House Calls

SPR 2018

House Calls Magazine is a quarterly publication that focuses on health and wellness. It includes a wide assortment of articles with topics on the latest health and wellness information, nutrition, safety, lifestyles, and more.

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Roper St. Francis Healthcare affiliated endocrinologist Dr. Louis Haenel explains that the clear connection between diabetes and heart disease became evident with the release of a 1998 study in the New England Journal of Medicine. In it, researchers identified the risk for heart attack among type-2 diabetics to be on par with the risk among people who had already suffered one heart attack. "The rate of cardiovascular events increases dramatically in diabetic patients, so we now try to be aggressive in mitigating vascular risks," says Dr. Haenel. We'd all like to avoid both heart disease and diabetes. So what's the root behind these killers and how do we fend them off? Understanding Diabetes When a person is diabetic, his or her metabolism doesn't work like it should to process a hormone called insulin, which helps balance the amount of glucose in our blood. Glucose is a simple sugar our body creates from food, and we rely on it for energy. But if our pancreas doesn't produce enough insulin, glucose levels can soar, causing "high blood sugar." There are two main forms of diabetes, type 1 and type 2. Type 1 diabetes is a chronic autoimmune disorder in which the immune system attacks insulin, requiring injections to control blood sugar. "The body simply cannot make the correct levels of insulin, so we try to give insulin back and mimic what the body should be doing," explains Dr. Haenel, noting that the disorder is typically diagnosed during childhood or adolescence. Type 2 diabetes is a far more common condition that accounts for 90 percent of diabetic cases. "It's a multi-factorial condition that is heralded by the genetic influences of insulin resistance," explains Dr. Haenel. "As we get older, the body becomes less capable of using insulin; as we gain weight and become more sedentary, all of these factors aggravate this insulin resistance problem."Type 2 diabetes is typically diagnosed after age 40— though as childhood obesity rates rise, so too does this condition's prevalence among children and teens. Symptoms include increased thirst and urination, fatigue, blurry vision, and slow-healing sores. Twenty-seven million people in the U.S. have type 2 diabetes, while 86 million have high enough levels of blood glucose to qualify as pre-diabetic, notes Dr. Haenel. "That's a third of the U.S. population, and they're nearly all at a higher risk of heart disease as a result." Defining Heart Disease Conditions that compromise the heart's ability to pump blood throughout the body are collectively called heart, or cardiovascular, disease. The term includes conditions in which plaque blocks or restricts blood vessels (known as atherosclerotic disease), which can eventually lead to a heart attack or stroke. It also refers to disorders like arrhythmia, in which the heart is unable to maintain a proper rhythm. Though symptoms vary based on the type of heart disease a person has, the condition presents itself in both subtle and severe ways before culminating in a heart attack or stroke. If you have chest pain or pressure (more common among men) or experience extreme fatigue or nausea (more common in women), see a doctor and adopt lifestyle changes to ward off a life-threatening event (see sidebar to learn about the risk factors for heart disease). Untangling the Connection Type 2 diabetes and heart disease share risk factors like hypertension (high blood pressure) and obesity, and where one occurs, the other often follows. Although existing heart disease isn't a risk factor for diabetes, it does work in the other direction: Diabetes patients have a much higher chance of developing heart disease than non-diabetics. "Diabetics have a greater risk of both microvascular diseases— conditions affecting small vessels to organs like the kidneys—and macrovascular issues like stroke, coronary heart disease, and even limb amputation due to poor circulation," says Dr. Haenel. "There aren't specific guidelines to say that a diabetic should have an electrocardiogram, or EKG, to test for heart health every year, so it's important for patients and their doctors to be mindful of the potential for heart disease symptoms, and to pay attention to small signs, like a little cramp in the chest or shoulder," he says. 32 { spring 2018 } h o u s e c a l l s Y our heart—that throbbing ticker that pumps oxygen-rich blood throughout your body—works 24/7 to keep you alive. Yet statistics show that Americans aren't working as hard for their hearts as their hearts are working for them. Heart disease—often preventable—causes one in four deaths in the U.S. each year, more than any other factor. One of the most devastating risk factors for the condition is type 2 diabetes, which increases a person's risk of dying from heart disease by 200 to 400 percent. In fact, once a diabetic person reaches age 65, there's a 68 percent chance that heart disease will be their cause of death. Dr. Louis C. Haenel P H O T O G R A P H ( D R . H A E N E L ) B Y B R E T T T I G H E Among Charleston County's 400,000 residents, the Centers for Disease Control and Prevention (CDC) estimates that between 1,150 and 1,740 die each year from heart disease.

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