Even if they haven't been diagnosed with heart disease, diabetics with classical heart-risk factors like smoking and elevated "bad" cholesterol are at heightened risk of serious heart-related "events" and death, according to a new study.
Among people with diabetes but not heart disease, researchers linked more than a third of cardiovascular "events" - such as heart attack and stroke - and 7 percent of deaths to inadequate control of heart risk factors.
That means those cardiac events and deaths might have been avoided with better control of the known risk factors, the study team writes in Diabetes Care.
"The take home message from this study is that adults with diabetes can reduce their risk of cardiovascular events, and patients should work together with their provider to set a care plan including goals and strategies to reduce modifiable risk factors," said lead author Gabriela Vazquez-Benitez, a research investigator at HealthPartners Institute for Education and Research in Minneapolis, Minnesota.
"This can include regular care visits, screening, laboratory, weight, and blood pressure," she told Reuter's Health in an email.
Read: Diabetes and the heart
Risk factors for cardiovascular problems in diabetics
The risk factors for cardiovascular problems in diabetes are well known and include high blood pressure, smoking and poor control of blood sugar. If more attention were paid to these risk factors, the rate of cardiovascular problems and death could be substantially reduced, the study team argues.
There are nearly 25 million Americans with diabetes and if current trends continue, more than one in three adults are projected to develop the disease.
Stroke and coronary heart disease are the major causes of complications, deaths and healthcare costs in adults with diabetes, they write.
The authors point out that medical advances have improved the health of people with diabetes, especially when it comes to cardiovascular problems. But for people with diabetes as a group, the burden of cardiovascular problems remains very high.
In their study, Vaquez-Benitez and her team analysed data on nearly 860,000 adults with diabetes.
They looked at rates of major cardiovascular complications such as heart attacks and heart failure, as well as deaths from all causes, plus four risk factors: blood pressure, levels of LDL cholesterol, smoking and blood sugar levels over the months.
The authors emphasise that overall rates of major cardiovascular complications and deaths were "substantially higher" in people with diabetes who already had heart disease, compared to those without it.
But delaying diabetes complications is possible, Vazquez-Benitez said, not only for cardiovascular events but for problems like nerve damage and kidney disease.
"Although there is a genetic component of diabetes, there are modifiable risk factors that can reduce risk of heart attack, stroke and death," said Deborah Greenwood, a registered nurse and president of the American Association of Diabetes Educators. Lowering blood sugar, LDL cholesterol and blood pressure, as well as quitting smoking can greatly reduce risk, she said.
All adults over 45 should be screened for diabetes so it can be diagnosed and treated early, said Greenwood, who was not involved in the study. For most people with so-called pre-diabetes, she pointed out, losing 5 to 7 percent of body weight and doing 150 minutes of physical activity per week could avert progression to full-blown diabetes.
She also emphasized the importance of participating in diabetes self-management education and partnering with a diabetes educator to change behaviours and improve modifiable risk factors. "A diabetes educator will work with you to develop a plan specifically tailored to your individual needs, preferences and lifestyle to ensure success," Greenwood said.