A Heart Attack Is A Hard Lesson

The New York Times posted an article this morning on the importance of treating various aspects of the metabolic syndrome that accompany diabetes, not just blood glucose:

Looking Past Blood Sugar to Survive With Diabetes

It chronicles the story of Dave Smith, a 43-year-old pastor from Fairmont, Minnesota. He was diagnosed with type 2 diabetes when he was 34. Since the time of his diagnosis, he dieted, watched his carbohydrate intake, lost weight, and took medications to lower his blood glucose. When that proved ineffective, he added insulin to the mix.

Eight years of failing to address conditions that often accompany diabetes (e.g. high blood cholesterol and high blood pressure) proved a hard lesson for Mr. Smith and his healthcare providers. He landed in the hospital with a major heart attack - 90% of a prime artery to his heart was blocked.

You can watch Mr. Smith describe his ordeal by clicking the photo below:


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Diabetes And Life Expectancy

According to the CDC, people in the US who were born in 1950 (all races combined) are estimated to live about 68.2 years (men 65.6, women 71.1). People born in 1960 are estimated to live about 69.7 years (men 66.6, women 73.1).
(See CDC: Health, United States 2006, Table 27 for more information.)

Those are averages. The course of your life and the choices you make can affect how long you live. A recent study suggests that having diabetes can shave off quite a few years from those averages.
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We know that people with diabetes have an increased risk for heart disease and that most will die from a heart attack.

Researchers reporting in the Archives of Internal Medicine last month reinforced this knowledge in their analysis of participants of the Framingham Heart Study.¹ They found that men and women in this population who had diabetes more than doubled their risk for developing cardiovascular disease (CVD).

However, the leading cause of death in this country for all people is heart disease. And these researchers found that both diabetics and nondiabetics live about the same number of years with heart disease.

So, does having diabetes cause people to die any sooner than if they didn't have the disease? These researchers say yes, an average of 8 years sooner:

"Diabetic men and women 50 years and older lived on average 7.5 and 8.2 years less than their nondiabetic equivalents."

Also,

"The differences in life expectancy free of CVD [for diabetic men and women 50 years and older] were 7.8 and 8.4 years, respectively."

This is because people with diabetes get CVD earlier than those without diabetes.

A few more findings (keep in mind that people with diabetes in this group tended to be older than those without diabetes):

• There were more men with diabetes than women.
  
• There were fewer smokers among diabetics. (If smoking increases the risk for developing diabetes, can you speculate why this was found?)
  
• Among those with diabetes, twice as many had a family history of the disease.
  
• Systolic blood pressure was higher among diabetics (149 mm Hg vs. 137 mm Hg).
  
• Body Mass Index (BMI) was higher among diabetics (27.5 vs. 26.0).

The authors concluded, not surprisingly:

"These findings underscore the importance of diabetes prevention for the promotion of health aging."

________¹ Associations Of Diabetes Mellitus With Total Life Expectancy And Life Expectancy With And Without Cardiovascular Disease

Early Warning Signs of Heart Attack in Women

Chest pain is not a frequent early warning symptom of a heart attack in women.

But what is?

In a study funded by the NIH that appeared in the journal Circulation in 2003,¹ the most frequent early warning symptom of heart attack in women was unusual fatigue ... not a tiredness that you might link to overwork or stress, but a fatigue so severe some women gave the example of not being able to make a bed without resting.

Most Women Have Early Warning Symptoms

Of the 515 women studied, 95% of them reported experiencing symptoms a month or more before a heart attack.

The most frequent symptoms reported were:

• unusual fatigue (70.7% of women experienced)
  
• sleep disturbances (47.8%)
  
• shortness of breath (42.1%)
  
• indigestion (39.4%)
  
• anxiousness (35.5%)

The minority of women who did report chest discomfort in the weeks leading up to a heart attack "used descriptors such as aching, tightness, or pressure, not pain" to explain it.

Even during a heart attack, 43% of women in this study "did not experience any type of chest discomfort."

The lead author of the study, Jean C. McSweeney, PhD:²

"McSweeney said her best advice is for women who have risk factors for heart disease such as smoking, high blood pressure, high cholesterol, diabetes or a family history of heart disease and who are experiencing [early warning] symptoms should contact their doctor before seeking emergency treatment."

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¹ For the study (full free access):
Women’s Early Warning Symptoms of Acute Myocardial Infarction

² For a summary, provided by Yale-New Haven Health:
Signs Of Impending Heart Attacks Among Women

American Heart Association - 2007 Guidelines for Prevention of CVD

The American Heart Association last week published an update to their guidelines for the prevention of cardiovascular disease (CVD). Their paper addressed women specifically.

Here is the table of recommendations included in their paper:



You can click the pictures above for a larger version, or you can download their entire paper at:
Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update

For people with diabetes, heart disease looms as the most fatal complication. The National Diabetes Education Program (NDEP) describes some links between the two:

• CVD is the leading cause of early death among people with diabetes - about 65% of them die from heart disease and stroke.
  
  
• Adults with diabetes are 2 to 4 times more likely to have heart disease or suffer a stroke than
  people without diabetes.
  
  
• High blood glucose in adults with diabetes increases the risk for heart attack, stroke, angina, and
  coronary artery disease.
  
  
• People with type 2 diabetes also have high rates of high blood pressure, lipid problems, and obesity,
  which contribute to their high rates of CVD.
  
  
• Smoking doubles the risk of CVD in people with diabetes.
  
  - NDEP, The Link Between Diabetes and Cardiovascular Disease

In addition to their recommendations for all women (e.g. don't smoke, be physically active, eat a healthful diet), the AHA 2007 Guidelines gave some special advice for women with diabetes.

• * Achieve an HbA1c of <7% through medication (and lifestyle)
  
• * Blood pressure of >130/80 mm Hg should be treated with medication (and lifestyle)
  
• * LDL cholesterol of >100 mg/dl should be treated with medication (and lifestyle)
  
• * Aspirin (75 to 325 mg/day) should be used in high risk (i.e. diabetic) women unless it cannot be tolerated.
  
• * ACE inhibitors or ARB's (for blood pressure management) should be used.

If you fall into any of the above categories and are not receiving treatment, you may want to discuss your therapies with your doctor. You could even bring the above AHA Tables, or their entire paper, with you.