Diabetes and Coronary Heart Disease

[Dillinger]

Hi,

It seem uncontroversial to say that the risks of CHD for diabetics are fairly well established; here is a link that deals with just that http://journal.diabetes.org/diabetesspe ... 2/pg81.htm

What I wonder is what is the explanation for that increased risk; does anyone have any information on the biology of increased risk of CHD as a consequence of having diabetes? Doesn't seem very clear to me?

Not a particularly happy topic for a Tuesday afternoon, but there you go...

All the best

Dillinger

 

[IanD]

Hi,

It seem uncontroversial to say that the risks of CHD for diabetics are fairly well established; here is a link that deals with just that http://journal.diabetes.org/diabetesspe ... 2/pg81.htm

What I wonder is what is the explanation for that increased risk; does anyone have any information on the biology of increased risk of CHD as a consequence of having diabetes? Doesn't seem very clear to me?

Not a particularly happy topic for a Tuesday afternoon, but there you go...

All the best

Dillinger

From the article....
As hyperglycemia alone does not explain all the increased risk for CHD in people with type 2 diabetes, other factors must be considered. It has been postulated that rather than being a complication of DM, CHD and DM share common genetic and environmental antecedents.16 They have in common many CHD risk factors, and a possible link between them is insulin resistance syndrome. Compared with the nondiabetic population, the prevalence of dyslipidemia, hypertension, obesity, and sedentary lifestyle is higher in people with type 2 diabetes. In addition, people with diabetes have multiple risk factors more often than do their nondiabetic counterparts.

I understand also that the presence of excess glucose in the blood has a particularly adverse effect on the capillaries that serve the nerve endings throughout the body, resulting in kidney disease, retinopathy, CHD, foot disease, etc.

See:
Long-term complications :

http://www.wellness.com/reference/conditions/diabetes/symptoms-and-causes
Long-term complications of diabetes develop gradually. The earlier the individual develops diabetes and the less controlled the blood sugar levels are, the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

Heart and blood vessel disease:
Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis), and high blood pressure. According to the American Heart Association, approximately 75% of individuals who have diabetes die of some type of heart or blood vessel disease. Diabetic microangiopathy is the damage to very small blood vessels due to high blood sugar levels. Microangiopathy causes the walls of very small blood vessels (capillaries) to become so thick and weak that they bleed, leak protein, and slow the flow of blood. Diabetics may develop microangiopathy with thickening of capillaries in many areas including the eyes, feet, legs, and kidneys.

 

[Dillinger]

Compared with the nondiabetic population, the prevalence of dyslipidemia, hypertension, obesity, and sedentary lifestyle is higher in people with type 2 diabetes.

Hi Ian,

Thanks for that but I've got to say I'd bet quite a lot of money that the obesity and sedentary lifestyle bit is not going to go down very well here... :shock: :lol:

It doesn't really provide an answer though either; it's essentially saying "if you've got diabetes your more likely to have CHD because you've got diabetes". Or it's putting diabetes into a set of causative risk factors rather than explaining what the link is.

I understand also that the presence of excess glucose in the blood has a particularly adverse effect on the capillaries that serve the nerve endings throughout the body, resulting in kidney disease, retinopathy, CHD, foot disease, etc.

As I understand it a myocardial infarction is caused by the rupture of a atherosclerotic plaque in the wall of an artery and the clot which forms to deal with this then either blocks the artery or breaks off and moves 'downstream' and blocks off blood supply to heart muscle. So that isn't a capillary related problem; that's a full on artery getting into trouble.

I wonder whether any studies say can say that this element of diabetes leads to this element of CHD and thereby increases the risk?

All the best

Dillinger

 

[catherinecherub]

Inflammation is the common cause that is cited now. Google, "inflammation causes heart disease diabetes".

By googling," life expectancy and diabetes" you will come up with quite a few facts relating to heart disease.

 

[timo2]

I'm thinking that thiamine deficiency sould be somewhere on our list of guilty parties.

a thiamine deficiency would seem to adversely affect all of the organ systems. However, the nervous system and the heart are particularly sensitive to thiamine deficiency, because of their high oxydative metabolism.

It is thought that many people with diabetes have a deficiency of thiamine and that this may be linked to some of the complications that can occur.
http://en.wikipedia.org/wiki/Thiamine

Researchers found people with diabetes expelled thiamine - vitamin B1 - from their bodies at 15 times the normal rate
http://news.bbc.co.uk/1/hi/health/6935482.stm

We also have to consider the vascular effects from an absence of (in type 1 and some type 2) or an excess of (in many type 2) c-peptide.

 

[Soundgen]

http://care.diabetesjournals.org/content/29/9/2064.abstract

 

[howie]

hardening of arteries..? less elasticity and therefore more pressure on the heart, along with the reduction of the arteries size.

i've also heard somewhere that reduced kidney function plays a role somehow.

+ a lot of T2's are overweight or have been for many years...

 

[NickW]

Hyperinsulinemia (chronically elevated insulin levels) is a commonly-cited causal factor in type 2 diabetes, and is also a percursor to hypertension, hypertriglyceridemia, obesity and an elevated risk profile for CHD. I think there's compelling evidence that it's not T2D itself that raises risk of CHD, but that both are effects from the underlying cause, which is hyperinsulinemia.

Like everything else in biology, the correct answer is probably "it's complicated" and it's probably a combination of many different factors, but I believe that's a significant contributor.

 

[Soundgen]

Atherosclerosis is the major cause of heart attack and stroke,

this is from http://journals.cambridge.org/downl...62a.pdf&code=019c279598f868b6d69390f92ddf4fcd a study on rats where vitamin B6 lowers the rate of atherosclerosis by reducein elevated plasma homocysteine which is a risk factor for atherosclerotic disease. I wonder if diabetisc are prone to a B6 shortage as they are to B ? Other animal studies back this up thought another of which is http://sciencelinks.jp/j-east/article/200223/000020022302A0833308.php

 

[cugila]

When I become a Diabetic Rat I'll let you know.......

 

[fergus]

I think you're right NickW, that hyperinsulinemia is a significant factor and that other contributory hormonal responses add to the damage.
There were 3 large scale prospective studies, I think in Australia, Paris and Helsinki, which reported a direct relationship between serum insulin levels and CHD risk. The higher the insulin, the greater the risk. This partly explains the link between obesity (again a result of hyperinsulinemia) and heart disease.
The fact that insulin levels are a far better predictor of risk unfortunately isn't enough to direct the medical community's attention away from cholesterol, which is a very poor indicator of risk. This seems to be simply because insulin tests cost more than cholesterol tests!

Plaques and damage to the endothilium are the visible evidence of an impending heart attack, so the question is which are the risk factors for 'endothilial dysfunction'? The accepted risks are high blood sugar, high insulin levels, high cortisol levels (often stress related) and high levels of adrenaline.

So, I'm pretty certain that diabetes itself is not a direct cause of heart disease. However, poorly controlled blood sugar and insulin levels most certainly are.

All the best,

fergus

 

[Soundgen]

High blood plasma levels of Homocysteine are being connected to inflamation and heart attacks

Theoretically, an elevated level of homocysteine in the blood (hyperhomocysteinemia) is believed to cause narrowing and hardening of the arteries (atherosclerosis). This narrowing and hardening of the vessels is thought to occur through a variety of ways involving elevated homocysteine. The blood vessel narrowing in turn leads to diminished blood flow through the affected arteries.

Elevated levels of homocysteine in the blood may also increase the tendency to excessive blood clotting. Blood clots inside the arteries can further diminish the flow of blood. The resultant lack of blood supply to the heart muscles may cause heart attacks, and the lack of blood supply to the brain causes strokes.

http://www.medicinenet.com/homocysteine/article.htm

High levels of homocysteine are caused by lack of B vitamins

Elevated homocysteine

Deficiencies of the vitamins folic acid (B9), pyridoxine (B6), or B12 (cyanocobalamin) can lead to high homocysteine levels.[4] S

http://en.wikipedia.org/wiki/Homocysteine

Diabetics can have low blood plamsa levels of BI http://www2.warwick.ac.uk/fac/med/r...e/researchinterest/thiamine_and_benfotiamine/ Perhaps they also have depleted levels of the other B vitamins mentioned in Wikipedia ,

 

[howie]

lol back to my kidney damage comment,

cos kidneys involved in the re-uptake of B vitamins right?

 

[Soundgen]

I'm not sure about reuptake of B vitamins from the kidneys very interesting where did you see that ?

This is interesting site fsponline-recommends.co.uk/page.aspx?u=Ubiquinol0409&tc=E975KA02&PromotionID=2147066075&u=10541129&g=0&o=92510&l=173597& although this is an advertising link for a product called ubiquinol a special type of coenzyme Q10 and may be removed by the moderators , I actually think it should be left as the information is interesting re heart attacks and statin use which depletes coenzymeQ10 from the body and as I understand NHS policy all diabetics are automatically prescribed 40mg of Simvastatin as soon as diagnosed ( Type 2 ) is it prescribed for type 1 as well ? If it is removed anyone who wants to read it will have to contact me by pm.

 

[Soundgen]

When I become a Diabetic Rat I'll let you know.......

You and we are all already 25% rats as we share this amount of DNA with them , shared DNA is most likely to be about basic functions that's why you can look at rats and mice in diabetes and draw comparisons because the processes are the same


http://www.sciencedaily.com/releases/2004/04/040401075930.htm

 

[cugila]

Oh, right.

So, I'm a quarter Rat, half lizard, and probably quarter Irish 'cause I drink Guinness ? :lol:
I suppose you'll be telling me next I should be taking Vit B, or is that Benfloataminute ? (sp) ?

Well I never.... :? :wink:

 

[Soundgen]

Cugila you've cracked it ! how many pints a day ?

There is an awesome new study published (by the University of Wisconsin) about the different health factors of various beers - carbs, calories, alcohol content, etc. Of course, my friends, you knew where the "nectar of the gods" wound up on the study - as the best bloody beer in the world (for your health). Of course, it's healthy! If it wasn't so good for your health, the life expectancy of an Irishman would only be about thirty years.Guinness has a higher concentration than lighter beers of vitamin B, which lowers levels of homocysteine, linked to clogged arteries. And researchers have found that anti-oxidants from the moderate use of stout might reduce the incidence of cataracts by as much as 50%...

http://www.blackfive.net/main/2004/04/d ... ness_.html

 

[catherinecherub]

This one even wears a smart hat. :lol:

 

[cugila]

:lol: :lol: :lol: :lol: :lol:

Have you seen this 'Tree Rat ?'.......... takes after me ?

 

[Soundgen]

According to this Daily mail recent story low carbs incease risk of heart attack http://www.dailymail.co.uk/news/art...diets-increase-risk-heart-disease-stroke.html

Yes previous reports say it's Ok which to believe ? http://www.sciencedaily.com/releases/2007/12/071203091236.htm