Consultant Cardiologist, Dr Low Lip Ping

Consultant Cardiologist, Dr Low Lip Ping

Dr Low Lip Ping (Dr L): Diabetes is a primary risk factor for CVD. CVD affects 32.2% of patients with type-2 diabetes, a condition characterised by elevated blood sugar levels due to the body’s inability to utilise insulin effectively.

Diabetes is a leading risk factor for CVD because high blood sugar damages the blood vessels and nerves that control your heart. People with diabetes often have other comorbidities such as high blood pressure and high cholesterol, which can increase the risks of cardiovascular disease and lead to heart attacks, stroke, and heart failure.

In addition to diabetes, other factors that can raise your risk for heart disease include smoking, being overweight/obese, lack of physical activity, poor dietary habits and consuming too much alcohol.

FL: Why is it important to manage diabetes early before it progresses to heart disease?

Dr L: Diabetes is a precursor to coronary heart disease, heart failure, stroke, and peripheral artery disease. In fact, people with diabetes face up to a fourfold increased risk of stroke and twice the risk of dying from a heart attack compared to non-diabetic patients. Not just that, diabetics have nearly the same mortality rate as patients with a history of heart attacks.

People with diabetes are also more likely to have heart failure, which occurs when your heart is unable to pump sufficient blood and oxygen to support organs in your body.

Diabetes also affects the small blood vessels throughout the body, in addition to the heart. This potentially results in microvascular complications such as damage to the eyes and kidneys, leading to vision loss and chronic kidney disease, respectively.

The risk of CVD increases the longer that individuals have high blood sugar. Therefore, it’s imperative for diabetes to be managed early before it progresses and causes damage to the organs in the body. Diabetes management usually encompasses lifestyle modifications, medications, close monitoring of blood sugar, blood pressure and cholesterol levels.

FL: What can diabetic patients do to prevent the onset of CVD?

Dr L: Managing diabetes and CVD often requires a multidisciplinary approach involving primary care physicians, endocrinologists, and cardiologists. All diabetics should also be referred to a physiotherapist and dietitian for a tailored exercise and diabetic diet plan for effective weight management and glycaemic control.

Diabetic patients are also strongly advised to avoid alcohol and stop smoking as alcohol and nicotine use increases blood pressure and damages the heart.

If diabetic patients have already been diagnosed with CVD, they may also be prescribed a range of medications, depending on the stage of their disease.

FL: What treatment options are available for managing CVD?

Dr L: Diabetic patients with established or at high risk of CVD should receive antiplatelet therapy with aspirin and statin therapy, as this can reduce the risk of heart attacks, stroke and death due to arterial thrombosis.

Some diabetic individuals who are asymptomatic may be diagnosed with coronary artery disease (CAD) during screening. Such patients should be referred for further assessment to determine the extent and severity of their condition and the need for coronary revascularisation with percutaneous intervention or coronary artery bypass graft surgery.

Statins and other lipid-lowering agents are prescribed to reduce cholesterol to recommended levels, while Beta blockers reduce the severity and frequency of anginal (chest pain) attacks. In addition, angiotensin-converting enzyme (ACE inhibitors) and angiotensin II receptor blockers (ARBs) help to reduce blood pressure levels and treat acute heart attacks, heart failure and elevated protein in the urine.

Recent therapeutic developments have also introduced sodium-glucose contransporter 2 (SGLT2) inhibitors. SGLT2 inhibitors have been shown to effectively manage diabetes, reduce the rate of deaths and hospitalisation associated with heart failure in patients with diabetes and pre-existing CVD, lower blood pressure, and even deliver weight loss benefits.

All diabetic patients with CVD should adopt a heart-healthy lifestyle as a pre-emptive measure. Speak to your doctor about cardiovascular rehabilitation programmes that offer supervised exercise, as well as helpful lifestyle modifications solutions tailored to individual needs.

Featured photo by Shutterstock.
Dr Low Lip Ping photo courtesy of Dr Low Lip Ping.