Diabetes, a dangerous disease for the heart and blood vessels

More than 3 million French people have diabetes, a condition that is currently spreading. However, this disease exposes you to the early onset of cardiovascular complications, which can be serious.

By definition, diabetes is an excess of glucose in the blood . In more than 9 out of 10 cases , it is type 2 diabetes , which is found in adults over the age of 50, who are often sedentary and overweight. Type 1 diabetes is less common and can be diagnosed in childhood or adolescence. But, in both forms of diabetes, there are changes in the large and small blood vessels.

Diabetes, heart and blood vessels: the relationships

Due to chronic hyperglycemia and/or its association with other cardiovascular risk factors such as excess blood triglycerides, obesity, arterial hypertension, sedentary lifestyle, etc.,  diabetes promotes the development of fatty plaques ( atherosclerosis ) in the large arteries (macroangiopathy). 

The  accelerated aging of the coronary arteries of the heart thus determines premature mortality in diabetics, in particular in women, who are usually protected against cardiovascular diseases until menopause.

• The risk of developing a myocardial infarction is multiplied by two to four in a diabetic compared to a non-diabetic and these infarctions are twice as often fatal; 
• Diabetics are twice as likely as people without diabetes to develop arteritis of the lower extremities , an even greater risk if they smoke heavily; 
• Finally, these patients are more often victims of cerebral vascular accidents and these problems are, in general here too, more serious than in non-diabetics.

Damage to small vessels 

If the attack of the large vessels makes the seriousness of the diabetic disease (myocardial infarction, cerebral vascular accidents), that of the small vessels like the arterioles and the capillaries induces complications specific to diabetes.

This microangiopathy is directly related to hyperglycemia . Reaching the small vessels irrigating the retina thus determines  visual alterations , which go unnoticed for a long time but can lead to blindness.

Blood circulation is also often less good in the vessels of the feet . This aggravates the consequences of any damage to the large arteries of the legs and explains the need to sometimes resort to amputation of the toes when they are no longer sufficiently irrigated.

In addition, diabetes exposes you to  early lesions of the small vessels irrigating the kidneys , with the risk of developing kidney failure.

Diabetes and hypertension 

High blood pressure is present in many diabetic patients . Indeed, these two pathologies present many common causes , such as overweight, obesity, physical inactivity, tobacco... It is important to control your blood pressure because the excessive pressure of the blood against the wall of the arteries will tire the heart and wear out the arteries . 

A healthy lifestyle , health check-ups with regular blood pressure checks and treatment if necessary help regulate blood pressure and therefore limit the risk of cardiovascular disease . 

Cardiovascular risk: screening and diagnosis 

Diabetics should be carefully monitored from a cardiovascular point of view . It is usual to perform an electrocardiogram to determine if the coronary arteries are affected by atherosclerosis. Nevertheless, coronary attacks are less often accompanied by electrical signs at rest in diabetics than in other coronary patients.

As a result, we tend to ask them more willingly for a stress test  to check the state of the heart, or even to perform a coronary angiography when we fear a stenosis, that is to say the narrowing, coronary arteries.

A Doppler ultrasound will also be prescribed, when it is thought that the arteries of the legs or the carotid arteries of the neck are invaded by atherosclerosis.

Finally, regular fundus examinations will check the quality of the retinal circulation. The filtration capacity of the kidneys will be appreciated indirectly by looking at the blood level of creatinine as well as the quantity of albumin which passes into the urine.

Prevent cardiovascular disease

Many people with diabetes, especially type 2, have many risk factors whose negative effects reinforce each other. While it is fundamental to normalize the blood glucose level through diet and taking oral anti-diabetic drugs or insulin , it is also essential to eliminate these additional  risk parameters at the same time .

These measures will go through:

• Correction  of overweight ; 
• A diet too rich in fats or alcohol ;
• Regular practice of physical activity  ;
• Of course, the discovery of diabetes must also lead to getting rid of tobacco permanently  ;
• Good foot hygiene is essential to prevent the appearance of infections in the toes, which would aggravate the vascular lesions of the extremities; 
• It will also be necessary to normalize the blood pressure figures as much as possible and to correct any lipid anomalies , which have persisted after a reduction in fat intake. This may require taking anti-hypertensive or lipid-lowering medication.

• Treatments 

  Apart from anti-anginal drugs , the treatment of coronary anomalies is based on two techniques:   

  • Angioplasty , a technique that involves widening the diameter of blocked coronary arteries by inserting a balloon and then inflating it. A small spring or "stent" will then be left in place. The fact remains that in diabetics, the risk of secondary narrowing or “restenosis” is particularly high, even in the presence of a stent, because the atherosclerotic lesions are often long and multiple; 
  • Surgery  ( bypass ): the surgeon short-circuits the blocked coronary artery by creating a new passage for the blood. It can use the small arteries that supply the chest muscles or veins taken from the leg. 

  In the event of a heart attack, the drug treatment called BASIC is put in place, it consists of the alliance of Beta-blockers, Aspirin, Statin and Control of other risk factors. 

  Focus on the metabolic syndrome 

  Metabolic syndrome is characterized by a set of disorders including abdominal obesity , low HDL (“good cholesterol”) cholesterol, high venous blood sugar and triglyceride levels , and high blood pressure . A lack of adaptation of insulin secretion , the needs of which are increased, will lead to the onset of hyperglycaemia and then diabetes . An inflammatory phenomenon will also develop. With all these factors, metabolic syndrome increases the risk of cardiovascular disease.