Battling Heart Disease Risk In Diabetic Patients

By Bhavesh J. Shah, DPM

Every year, 800,000 additional cases of diabetes are diagnosed and it is projected that nearly 9 percent of all Americans will have diabetes by the year 2025.1 More shockingly, the incidence of diabetes has gradually increased among young people over the last decade, mainly related to an increase in obesity and sedentary lifestyles. In addition, diabetes may commonly reappear in women who previously had gestational diabetes.2
Diabetes has truly proven itself to be a progressive Pandora’s box, which can cause severe complications such as heart disease, kidney disease, blindness and lower extremity amputations. The intricacies of the disease process and its effect on multi-organ systems have warranted a multidisciplinary approach. Simply put, a disease process without boundaries requires an unrestricted approach in its management. Otherwise, this disease process cannot be stopped but just managed.
One of the most troubling statistics is the fact that people with diabetes are two to four times more likely to have coronary heart disease (CHD) and stroke than people without diabetes.1 Indeed, heart attack is the biggest cause of death for people with diabetes. The disease process makes these patients prone to fatty deposits in their arteries, blood clots and a higher risk of high blood pressure, all of which can lead to heart attacks and strokes.
To manage this disease process effectively, an unconventional approach may be necessary. For instance, recently there has been increasing evidence that vitamin B3 (niacin) will play an integral role in reducing the incidence of heart disease, especially in people with diabetes. Researchers found that niacin produced favorable, cardio-protective results among people with heart disease risk factors.3,4 (See “Controlling Risk Factors” )

Rethinking The Reduction Of Heart Disease Risk
Abnormal lipid levels contribute significantly to the risk of coronary heart disease, which is increased further in the presence of other risk factors. The association between elevated low-density lipoprotein (LDL) cholesterol and CHD risk is well established and several studies have shown that lowering LDL cholesterol levels reduces CHD episodes and overall mortality.

LDL cholesterol reduction remains the cornerstone of CHD prevention. Statin therapy provides the most dramatic and consistent reduction in LDL cholesterol and CHD risk. You would pursue this treatment regimen with those who are at high risk for CHD. These high-risk patients have a history of preexisting atherosclerotic disease, diabetes or familial hypercholesterolemia. Statin therapy is generally found to reduce cardiovascular risk by 35 percent over five years of treatment. Other options for achieving LDL cholesterol goals include bile acid sequestrants, plant stanols and niacin.
While statins are commonly given to people with heart disease when diet and exercise do not sufficiently lower cholesterol, researchers now believe the addition of niacin can lower the risk for heart disease even further. Many of the patients with heightened risk for cardiovascular disease will require multi-level treatment regimens involving statins in concert with niacin, fibric-acid derivatives or bile acid resins.

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