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Preventing Heart Attack in Diabetes

It was the wee hours of the morning. I heard the door to my parents’ room open and heard my father coughing hard. He went to the kitchen hurriedly followed by my mother’s nervous queries of whether he’s alright. They went back to their room, with my father coughing even harder, as , if trying to spit out something that was obstructing his breathing. In a few more seconds, all I heard was my mother’s piercing screams. And before I even reached their room, he was gone. Heart attack took Papa from us, just like that.

The silent killer
Often likened to a thief in the night, a heart attack hits its victims without warning and does irreparable damage,and oftentimes, fatal results in the blink of an eye. My father who was a type 2 diabetic was undergoing weekly dialysis for his kidney disease when he succumbed to heart attack. It was not the high blood sugar, nor the kidney problem that got him. Rather, it was the heart complication that took his life.

Most patients with diabetes these days die not of diabetes but firstly because of heart attack, second by renal (kidney) failure, said Dr. Eduardo Vicente Caguioa, chairman of the Preventive Cardiology Council of the Philippine Heart Association and consultant cardiologist at the University of Santo Tomas Hospital and St. Luke’s Medical Center. “Cardiologists consider diabetes as a coronary equivalent. Once you are a diabetic, your life span is equivalent to somebody who already has had a heart attack,” he said.

This is because diabetics have a metabolic problem that makes them more prone to develop heart problems and complications, according to Dr. Caguioa. “The risk of cardiovascular events which include heart attack, heart failure, stroke, hypertension, even kidney disease is higher in diabetics primarily because atherosclerosis (clogging of heart arteries), which is all over the body, is accelerated,” he said.
Heart attack results from the sudden, complete blockage of a coronary artery (blood vessel supplying the heart muscle) by a blood clot. The blockage can cause significant damage to the heart muscle and may lead to death, heart failure and related complications.

Prevention and treatment
For Dr. Caguioa, the most important way to prevent heart problems in diabetes is education. “Diabetics should understand that diabetes is not a disease of sugar alone,” he said. According to him, 50 or 60 years ago, when insulin and oral hypoglycemics were still not available, diabetics die because of high blood sugar.

But now, with the availability of insulin and oral hypoglycemic agents, diabetics who are being treated do not generally die anymore of high blood sugar, rather they die of heart attack, coronary artery disease, kidney failure and stroke. Given the case, most diabetics should realize that they should not only see an endocrinologist or diabetologist, but also see a cardiologist because of the heartrelated complications associated with diabetes, explained Dr. Caguioa.

Another important measure in preventing heart attacks is good blood sugar control. Tight control of blood sugar, resulting from proper diet and use of insulin or oral hypoglycemics, helps prevent the other silent problems associated with diabetes like abnormalities in cholesterol metabolism. Proper management of the disease is also important to prevent a possible heart attack. According to Dr. Caguioa, treatment of diabetes is multi-factorial, where it is not only diabetes that is being treated, but also other risk factors like weight, cholesterol and blood pressure levels. He said that diabetics should reduce their weight as most of them are overweight or obese, lower their cholesterol to optimal levels, and control their blood pressure.

Dr. Caguioa also emphasized the need to screen diabetics for peripheral vascular disease (PVD) because the presence of PVD means that the patient already has coronary artery disease. However, he pointed out that as in all other diseases, no amount of treatment or medication would be effective without diet and lifestyle modification.

PHA efforts
The Philippine Heart Association (PHA), through its Council on Preventive Cardiology is currently implementing programs that help address the diabetic problem in the country, especially regarding cardiovascular complications like heart attack. Dr. Caguioa shared some of the Council’s plans on how to address the diabetes and heart disease problem in the country. As of the now, the Council already came out with guidelines that can be used by Filipino doctors in addressing marginalized patients. “These guidelines will give options to doctors on how to manage patients who are diabetics with atherosclerosis, or diabetics with cholesterol problems,” he said.The guideline, as of this writing, is currently being printed and will be ready for dissemination to physicians all over the country.

Another project that the Council is looking at is that of gathering data to be able to come up with PHA guidelines or statements on particular issues that concern diabetes and cardiovascular problems. “We have to come out with statements that help doctors and help the laymen understand better. We are also coming out with pamphlets for laymen to talk about diseases of the heart, like diabetes,” according to Dr. Caguioa.

Finally, the Council on -Preventive Cardiology is also planning to forge an agreement with the diabetic societies and collaborate on how to go about managing holistically the diabetic problems in the country.

Heart-friendly advice
To prevent heart attacks and other complications in diabetes, Dr. Caguioa offered some healthful advice:

  • Know your family history. Having a parent, a brother or sister who has diabetes makes you a very likely candidate for diabetes too. So it is important to have yourself checked by a doctor.
  • If you are a diagnosed diabetic, you have to see not only a diabetologist or endocrinologist, but also a cardiologist because diabetes is considered a coronary equivalent.
  • Do not be satisfied with just having your blood sugar controlled. You have to control everything that is associated with diabetes like blood pressure, cholesterol and weight.
  • Regular check-up and monitoring of your diabetes is important. Having diabetes means monitoring your self for the rest of your life. Go back to your doctor for regular checkups and follow your prescribed medications religiously.
  • Lastly, lifestyle modification is essential. Remember that no amount of medication will work without lifestyle modification.

Diabetes need not always end with a heart attack. As a diabetic, you can still live a longer, healthier life if you will only take good care of your self. With careful monitoring of your diabetes plus the other risk factors like cholesterol, blood pressure and weight, add to that diet and lifestyle modification, you can protect your heart and prevent a heart attack. Doing these preventive measures can save not only your life but the lives of those you love as well. Preventing heart attacks translates to husbands and wives growing old together, parents living to see their children’s children grow up, and children not having to be orphaned early.

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