4) Diabetes and Heart Disease
c) Large Blood Vessel Mechanisms
"Large Blood Vessel" disease is the killer in type 2 diabetes. It is exactly what it says, it is the stiffening and closing down of the blood vessels more than an eighth of an inch in diameter. "Large blood vessel disease" is generally first evident as "peripheral arterial disease" or PAD. PAD is where the blood vessels of the legs become clogged with deposits. Most people think a heart attack originates in the heart when the blood vessels in the heart become restricted. In actuality 70% of heart attacks are caused by stoppages of blood in the heart from masses of cholesterol and fatty tissue (alternatively they can be blood clots) that have formed and broken off from major vessels in other areas of the body, typically the legs. In very simple terms, the major mortality route in diabetes is where diabetes causes fat deposits in the large leg blood vessels which cause PAD which causes cholesterol masses or blood clots in the blood stream which cause heart attacks, strokes or lung clots (pulmonary embolisms).
There are other types of "large blood vessel disease". The stiffening of the walls of the large vessels leads to high blood pressure (hypertension). The blood vessels in the neck (carotid arteries) which supply the brain can become clogged and shut down or release clots, leading to a stroke (cerebrovascular disease). And then of course there is the closing down of the arteries of the heart. This closing down of coronary arteries results in heart pain (angina), heart attacks and heart failure. Through out this ebook we will simply use the term "heart disease" to mean "large blood vessel disease" or "macrovascular disease".
Heart disease accounts for 75% of the deaths in type 2 diabetes. This heart disease is caused both by the diabetes and by the same factors causing the type 2 diabetes. So the two are almost always present in cases of type 2 diabetes.
The actual cause of heart disease and mortality in diabetes is a long and complex series of interrelated cause and effects. The multiple routes where diabetes, poor diet, high weight and lack of exercise create major large blood vessel problems are very diverse and complex. As mentioned above, large blood vessel disease (i.e. heart disease and stroke) in a person with type 2 diabetes responds to many factors. Recent research has shown that blood pressure medications, cholesterol medications, cardiovascular (aerobic) exercise, weight reduction and very tight control of blood sugar levels via both diet and drugs can reduce heart disease risk in a person with diabetes by up to 80%. That is a huge reduction and is cause for optimism among persons with type 2 diabetes willing to make the sacrifices necessary.
What is unclear is what the cross effects are, for instance, two of the keys to controlling blood sugar are weight control and exercise. So which is most important factor, blood sugar control, weight control or exercise? Control of all three factors, weight, exercise, and blood sugar must be present to some degree in order for good control of heart disease to be achieved. Weight control, exercise and blood sugar control are all necessary to control type 2 diabetes. It is important to do at least try to do some degree of all three factors. Ultimately, controlling weight and good blood sugar control are just a matter of will power. However, exercise can be problematic. Many people have conditions which make exercise difficult, especially if they have type 2 diabetes. But there are solutions. For instance, if hip degeneration makes walking and exercise difficult, an individual can get enrolled into a water exercise course.
Current Chapter: 4) DIABETES AND HEART DISEASE
a) Introduction
b) Small Blood Vessel versus Large Blood Vessel Disease
c) Large Blood Vessel Mechanisms
d) Blood Lipid Chemistry
e) Diabetes and "Heart Failure"
f) Peripheral Arterial Disease (PAD)
g) Blood Proteins, Diabetes and Heart Disease
h) Genetic Risk Factors for Diabetes and Heart Disease
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