Cardiovascular Disease – Links to Diabetes and Gout

CARDIOVASCULAR DISEASE-Links to Diabetes and GoutThe fist-sized heart is a powerful muscle that beats about 100,000 times a day and pumps 7,500 liters of oxygen and nutrient-rich blood to the body through a network of blood vessels. Every cell in the body relies on the heart and blood vessels (i.e. the cardiovascular system) for sustainability.

What is Cardiovascular Disease?

Cardiovascular disease (CVD), also known as heart disease, is the biggest cause of death worldwide. Cardiovascular disease is not a single disease but rather refers to changes or conditions that negatively affect the cardiovascular system.  These include, but are not limited to:

High blood pressure

  • Long-term high blood pressure can cause ‘wear and tear’ to the blood vessels.

Atherosclerosis

  • Atherosclerosis is the hardening and narrowing of blood vessels, often due to the accumulation of cholesterol in the vessels. This reduces blood flow and increases the risk of a ‘clot’ breaking free and blocking blood flow in a blood vessel.

Coronary Artery Disease

  • Coronary artery disease is atherosclerosis of the heart. When blood vessels in the heart narrow and harden, less blood is supplied to this organ. This can result in angina (chest pain), a heart attack and even heart failure.

Heart attack

  • A heart attack occurs when a clot blocks a blood vessel supplying blood to the heart. As a result, the part of the heart that can no longer receive blood and nutrients dies. Heart attacks result in permanent damage to the heart and can result in death.

Stroke

  • A stroke occurs when a clot blocks blood supply to a vessel in the brain. Strokes can result in paralysis, loss of brain or body function, or death.

Heart Failure

  • Heart failure occurs when the muscles of the heart are not strong enough to pump blood or are too stiff to relax to let blood back into the heart.

CVD Risk Factors

Smoking

  • Smoking isn’t just bad for your lungs and your looks. The nicotine in cigarettes contributes to elevated blood pressure which, over time, can lead to the hardening of artery walls.

Poor Dietary Habits

  • The consumption of ‘heart-unhealthy’ foods such as saturated fats and sugary desserts and drinks contributes to elevated cholesterol levels and clogged blood vessels.

Ethnicity

  • Some ethic groups are at a high risk for CVD due to genetic factors. These groups include South Asians (e.g. individuals with Indian, Pakistani, Sri Lankan, and Bangladeshi ancestry), Aboriginals and individuals with African/Caribbean heritage.

Family History

  • A family history of CVD or related conditions such as type 2 diabetes increases the risk for CVD.

Diabetes

  • Individuals with diabetes are 2-6 times more likely to develop CVD than individuals without diabetes. High blood glucose (sugar) levels characteristic in uncontrolled type 1 and type 2 diabetes increases the risk of CVD because glucose can react with and damage blood vessels. Diabetes is also often associated with high cholesterol. It is therefore important to regularly monitor glucose and cholesterol levels and attempt to keep the condition under control.

Gout

  • Gout is a type of arthritis that often afflicts the big toe. Individuals with gout often have elevated levels of uric acid which is a by-product of meat and seafood digestion. Uric acid is pro-inflammatory and contributes to atherosclerosis, coronary artery disease, stroke and heart failure.

Taking Action

Although some risk factors such as ethnicity and family history cannot be altered, there are some measures you can take to lower your CVD risk.

Lace up your sneakers

  • Activities such as walking, gardening, dancing and jogging help keep the heart healthy by training it to work efficiently, lowering blood pressure and reducing stress. Regular exercise also lowers resting heart rate (because the heart doesn’t have to work as hard to pump blood as before) and promotes the growth of blood vessels which improves circulation. A sedentary lifestyle, on the other hand keeps you from reaping the benefits of physical activity.

Diet

  • Aside from cutting down on fatty and sugary foods, the consumption of foods with heart-healthy compounds such as omega 3s and antioxidants can help protect the heart and increase longevity. Omega 3s can be found in fortified eggs and in fish; and fruits and vegetables are rich in antioxidants. HDL, also known as the ‘healthy cholesterol’ is found in sources such as nuts and olive oil. However, it’s important to keep in mind that HDL sources are often high in calories and you should limit consumption to a tablespoon of oil and a few nuts per serving.

Quit Smoking

  • The risk for heart attacks drops and lung function begins to improve anywhere from a few weeks to 3 months of butting out; and after one year the risk for coronary heart disease is half that of a frequent smoker’s.

Keep Diabetes and Gout in check

  • It’s estimated that 3-10% of people with diabetes don’t even know they have it. Given the strong association between diabetes and CVD it is very important to take action to control the condition, and this can’t be done if you don’t think you have a problem.
  • Gout has only recently garnered interest as an important health condition. Currently the recommendations for ‘normal’ uric acid levels vary from country to country and are substantially higher in Canada than the United States and Europe where more research is occurring. As a result, many Canadian physicians and patients may not be aware of the need for their patients to lower uric acid levels. Furthermore, patients with high uric acid levels do not always have symptoms of gout and may not take uric-acid lowering medications appropriately, but rather treat the painful symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) –which are associated with cardiovascular problems themselves- rather than Colchicine. Therefore patients may not be appropriately lowering their risk for CVD by controlling uric acid levels, and may also be increasing their risk by using some NSAIDs.

Research Efforts

Metformin, which is considered the first line of drug treatment for diabetes is associated with not only improved glucose control, but also a decreased the risk of death among patients with heart failure1,2 and new users of anti-diabetic medications3. New research is aiming to find treatments that will not only help manage glucose, but also protect patients from developing and succumbing to cardiovascular abnormalities in the future.

Similarly, gout research is aiming to target both the condition as well as its associated complications4. New research is examining the ability of medications to both control uric acid levels as well as protect patients from cardiovascular problems and related death.

Sources

1Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Eurich DT et al. Diabetes Care. (2005)

2 Metformin therapy and prognosis of patients with heart failure and new-onset diabetes mellitus. A propensity-matched study in the community.Romero SP et al. Int J Cardiol. (2011)

3 Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes. Johnson JA et al. Diabetes Care. (2002)

4 Drug treatment of hyperuricemia to prevent cardiovascular outcomes: are we there yet? Gaffo, AL and Saag, KG. Am J Cardiovasc Drugs. (2012)

– See more at: http://www.clinicaltrialsmagazine.com/cardiovascular-disease-links-to-diabetes-and-gout/#sthash.HeCxjVXs.dpuf

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