A cross-sectional study published November 13 in the European Journal of Preventive Cardiology reported that 93 percent of participants with type 2 diabetes were at high or very high risk of a fatal cardiovascular event within 10 years. Researchers looked at a database containing health records for about 375,000 adults with type 2 diabetes in Catalonia, Spain, and used guidelines from the European Society of Cardiology (ESC) to calculate each person’s risk of having a fatal heart attack or stroke within 10 years. They found:
About 53 percent were at very high risk (greater than 10 percent risk). People in this group had cardiovascular disease, organ damage, or more than three risk factors, such as smoking, hypertension, or being over 50 years old.Almost 40 percent were at high risk (5 percent to 10 percent risk). People in this group had diabetes for more than 10 years and one other risk factor.The remaining 7 percent were at moderate risk (less than 5 percent risk). This group included people under 50 who had diabetes for less than 10 years and no other risk factors.
Robert Eckel, MD, the Aurora, Colorado–based president of medicine and science at the American Diabetes Association (ADA), says the idea that patients with type 2 diabetes could be considered “coronary artery disease equivalent” has been around for a while. “There are some studies that support this, and there are others that don’t,” said Dr. Eckel, who wasn’t involved in the study. “So, I think this is a new twist at this important question.” He says it’s important to keep in mind that the study is a snapshot of observational data from one specific region with a low overall incidence of cardiovascular disease, so the results might look different in other places. In the United States, cardiovascular disease is the leading cause of death, according to the Centers for Disease Control and Prevention (CDC). In addition, the CDC’s National Diabetes Statistics Report found that 34.2 million Americans — more than 1 in 10 — have diabetes, most of them type 2, and another 88 million — about 1 in 3 — have prediabetes, the precursor to type 2 diabetes. RELATED: Diabetes Nearly Doubles the Risk of Heart Failure, Study Finds
Primary Care Is Critical for Managing Cardiovascular Risk
“Type 2 diabetes is one of the main factors causing arteriosclerosis in the human body — and especially type 2 diabetes that is not well regulated will cause rapid accelerating arteriosclerosis, leading to stroke, heart attacks, or problems with circulation in your legs or your kidneys,” says Joep Perk, MD, a professor of health sciences at Linnaeus University in Kalmar, Sweden, and an ESC spokesperson on prevention. Dr. Perk wasn’t involved in the study. Also called atherosclerosis, arteriosclerosis is a clinical term for plaque buildup in the arteries that contributes to heart disease, according to MedlinePlus. The cardiovascular risk estimate used in the study looks only at the likelihood of a fatal cardiovascular event. The risk of fatal versus nonfatal heart attacks or strokes, which the study did not analyze, could be around three times higher, according to European Society of Cardiology guidelines. But Perk is quick to point out that this increased risk isn’t necessarily permanent. “The newly diagnosed type 2 diabetes patient — when he or she really takes lifestyle changes on board and gets proper medication — the risk of this patient getting a heart attack or stroke is not higher than other persons in the general population,” he says. That’s why primary care medicine is so important for managing the risk of heart attack and stroke if you’re living with type 2 diabetes. The study authors say that in addition to keeping your blood glucose in a healthy range, you should regularly have your cholesterol and blood pressure monitored. “That’s the message that I think [the authors are] attempting to get across here — that primary care physicians play a major role in probably the majority of patients with type 2 diabetes,” says Eckel, “and they need to be better informed about how important cardiovascular disease prevention is in their patient population.” According to the 2020 American Diabetes Association (ADA) Standards of Medical Care for Diabetes guide, people with diabetes should aim to:
Maintain a hemoglobin A1C under 7 percentKeep blood pressure under 130/80 millimeters of mercury (mmHg)Bring cholesterol under 100 milligrams per deciliter (mg/dL), possibly with lipid-lowering medications like statins or aspirin
While metformin remains the standard of care in the United States, the study highlights the clinical value of new diabetes medications that lower blood glucose and may reduce heart risks. Eckel says these include GLP1 receptor agonists and SGLT2 inhibitors. “The field has evolved over the last five years in an incredibly rapid way,” notes Eckel. “I would encourage people living with type 2 diabetes to consult with their primary care physicians about next steps in reducing cardiovascular disease risk.” RELATED: Why Black Americans Are Less Likely to Start Newer Type 2 Diabetes Drugs
How People With Type 2 Diabetes Can Help Lower Their Risk of Heart Disease
If you have type 2 diabetes, many of the steps you’re already taking to manage your blood sugar can also help reduce your risk of heart disease. Here are a handful of strategies.
Find a healthcare provider you trust. Establishing a relationship with a primary care provider is crucial if you’re managing a chronic condition such as diabetes. If you belong to a community that experiences minority stress — which has been linked with both type 2 diabetes and cardiovascular disease, according to the American Psychological Association — look for a provider who practices culturally competent care.Quit smoking. According to the CDC, smoking brings a two to four times greater risk of heart disease and stroke. That extra risk drops significantly within one year after quitting and drops off completely within two to five years.Crank up the exercise. After smoking cessation, getting active is Perk’s strongest recommendation: “See to it that you have daily physical activity, not as a medication, but as a joy … and do it every day.” The ADA recommends 150 minutes per week of moderate exercise.Consider a Mediterranean diet. According to the Mayo Clinic, a widely recommended eating style for cardiovascular health is the Mediterranean diet, which focuses on plant-based whole foods and reducing most animal-based foods. To get started, swap in olive oil, nuts, and fatty fish and swap out butter and red meat.Limit alcohol intake. While the relationship between moderate alcohol consumption and cardiovascular health is murkier, there’s no doubt that heavy drinking — that’s anything more than one 12-ounce beer or 4 ounces of wine per day, according to Johns Hopkins University — has been linked to high blood pressure, heart failure, and stroke.
The ADA has teamed up with the American Heart Association to offer an educational program called Know Diabetes by Heart that strives to help healthcare professionals and individuals better understand the relationship between diabetes and cardiovascular health. If you’re interested in learning about your personal risk for type 2 diabetes or prediabetes, try taking the ADA’s 60-Second Risk Test. RELATED: 8 Ways to Manage Type 2 Diabetes and Heart Health
