DIABETES AND HEART DISEASE Dr Hassan Makki DO

DIABETES AND HEART DISEASE Dr Hassan Makki DO FACC Phoenix Heart Center

DIABETES…what is it? � Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. � The term diabetes mellitus describes a metabolic disorder of multiple causes characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

The SCOPE

Diabetes symptoms

Populations at most risk � � At least 10. 3 million Americans have been diagnosed with diabetes mellitus, and another 5. 4 million are estimated to have undiagnosed diabetes. Onset often precedes diagnosis. 90% of diabetic patients have Type II diabetes Hispanics 11 %, African Americans 10%, Native Americans, and Asians Diabetes in women essentially cancels out any hormonal protection (up to 13%).

Vascular effects of DM � � Makes cholesterol particles smaller, stickier and more plaque forming Sugar molecules actually directly (and indirectly) damages artery walls Sets up a Pro. Inflammatory and Pro. Clotting environment Hormone activation of immune cells

Vascular effects of DM � � � ~80% of all diabetic mortality � 75% from coronary atherosclerosis � 25% from cerebral or peripheral vascular disease >75% of all hospitalizations for diabetic complications >50% of patients with newly diagnosed type 2 diabetes have heart or vascular dz

What we see: DM vs Normal

DM vs Normal

DM Ulcer � � #1 Cause of amputation Every 30 sec someone looses a limb to DM 1/5 require amputation 1/4 diabetics will develop an ulcer

Symptoms of heart attack � � With DM Often no symptoms Neck, back, shoulder, stomach pains The longer someone is diabetic, the more subtle the symptoms

SCREENING IS KEY � � � � � Activity LEVEL Weight (BMI >30), waist size (40/36 m/f) BP Family history Sugars…. Fasting (>100), Post meal (>200) CHOL screening STOP SMOKING If known DM, more testing may be required; stress test, ABI, Ultrasound, Calcium score. Consult Cardiologist!

Treatment requires recognition

Treatment � � � Impaired Fasting sugar (>100) or Post meal (>200), HGAIC less than 5. 7 HGAIC >6. 0 Full blown DM � � � Diet exercise, follow up Start DM Meds Start HEART MEDS!

Heart MEDS � ASA � � STATINS � BP meds ACE inhibitors � � � 17% reduction in cardiac/vascular events 52% reduction vs 32% in non DM 51% reduction when diastolic less than 80 -85

Final thoughts � � � Diabetics are a delicate population with serious medical problems. Problem is an epidemic! Early detection and appreciation is key High index of suspicion is required when diabetics have any symptoms…. or not having symptoms. Aggressive risk modification upstream prevents problems downstream Very preventable disease!

� � Thank you Questions!?

Resources � � � � www. Phoenixheartcenter. com DM www. Yourdiabetesinfo. org http: //diabetes. niddk. nih. gov/ For Diabetes screening: • http: //ndep. nih. gov/am-i-atrisk/Diabetes. Risk. Factors. aspx • http: //ndep. nih. gov/am-i-at-risk/diabetesrisk-test. aspx