Heart health & T1D

WRITTEN BY: Anne R. Albers, MD, PhD, RVT, FACC, FASE, FAHA
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Note: This article is part of our Daily Life library of resources. To learn more about the many things that affect your health and daily management of Type 1, visit here.


February (and every month) is Heart Month! Physicians board certified in Cardiovascular Medicine focus on heart and circulatory health as well as Cardiovascular Disease (CVD).

Cardiovascular disease is a broad term that includes the following:

  • Coronary heart (or coronary artery) disease
  • Cerebrovascular disease
  • Peripheral Artery Disease (PAD)
  • T1D cardiac neuropathy and cardiomyopathy

The bad news

Heart disease and stroke (CVD) are the leading cause of death both in the US and worldwide, in particular for people with diabetes (PWD).(1,2)

T1D increases risk for all CVD. For women, having T1D increases her CVD risk compared with a woman who does not have T1D.

Beyond cause of death, CVD is a major cause of disability and impacts quality of life for survivors of heart attack, people with peripheral artery disease (PAD), those who have had a stroke, who have cardiomyopathy, and/or heart failure.

Can affect any age

Although complications from CVD are primarily seen in the adult population, CVD can start in young people. Risk factors for heart disease are present in adolescence as well. (4)

Cardiovascular risk factors

  • Hypertension (also called high blood pressure)
  • Dyslipidemia
  • Smoking, tobacco use
  • Obesity
  • Lack of exercise
  • Hyperglycemia
  • Diabetic nephropathy impact CVD risk.(4)
  • Heredity
  • Inflammation (impacted by dental/hygiene)
  • Renal function (renal insufficiency or diabetic nephropathy)
  • High LDL cholesterol
  • Stress
  • Age

For someone with T1D, number of years with T1D increases risk for CVD. T1D associated neuropathy can impact resting heart rate and peak heart rate and add complexity to diagnosis of cardiovascular disease. (3)

Don’t smoke

Smoking accelerates atherosclerosis – and is a bad combination with T1D in particular for PAD, but also coronary artery disease and stroke. Best is never to start/try smoking or stop immediately. Even second hand smoke and third hand smoke increase heart risk.

What is third hand smoke? 

The exposure to chemical residue left from tobacco smoke. Children, especially infants and toddlers who are crawling or teething have risk for third hand exposure. Avoid nicotine products.

Symptoms of CVD

Symptoms of cardiovascular disease can be as straightforward as the “Hollywood Heart attack” — a man clutching his chest in the cold, or as nebulous as a woman presenting simply with complaint of fatigue. While PWD can present with atypical signs and symptoms of heart issues, even people without diabetes can suffer symptoms of indigestion and it is a cardiac issue or heart attack. It is important to know that not just chest pain, but dizziness, fainting, sweats, nausea, fatigue can be symptoms of heart attack.

So how do you know whether to get help or call 911? 

There is no easy answer — best is not to ignore any of the above symptoms, especially if concerned.

Stroke

Symptoms of a stroke are best identified by thinking FAST

  • Face drooping
  • Arm weakness
  • Speech change
  • Time to call 911

Hypoglycemia can present in ways that could mimic stroke; it’s not always easy to tell. Time from symptom onset is very important in stroke and heart attack so best is to treat a low blood sugar but be ready to activate EMS.

 

The good news

Cardiovascular disease in large part is preventable! Prep for heart month (and every month) with the following information about CVD.

  • Know the risk factors, symptoms
  • Know how to protect and promote your cardiovascular health

While anyone with T1D (or their family) knows they didn’t choose to have it; you can choose to help your heart and circulatory health in a number of ways.

The American Heart Association’s Simple Seven are good to know and optimize for heart health:

Life’s Simple 7

  1. Be active
  2. Keep a healthy weight
  3. Learn about cholesterol
  4. Don’t smoke or use smokeless tobacco
  5. Eat a heart-healthy diet
  6. Keep blood pressure healthy
  7. Learn about blood sugar and diabetes (or in a case of T1D, the goal is control of blood sugars as best able)

So what can you do to keep your heart strong?

Identifying and optimizing risk factors is key for people with T1D . Staying active with exercise – is the ultimate multitask for heart health and has been shown to improve all risk factors for CVD. Regular exercise lowers BP, maintaining goal weight, lowers LDL cholesterol, manages stress, helps stabilize blood sugars. A recent study from Finland supports active lifestyle/exercise. Based on lifestyle questionnaires, exercise correlated to decreased number of first cardiac events and prolonged time to second event in people with T1D, the benefit related to increased intensity of the physical activity. (5)

For anyone with T1D, controlling additional risk factors is important. Check with your physician and care team about your risk factors and ways to optimize your heart and vascular health. Know your numbers such as blood pressure, blood cholesterol. Never use tobacco.


References –

(1) https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

(2) Benjamin EJ et al Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Circulation. 2017;CIR.0000000000000485, originally published January 25, 2017

(3) deFerranti et al Type 1 Diabetes Mellitus and Cardiovascular Disease A Scientific Statement From the American Heart Association and American Diabetes Association. Circulation. 2014;130:1110-1130.

(4) Wong SL, Donaghue KC. Traditional Cardiovascular Risk Factors in Adolescents with Type 1 Diabetes Mellitus. Curr Diabetes Rev. 2017 Jan 23. [Epub ahead of print]

(5) Tikkanen-Dolenc H et al. Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes. Diabetologia. 2016 Dec 24. doi: 10.1007/s00125-016-4189-8. [Epub ahead of print]


Read Start Working Out by Christel Oerum.

Anne R. Albers, MD, PhD, RVT, FACC, FASE, FAHA

Dr. Albers is a cardiologist with OhioHealth in Columbus, Ohio. She is a cardiovascular imaging specialist with focus on echocardiography, cardiac stress testing, and vascular studies. Dr. Albers maintains an active consultative cardiovascular practice. Her clinical interests include cardiovascular disease management for women, cardiac issues & management for athletes, primary and secondary prevention of heart & vascular disease, and heart disease in diabetes. At OhioHealth she is co-director of the Sports Cardiology Program, and is a member of the OhioHealth Vascular Institute. Anne and her partner have a heart health blog: https://hearthealthdocs.com/. You can also find her on Twitter @drannealbers.