Cardiovascular risk in Diabetes

Exercise can reduce your risk of stroke and heart disease.

What is cardiovascular disease?

Exercise can reduce your risk of stroke and heart disease.
‘Cardio’ means to do with the heart and ‘vascular’ to do with the blood vessels. ‘Cardiovascular’ means the heart and circulation. Diseases of the circulation are caused by hardening of the arteries, and are common in Western society.

They are:

• angina (chest pains)
• heart disease
• heart attacks (when blood supply is cut to the heart)
• stroke (when blood supply is cut to the brain)
• poor circulation to the legs.

Atherosclerosis (hardening of the arteries)

Atherosclerosis is the underlying process that leads to cardiovascular disease. Arteries are the blood vessels that lead away from the heart and which deliver oxygen-rich blood to the tissues of the body.They are essentially tubes of muscle with a special interior lining of cells that ensures blood flows along smoothly.When affected by atherosclerosis, diseased arteries become substantially narrowed by thickening of the muscle layer and in particular by a fatty deposit (plaque) that builds up under the lining.

Plaque in arteries is a mixture of:

• fats, particularly cholesterol
• a build up of cells from the body’s immune system
• proteins like those that form in a scar.

A plaque starts off small but with time it gets bigger, steadily narrowing the artery at this point.

As well as obstructing blood flow, a plaque is also a weak point in an artery. The thin covering of the plaque can rupture, exposing it and the underlying muscular layer of the artery.

This can trigger a sequence of reactions that results in the blood clotting at the site of the plaque rupture. Suddenly what had been a narrowed artery can turn into a completely blocked one.

This is very often what happens in a stroke - or a heart attack if it occurs inside one of the heart’s arteries rather than the brain.

What are the risk factors for cardiovascular disease?

The UK has one of the worst records in the world for cardiovascular disease because of factors such as:

• high fat diet
• a tendency to eat lots of salt which raises blood pressure
• low levels of exercise
• the effect of smoking.

Diabetes and cardiovascular risk

Diabetes increases the risk of cardiovascular disease by as much as four times.
While blood sugar control is still important, you also need to tackle the other risk factors such as obesity.

The most important risk factors that affect your chances of getting a cardiovascular disease are:

• diabetes
• smoking
• high blood pressure (hypertension)
• raised blood fat (lipid) levels - mainly cholesterol and triglyceride
• excess body weight

Calculating risk

A great deal of information has been built up about what effects the various cardiovascular risk factors such as age, smoking, high blood pressure etc have on an individual’s long-term health.

This has led to the concept of quantifying risk. Most of these calculators attempt to put a figure against your eventual likelihood of having a major cardiovascular event (heart attack, stroke).

This is usually stated as a percentage likelihood of an event occurring within a certain time span.

Doctors divide risk into:

• low: less than 15 per cent chance of an event in the next 10 years
• medium: 15-30 per cent chance in the next 10 years
• high: more than 30 per cent chance in the next 10 years.

What are the pros and cons of risk calculators?

On the positive side they can allow people at the highest risk to receive the most medical attention that will improve their health.In recent years this has resulted in prescribing guidance for doctors that states which risk group of patients can receive certain types of drugs.On the downside, many doctors feel that categorising people this way is too simple.Many people within the ‘lower risk’ categories would still benefit from receiving certain types of treatment. This has been well shown in the case of statin statin treatment to lower cholesterol levels in diabetes.

How can they help me?

You can use risk calculators to help you see the impact of making changes.

Risk calculation shouldn't be taken as fact. Many of the ways we currently assess risk will probably be shown to be inaccurate in the future, but they are the best we presently have.

As always, the important actions we can all take are those that follow the lines of healthy living.

Source: http://www.netdoctor.co.uk/diabetes/index.shtml