Closely linked

 

If you're one of the 75 million Americans with diabetes or pre-diabetes, you need to know what may be happening to your heart

By Polly Turner

If you have diabetes, the truth is you are more likely to experience a heart attack, stroke or another cardiovascular health problem than any other complication of diabetes. In fact, heart disease is the leading cause of diabetes-related deaths. Scientists are just discovering why this is.

"If you have type 2 diabetes, your chances of developing symptoms of hardening of the arteries from a build up of fatty substances that block blood flow (atherosclerosis) are extremely high-high enough that they are equal to those of someone who's already had a heart attack," says Anthony L. McCall, M.D., Ph.D., co-director of the University of Virginia Health System's Diabetes Cardiovascular Clinic.

Even blood sugar levels in the "pre-diabetes" range-levels higher than normal but not high enough to be called diabetes-put you at an increased risk of atherosclerosis, McCall notes.

 

finding the connection

So why do so many people with diabetes have heart disease? UVA's Zhenqi Liu, M.D., and his research team have shown that insulin (the hormone that helps regulate blood sugar) greatly increases blood flow in heart muscle. Now they are conducting trials to test their theory that insulin resistance, a cardinal feature of type 2 diabetes, limits circulation in heart muscle and is the major contributor to the development of heart disease. "I hope findings from this project will lead to the development of new ways to diagnose and treat diabetes-related cardiac complications," Liu says.

Inflammation has much to do with hardening of the arteries as well as with heart attack and stroke, McCall adds. Both high blood sugar and insulin resistance can contribute to that inflammation. His research is exploring a novel anti-inflammatory agent that appears to significantly reduce damage to blood vessels related to metabolic syndrome, the cluster of major risk factors for cardiovascular disease and diabetes that includes obesity, high blood pressure and high levels of cholesterol (See "Metabolic Syndrome Clinical Trial").

 

comprehensive attack     

"The word ‘syndrome' comes from a Greek word meaning ‘running together.' The major risk factors for cardiovascular disease and diabetes run together a long way," McCall explains. Both diseases may have their roots in the teens or younger and can be both genetic and lifestyle related. Either disease may precede the other.

The only way to truly break the cycle of disease is to launch a comprehensive attack on all of the risk factors, McCall stresses. "You can't just treat the blood pressure or the glucose or the sedentary lifestyle or bad diet, or high cholesterol," says McCall. "You've got to treat them all. Through teamwork, we can help this happen."

UVA's innovative Diabetes Cardiovascular clinic is designed specifically to offer diabetes patients the support, guidance and specialized treatment they need to control the risk factors that comprise metabolic syndrome. "Here at the clinic, endocrinologists (diabetes doctors) and cardiologists (heart doctors) practice side by side with dietitians, exercise physiologists, cardiac rehab nurses, diabetes educators, and a pharmacist," says McCall, who co-directs the clinic along with Angela Taylor, M.D.

Patients typically are referred to the clinic by their primary care physician. From one visit to the next:

  • An exercise physiologist may go over barriers to physical activities.
  • A cardiac rehabilitation nurse may help set reasonable goals for physical activity.
  • A registered dietitian may meet with the patient, as well as the person from the household who does the food preparing and shopping, to suggest effective changes that can help reduce blood sugar or blood pressure levels.
  • A physician will meet with the patient at most visits. All team members work closely together to ensure that each patient has the right self-care plan in place and that their therapy is monitored and adjusted according to the patient's primary care doctor's recommendations.

One satisfied patient of the clinic is Barbara Blair. Blair, who lives 30 minutes outside of Charlottesville, has been visiting the clinic team ever since she learned she had diabetes. "I can't emphasize enough," she says, "how fascinating it is to watch the team at work. One is specializing in diet and one on exercise. I'll go see the diabetes doctor with the team and go back and see the heart specialist with the same team. Everybody knows everything-and of course, that benefits the patient."

 

enlist uva's team

If you have diabetes and would like help improving your heart health, talk to your doctor about a referral to the University of Virginia Health System's Diabetes Cardiovascular Clinic.

 

Do you have metabolic syndrome?

Some 50 million Americans suffer from metabolic syndrome, a cluster of health problems that are major risk factors for heart disease, stroke and diabetes. A person has metabolic syndrome, if they have three or more of the following conditions:

  • obesity, especially around the waist (having an "apple-shaped" body)
  • high blood pressure
  • high cholesterol levels
  • high triglycerides (a type of blood fat)
  • resistance to insulin, a hormone that helps regulate blood sugar

"These conditions are all interrelated, and they exacerbate one another," says Kim E. Innes, Ph.D., of the UVA Health System-meaning, if you have one, you're likely to have another, and the more of these factors you have, the higher your risk for major health problems. Certain lifestyle changes can help reduce these risks: regular physical activity, weight loss, smoking cessation-and based on the research, perhaps also yoga.

metabolic syndrome/cardiovascular clinical trial

UVA Health System is participating in a national research study known as the CRESCENDO Trial. In the study, Anthony McCall, M.D., Ph.D., is examining the effects of an investigational drug called rimonabant. Although this drug is not yet approved by the U.S. Food and Drug Administration, it has been shown in previous studies to have a beneficial effect on multiple aspects of metabolic syndrome in some people. The study is looking for those:

  • who have abdominal obesity
  • age 55+
  • who were previously diagnosed with cardiovascular disease or have significant risk factors for cardiovascular disease, and meet other criteria.
Questions?
Contact study coordinator Shirley Fleishman: 434-243-5652 or sf9v@virginia.edu. (This trial is #12219, designated and approved by UVA's Investigational Review Board for Health Sciences Research.)

This article appeared in the summer 2008 issue of Vim & Vigor, a family health magazine sponsored by UVA Health System. If you don't already receive it at home, sign up today. It's free.