cardiac
HEALTH ON TIME
TM
heart hazard ahead
DOUBLE JEOPARDY
DIABETES SEVERELY IMPACTS CARDIOVASCULAR DISEASE
Type 1 diabetes results from a defect in Stomach insulin production and is usually diagnosed in Pancreas (Small “islet cells” childhood. Type 2 produce insulin) diabetes generally Small shows up later in life. intestine In the past, patients were typically diagnosed either with Diabetes Type 1: Type 1 or Type 2 • is usually diagnosed in children and young diabetes. Now more adults and more are showing • was previously known up with both, as juvenile diabetes • is a condition in which researchers say. The the body does not dangerous combination produce insulin* has been dubbed • causes excess sugar in “double diabetes.” The blood, damages blood vessels, other organs nation’s growing weight is certainly a Diabetes Type Source: U.S. Centers for Disease Control and Prevention, Home Health2: Handbook Graphic: Pat Carr, Garrick Gibson factor, since obesity is • is the most common known to cause insulin form of diabetes • is a condition in which resistance. Experts the body does not also fear that obesity produce enough insulin may make insulin or the body’s cells ignore the insulin producing cells more *Insulin is necessary for the susceptible to attack by body to be able to use sugar. the immune system, Sugar is the basic fuel for the cells in the body, and insulin increasing the risk for takes the sugar from the Type 1 diabetes. blood into the cells.
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octors have been worried about diabetes and heart health—and rightly so. Diabetes has been wellestablished as a risk factor for cardiovascular disease. According to the American Diabetes Association, 25.8 million Americans, or 8.3 percent of the population, has diabetes, and heart disease is noted on the death certificates of 68 percent of diabetesrelated deaths in people aged 65 and over. Among its many complications, Type 2 diabetes dramatically increases the risk of heart disease and stroke. And although the disease is sometimes called adult onset diabetes, adults aren’t the only ones at risk. More and more teenagers and young adults are developing Type 2 diabetes. Equally worrying is that signs of cardiovascular disease are appearing in children. According to Medical College of Wisconsin researchers at Children's Hospital of Wisconsin, early signs of cardiovascular disease are appearing before the onset of puberty in many children with diabetes.
1 in 4 people with diabetes don’t
even know they have the disease.
65 128
%
of people with diabetes die from heart disease or stroke
increase in people with type 2 diabetes from 1988 to 2008
8.3
%
At the heart of this new diabetes epidemic is America’s expanding waistline. It may be that being overweight causes cells to change, making them resistant to the hormone insulin, which carries sugar from blood to the cells, where it is used for energy. When a person is insulin-resistant, blood sugar cannot be taken up by the cells, resulting in high blood sugar. In addition, the cells that produce insulin must work extra hard to try to keep blood sugar normal. This may cause these cells to gradually fail. Much can be done to reduce the danger, including basic healthy lifestyle changes. A federally funded study (The Diabetes Prevention Program) of 3,000 people at risk for diabetes found that a weight loss of 5–7 percent, achieved through exercise and lowered dietary fat and calories, may delay or even prevent Type 2 diabetes. For people
%
SUMMER 2014
of Americans have diabetes
who have already developed diabetes, carefully controlling blood sugar levels and managing other risk factors, such as high blood pressure and abnormal cholesterol levels, can dramatically reduce the risk of heart complications. The first step is identifying who’s at risk. About 1 in 4 people with diabetes—7 million Americans— don’t even know they have the disease. The same number are unaware that they already have early signs of diabetes.
Are you at risk? Find out your diabetes risk by completing our easy test at gru.edu/ diabetes. Worried about your heart? See a cardiologist today by calling 706-721-2426.
diabetes: take back control KNOW YOUR RISK—AND WHAT YOU CAN DO ABOUT IT
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iabetes rates in this country have climbed so high that experts at the Centers for Disease Control and Prevention are calling it an epidemic. According to the American Diabetes Association, 18.8 million people in the U.S. have the disease—but another
7 million remain undiagnosed. “Even more disturbing, 79 million are thought to be pre-diabetic,” said Rene Harper, M.D., an endocrinologist at Georgia Regents Medical Center. “Unless these people make lifestyle changes, they will develop diabetes, too.” Yet you don’t have to be overweight, have a genetic predisposition, or be a certain age to get diabetes. Consider this: Type 2 diabetes, the form that develops in adults, is striking more people—and many of them have no family history of the disease. But you can take preventive measures to help keep the disease at bay.
Factors you can control While you can’t do much about the
predispositions (if you are older than 40; if you are African-American, Hispanic American, Native American, Asian American, or a Pacific Islander; or if you have a close family history, you are at higher risk), you can take charge of your life by: n E xercising regularly. Inactivity is the most important risk factor for Type 2 diabetes and may be to blame for half of all cases. n M aintaining healthy eating habits. Follow a low-fat, low-sugar, high-fiber diet. n K nowing the warning signs. Watch for any irregular symptoms such as excessive thirst or extreme hunger, increased fatigue, blurry vision, frequent urination, and irritability. n G etting regular health screenings and discussing any changes with your doctor.
For more information, visit gru.edu/diabetes. GRU-012
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
bodies at risk
take diabetes danger signs to heart About 25.8 million Americans have diabetes. But many more—almost 79 million adults, or 1 in 4 adults, have a condition called pre-diabetes, which is characterized by abnormal blood glucose levels. Many people with pre-diabetes will go on to develop Type 2 diabetes unless they act to lower their risk. In the Diabetes Prevention Program, a large ongoing clinical trial, about 11 percent of people with pre-diabetes developed Type 2 diabetes every year. Symptoms of Type 2 diabetes include frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability, and blurry vision. Once someone has Type 2 diabetes, the risk for heart disease and stroke increases as much as fourfold. Diabetes is also the leading cause of new cases of blindness among adults and the leading cause of kidney failure. People with diabetes have medical expenses more than twice as high as people without it. Fortunately, there’s good news, too. Studies show that people at risk for developing Type 2 diabetes, many of whom are overweight, can cut their risk in half simply by shedding excess pounds (5 to 7 percent of their current weight) and walking for half an hour at least five days a week.
DAMAGE TO BLOOD VESSELS Over time, too much glucose and insulin in the blood injures blood vessels. Although researchers are Hemorrhage still working to understand how the damage occurs, evidence suggests that too much glucose could generate unstable free oxygen radicals, which can damage the lining of blood vessels. Symptoms of trouble may show up first in the tiny capillaries in the eye, causing diabetic retinopathy. Blood vessel damage also increases diabetics’ risk for developing high blood pressure and suffering both strokes and kidney failure.
Retinopathy
People with Type 2 diabetes typically have abnormally high levels of both glucose (blood sugar) and insulin in their blood. That combination can result in widespread damage throughout the body, including changes that dramatically increase the risk for heart disease and stroke.
eye
Abnormal Blood Vessel
Micro-Aneurysms
DANGEROUS CHOLESTEROL BUILD-UP Type 2 diabetes causes a variety of unhealthy changes in cholesterol. Too much glucose in the bloodstream is believed to make LDL cholesterol particles stickier, so they more easily clog arteries and damage artery walls. Glucose also seems to latch onto LDL particles, making them stay in the bloodstream longer, increasing the Artery danger that they’ll form plaques. Diabetes also is linked to abnormally low levels of good cholesterol, or HDL, the form that helps remove arteryclogging cholesterol.
INCREASED HAZARD OF BLOOD CLOTS head
Elevated glucose increases the likelihood that blood clots can form within already diseased blood vessels, blocking blood supply, and triggering either a heart attack or stroke. The combination of high glucose and high insulin is also linked to excess inflammation, which can damage the inner walls of blood vessels.
Embolism: clot that travels from site where it was formed
Thrombus: blood clot that forms in a vessel
heart
Arterial Blockage
Plaque Buildup
Narrowed Blood Flow
Lipid or Fat
DAMAGE TO KIDNEYS Diabetic nephropathy is a progressive disease that takes several years to develop. Many tiny blood vessels in the kidney act as filters to remove wastes, chemicals, and excess water from the blood. In diabetic nephropathy, these blood vessels are damaged and become leaky, and protein eventually spills into the urine (proteinuria). Eventually, the damaged filters are destroyed, putting more stress on the remaining filters and eventually causing them to become damaged as well. When the entire filtration system breaks down, the kidneys fail to function. This is called end-stage renal disease, a condition in which the patient requires dialysis or a kidney transplant in order to live.
GREATER RISK FOR HIGH BLOOD PRESSURE Three out of 4 people with diabetes also have high blood pressure, or hypertension. By creating additional strain on the circulatory system, this combination dramatically increases heart disease and stroke danger. For patients with Type 2 diabetes, controlling blood pressure has been shown to be even more effective than controlling glucose levels when it comes to preventing heart disease. The Centers for Disease Control and Prevention reported in 2011 that blood pressure control reduces the risk of cardiovascular disease in diabetics by up to 50 percent, and the risk of vascular complications in the eye, kidney, and nerves by a third. For every 10 mmHg drop in systolic blood pressure, there is a resulting 12 percent drop in risk of complications of diabetes.
kidney
diabetes and your heart: what you know could save your life Test your knowledge by completing this quiz, then check your answers below. 1. Diabetes kills more Americans each year than AIDS and breast cancer combined. A. true B. false 2. Diabetes is often associated with: A. high blood pressure B. vision problems C. abnormal cholesterol levels D. all of the above 3. Who runs the greatest risk for developing heart disease after being diagnosed with diabetes? A. men B. women 4. Nerve damage from diabetes can affect: A. feet and legs B. heart C. digestive system D. sweat glands E. all of the above
savvy substitutions for your favorite recipes
NERVE DAMAGE Half of diabetics show signs of nerve damage, or diabetic neuropathy. Abnormally high glucose levels in the blood may cause some of the damage. Insufficient blood supply to nerves—another consequence of diabetes—is another likely contributor. Nerve damage often shows up first as calluses, ulcers, and infections that don’t heal properly on the legs and feet. Neuropathy also can affect the heart’s ability to maintain normal heart rhythms and to control blood pressure. Many medical centers now have clinics devoted to wound healing, which specialize in treating skin and tissue problems associated with diabetic neuropathy.
Peripheral Nerves
Deteriorated Nerve Endings
Diabetic Foot Ulcer
5. The longer people have diabetes, the greater the danger of nerve damage. A. true B. false
foot
6. In 2010, how many people aged 20 and older were newly diagnosed with diabetes in the U.S.? A. 49,500 B. 645,000 C. 1.9 million D. 2.3 million
A heart-healthy diet is the first step to reducing your body’s risk for diabetes. Start by substituting high-fat ingredients for tasty, low-fat options. For example, fruit purees such as applesauce can replace some of the oil or shortening in a recipe and add extra moistness. Experiment with one whole egg and two whites for every three eggs in a recipe. Nonfat regular or Greek yogurt can replace sour cream, and evaporated skim milk can add creaminess without the fat in many sauces.
ANSWER KEY: A—True; 2. D—All of the above; 3. B—Women; 4 E—All of the above; 5. A—True; 6. C—1.9 million.
YOUR DIABETES AND HEART HEALTH LIFELINE
0-25 YEARS
25-40 YEARS
Be sure to have regular dental exams. Almost one-third of people with diabetes have severe periodontal diseases.
Prevent Type 2 diabetes complications. Focus on eye, foot, and skin care now.
Don’t smoke. Smoking damages and constricts blood vessels. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections.
Keep all prenatal appointments. Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and child.
DIABETES
40-55 YEARS Delay or prevent Type 2 diabetes. There are 79 million adults ages 20 and older in the United States who have pre-diabetes. Take action to manage your blood glucose. Keep an eye on your feet. People with diabetes can develop many different foot problems. Learn how to protect your feet by following some basic guidelines.
55-75 YEARS Have regular eye exams. Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74.
Stay heart healthy. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation. Talk to your doctor about healthy diet and exercise programs.
75+ YEARS Ask your doctor about alcohol use. If you have diabetes and take insulin shots or oral diabetes pills, you risk low blood sugar when you drink alcohol. Talk to your physician to learn more.
blood sugar screening every 3 years after age 45
BLOOD PRESSURE screening annually CHOLESTEROL screening every 5 years
screening every 3 years after age 50
HEART DISEASE
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People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
For more heart-healthy tips, visit us online at gru.edu/cardio.
on our heart and vascular team
Dr. Deepak Kapoor Interventional Cardiology Dr. Kapoor’s clinical and research interests include interventional cardiology, or cardiac catheterization, to treat blocked arteries. He is particularly interested in emerging therapies for coronary artery disease and has participated in clinical trials for drug-eluting stents and for new treatments for acute coronary syndromes and peripheral vascular disease.
Dr. Gyanendra Sharma Cardiology Dr. Sharma’s clinical interests include valvular heart disease, preoperative cardiac risk assessment, anticoagulation management, 3-D echocardiography, and pulmonary embolism. He also conducts research into cardiovascular risk reduction and myocardial infarction in young patients.
Get to know our physicians face to face: Check out their videos at gru.edu/cardio.
Q&A Which contributes most to diabetes risk—being overweight or inactive? Studies show that both are equally dangerous. One study showed that the higher people's body mass index (a measurement of body fat), the greater their risk for diabetes, regardless of how active they were. The same proved to be true for inactivity—less active people were found to be at greater risk of diabetes, even if their weight was normal. Either way, increasing physical activity leads to benefits beyond weight control, including stress relief, better sleep, and a stronger heart, muscle, and bones, among a host of other benefits.
a heart-safe community
The less active you are, the greater the risk for diabetes.
GEORGIA REGENTS HEART & CARDIOVASCULAR CENTER DONATES AEDs
Cholesterol: The good and the
THE GOOD, THE BAD, THE ARTERY
Can raising good cholesterol levels reduce heart disease risk? Yes. It’s been well known that lowering LDL, or bad cholesterol, lowers heart disease risk. Now we know that raising HDL, or good cholesterol, may be just as important. Experts believe that HDL carries cholesterol out of the bloodstream. It may also help inhibit the buildup of plaque in the arteries. A healthy level of HDL is 40 mg/dL or above in men and 50 md/dL in women. Recent research has also led to recommendations that cholesterol levels be more aggressively managed in people at higher risk for heart disease, such as diabetics and people with a strong family history.
Abnormal narrowed channel for blood
Artery wall thickened by fatty deposits
Normal artery wall
Blood flow
HDL, the ”good” cholesterol, carries cholesterol out of the bloodstream. LDL, the “bad” cholesterol, deposits itself on artery walls, causing waxy deposits called plaque.
Normal open channel for blood
breaking news Cholesterol
Cholesterol level is measured in milligrams per deciliter, or mg/dl.
at risk for depression Studies show that people with diabetes are at an increased risk for depression. Although scientists don't completely understand why this is true, depression can lead to people feeling out of control in terms of managing diabetes. Further, a recent study showed that depression increased the risk for diabetes, and diabetes increased the risk for depression. Moreover, poor control of diabetes can mimic symptoms of depression. Talk with your doctor about treatment options if you feel sad, have low energy or trouble concentrating, or experience changes in sleep patterns.
Dr. Kenneth Murdison Pediatric Cardiology As director of the pediatric cardiac catheterization lab, Dr. Murdison’s clinical interests include the diagnosis and management of congenital and acquired cardiac defects and the use of catheter-facilitated therapies in the management of congenital and acquired cardiac defects.
Ag
Average
Moderate
203040
20 22 24
200220240-
High
Goal level
220 240 260
18 20 20
binge drinking and Type 2 diabetes
Reduce cholesterol and fat by avoiding certain
In addition to reducing cholesterol, it also is important to reduce Fatty cuts of meat and organ meats (kidneys, liver) Whole milk products and eggs Shellfish (shrimp, crab, lobster) Coconut and palm oils Refined, processed grain products (eat whole-grain , high-fiver products instead) SOURCE: National Institutes of Health; American Heart Association;
A study reported in the Jan. 30, 2013, issue of Science Translational Medicine found that even occasional binge drinking (defined as five alcoholic beverages consumed within two hours for men, and four for women) induces insulin resistance even well after the alcohol has cleared the system. Since insulin resistance is a key factor leading to Type 2 diabetes, limit alcohol intake and don’t engage in binge drinking.
W
hen someone suffers sudden cardiac arrest, death can happen in minutes. The disorder—in which the heart malfunctions and stops beating—is the No. 1 cause of death in the U.S. With nearly 70 percent of U.S. adults overweight or obese, that risk is higher than ever. According to the American Heart Association, less than 8 percent of those who suffer sudden cardiac arrest outside of a hospital survive. But, said Justin Resley, CCP, LP, chief perfusionist at Georgia Regents Medical Center, “Communities with publicly available automated external defibrillators (AEDs) often see much better survival rates.” It’s why the medical center is leading the way to make Augusta a “heart-safe” community by donating AEDs to local churches and other public places. “Most cases of sudden cardiac arrest happen at home or in the community,” said perfusionist Erica Hawthorne. “By installing AEDs in churches and other public places throughout Augusta, we are providing a better chance for survival to many. In fact, AHA statistics show that help from a bystander can double or triple a victim’s chance of survival.” The program will continue to donate more of the easy-to-use devices to other local underprivileged churches on an ongoing basis. Also, perfusion staff from GR Medical Center’s Heart and Cardiovascular Services are training church staff and others on the use of AEDs. “Churches are places where people gather in groups, and we are all growing older,” said The Very Rev. Billy J. Alford of St. Albans Episcopal Church. “It’s good to know that in the case of an emergency, there are trained people in the congregation who can assist by using the AED. That precious 10 to 15 minutes could make all the difference in saving a person’s life.”
For more heart-healthy tips, visit us online at gru.edu/cardio.
Copyright © 2014 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
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