Written by Dr Choo Gim Hooi (Consultant Cardiologist at CVSKL)
Coronary artery disease (CAD) is the principal cause of death in Malaysia and the numbers continue to rise. In 2017, every day sees 37 deaths from CAD – an increase of 54% from 10 years earlier. This rise is accounted for by the increasing prevalence of major coronary risk factors like obesity and diabetes. In 2015, nearly 1 in every 2 Malaysians is either overweight or obese and 17.5% of them live with diabetes.1
It is a known fact that 2 out 3 people with diabetes die from heart disease or stroke events. With the diagnosis of diabetes, one’s life-span is cut-short by 6 years. If you have diabetes and a heart attack, your life expectancy is shortened by 12 years.2,3
Therefore, diabetes is a serious matter. Diabetes is not just about high blood sugar levels. The metabolic abnormalities associated with diabetes will cause abnormal lipid levels, damage the lining of your blood vessels and nerves, abnormal energy pathways in cells, and cause increased inflammation in your body. Amongst other things, these mechanisms promote the development of cholesterol plaque in your arteries, abnormal heart functions, and scarring in your heart muscles.
The diagnosis of diabetes is NOT a death sentence. There are many things that you can do to improve your prognosis.
If you are at risk (with obesity, family history of diabetes, personal history of diabetes during pregnancy, or have borderline high sugar levels – just to name a few), interval screenings will help with earlier detection and treatment of diabetes.
Healthy behaviours such as maintaining an ideal body weight, regular physical exercises, cutting down sugar, and restrictions in high caloric food must be incorporated into your daily lifestyle.
Patients with diabetes may or may not present with the typical manifestations of CAD. In fact, they are more likely to not experience any chest pain. These atypical presentations often cause delay or missed-diagnosis. Screening tests for CAD may be encouraged to pick up early heart disease.
We are fortunate today that we have many tools to manage diabetes and its complications. There are many types of medications to effectively manage the high blood sugar levels. In addition, some of these agents have beneficial effects in preventing diabetes-related heart and kidney complications. With the help of your doctors, side effects are usually uncommon and manageable.
Be concerned with effectively controlling diabetes rather than worry about the need for medications. The benefits in preventing various diabetes complications and improving survival far outweigh the side effects associated with them.
There is a long latent phase of years, even decades, before diabetes-related complications appear. By the time these complications develop, it is too late and irreversible. You should be more concerned in preventing them.
Addressing other cardiovascular risk factors, such as high cholesterol levels, hypertension, and cigarette smoking, must be equally emphasised.
If you develop CAD, various interventions like coronary angioplasty or bypass surgery may be necessary to improve the symptoms and survival.
Managing diabetes is a life-long process. With early detection and timely treatment, all the hazardous concerns may be delayed or prevented.
Even with diabetes, you may continue to enjoy a good quality of life with normal life expectancy if you are committed to an early and holistic approach to the good control of diabetes and its associated risk factors.
1 National Health and Morbidity Survey 2015 , MOH
2 Seshasai et al. N Engl J Med 2011;364:829-41
3 Association of Cardiometabolic Multimorbidity With Mortality. The Emerging Risk Factors Collaboration. JAMA 2015;314:52-60