Josanne Vassallo tells Stephanie Fsadni about the importance of a healthy lifestyle and adherence to medication to control blood glucose levels and help prevent heart problems.
Individuals suffering from diabetes are at a higher risk of developing heart disease. Other risk factors, such as high blood pressure, high cholesterol, overweight and obesity as well as smoking, significantly increase this possibility.
“A person with diabetes and none of the risk factors mentioned above has the same level of risk of heart disease as an individual who does not have diabetes but has already had a heart attack,” says Josanne Vassallo from the Division of Endocrinology and Diabetes, Department of Medicine at the University of Malta Medical School and Mater Dei Hospital.
The most common heart problem among diabetics is, in fact, ischaemic heart disease, which can result in fatal heart attacks.
The reasons why diabetics have a higher chance of heart disease are various.
“Glucose triggers a series of mechanisms at cellular levels that over a period of time lead to significant damage and as a result decreased circulation to different organs including the heart,” explains Vassallo.
Individuals with diabetes mellitus, particularly those with type 2 diabetes, are more likely to be overweight or obese and suffer from elevated blood pressure and cholesterol levels.
Vassallo explains that the insulin resistance prevalent in type 2 diabetes is also associated with a pro-inflammatory state which again translates into a series of events promoting atherosclerosis and, ultimately, the narrowing of blood vessels leading to angina and heart attacks.
Diabetes can also be associated with cardiomyopathy, a condition that affects the ability of the heart to effectively pump blood around the human body. As diabetes may also affect the nervous system, the control of heart rate and blood pressure can become problematic.
Women are most at risk.
“A number of studies show that women are more insulin resistant and less likely to achieve targets in risk factor control,” says Vassallo. “So although both men and women with diabetes have an increased risk of heart disease, the processes underlying the development of heart disease may be influenced by gender-specific factors.”
Studies show that women are more insulin resistant
It is imperative that diabetics control blood glucose, blood pressure and cholesterol levels through lifestyle measures – a healthy diet and exercise – and medication. Weight loss helps decrease insulin resistance and facilitates the achievement of a normal blood glucose level. It is also essential that they stop smoking.
“There is ultimately a genetic predisposition to diabetes mellitus and susceptibility to developing complications of diabetes including heart disease. These genetic factors to date cannot be tackled by available measures,” says Vassallo. “However, risk factor control can significantly decrease the risk of fatal and non-fatal heart attacks.”
The professor believes that the majority of people with diabetes actively try to control their diabetes but is aware that “it can be a struggle and, as a result, they give up”.
“This is the reason we emphasise the importance of a multidisciplinary follow-up on a regular basis to support people with diabetes in their fight against the disease.
“Achieving constant and perfect blood glucose control would be ideal but they have to focus on achievable effective targets given the chronic nature of the condition and available treatment options,” she points out.
In her opinion, awareness of diabetes has increased through a number of initiatives involving the Malta Diabetes Association, the Health Promotion Unit, the Directorate of Health Information and Research and the Malta Medical Students Association, through the media and events, but “there is still far more to be done both in terms of increasing awareness regarding the condition itself as well as highlighting the importance and reinforcing the importance of a healthy lifestyle”.
Vassallo acknowledges that the human and financial resources needed to support subjects with diabetes with continuous education and equitable access to the required healthcare are significant and have a major impact on healthcare budgets worldwide.
“Prevention remains the best form of treatment,” she says.
There has not been any recent formal epidemiological research regarding the prevalence of heart disease among the Maltese with diabetes mellitus, but two major studies are currently under way.
The MAMI study at the Faculty of Health Sciences has been running for approximately two years and is designed to look at the genetic and biochemical risks prevalent in patients with and without diabetes, with and without myocardial infarction.
“Data analysis is in progress and a number of interesting and pertinent observations have already been made.”
Furthermore, a population-based epidemiological study, titled Saħħtek, regarding the health of the Maltese population with a particular focus on diabetes and cardiometabolic disease, was launched recently by the Faculty of Medicine.
Another study currently in progress aims to study the different subtypes of diabetes that are known to exist apart from type 1 and type 2 diabetes such as MODY since this classification can help target specific therapies more effectively.
“In two or three years we hope to have important up-to-date epidemiological data regarding the prevalence of a number of chronic conditions, including diabetes and heart disease, as well as insight into risk factors of relevance to the Maltese population.”