To decrease the risk of heart disease in diabetes, in addition to controlling blood sugar, treatment of blood pressure and cholesterol problems is also essential.
Diabetes is an epidemic in India. More than 65 million people are affected with diabetes and another 77.2 million people with pre-diabetes, which means they may develop diabetes in future. It is much bigger a problem than we think or imagine. India seems to have the fastest growing burden of diabetes and the number of people affected is likely to double in the next 20 years. Like in western countries, non-communicable diseases like diabetes and heart disease have overtaken communicable or infectious diseases in India. This epidemic is now spreading in to the middle and low-income groups also. Recent data from the CARRS study suggests that in Delhi and Chennai almost 40% of individuals at the age of sixty may be diabetic! These are staggering numbers.
Related read: World Diabetes Day: All you need to know about the silent killer
We have known for years that patients with diabetes have a higher risk of heart disease. Heart diseases strike people with diabetes two to four times as often as people without diabetes. In fact, two out of three people with diabetes die from heart disease or stroke, also called cardiovascular disease. In Indian patients, these heart diseases occur at a younger age, almost one decade earlier as compared to the West.
To decrease the risk of heart disease in diabetes, in addition to controlling blood sugar, treatment of blood pressure and cholesterol problems is also essential. Medications like statins, aspirin, along with lifestyle measures (healthy diet, physical activity, avoiding tobacco) play a very important role.
Also read: World Diabetes Day: Healthier food tips for diabetics
The focus of anti-diabetes medications has been to control blood sugar effectively, thereby reducing the risk of complications. The search for medicines which would not only control blood sugar but have additional benefits for the heart has always been on. Metformin is one of the time tested drugs which has shown some cardio protective benefits. Very recently, a drug called empagliflozin, which belongs to a new class of drugs that remove the excess sugar in the body through urine has been shown to reduce fatal heart-related events (the EMPA-REG Study). This is an exciting finding which could have an impact on management of diabetics at high risk for heart disease.
The author, Dr Ambrish Mithal, is the Chairman and HOD of Division of Endocrinology and Diabetes at Medanta - the Medicity.
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