Heart disease: A serious complication of diabetes 24 January 2023 Heart disease is still the leading cause of death in Australia and unfortunately heart disease can occur 10 – 20 years earlier for Aboriginal and Torres Strait Islander people. Heart disease is also one of the most serious complications of diabetes. Diabetes Australia reports that heart disease: is the number one killer in people living with diabetes contributes to death in two out of three people living with diabetes is a major factor in reducing life expectancy by eight to nine years is only recongnised as leading to a greater risk of a heart attack by 12% of people living with diabetes How can we support people to live longer and stronger, with a healthy heart? Firstly, it is important to know what drives the risk of having heart disease (risk factors), how to help people recognise the signs and symptoms of a heart attack for themselves, their friends and family, and what to do to prevent a heart attack. Let’s take a look at these three areas. Risk factors Heart Research Australia reports that 90% of Australians have at least one risk factor for heart disease and that the more risk factors, the greater chance of developing heart disease. However, it is important to be aware that there is also an increasing number of people with very few ‘modifiable’ (potentially changeable) risk factors such as smoking, low physical activity and high stress levels, who are presenting to hospital emergency departments experiencing a heart attack, including younger adults (30-40yrs). Potentially changeable risk factors, where social and cultural determinants of health allow: Constantly high blood glucose levels Smoking High blood pressure High LDL-cholesterol and triglyceride levels Higher intakes of nutrient-poor foods and drinks (e.g. high soft drink intake; more than one soft drink a day) Low levels of physical activity and or regularly sitting for most of the day Diabetes and or other chronic disease e.g. existing heart disease Static risk factors – risk factors that can’t be changed: Age, the older we get the higher the risk Genetics Family history Some ethnic and cultural backgrounds including Aboriginal and Torres Strait Islander, Pacific Islander, and those with Indian subcontinent or Chinese cultural backgrounds Gender – more women die from heart disease than breast cancer Diabetes and or other chronic disease e.g. existing heart disease No or few risk factors Signs and symptoms of a heart attack Severe chest pain that some describe as ‘crushing’ pain Dull chest pain with chest tightening that gets worse and or doesn’t go away Pain from chest to the back Similar sensations to heart burn Shortness of breath or difficulty breathing A squeezing or choking sensation Pain in the shoulder(s) and or arm(s) Jaw or neck pain Dizziness or fainting Sweating Sudden overwhelming fatigue or weakness Nausea or feeling sick in the stomach Feeling the need to open the bowel Flu-like symptoms If a person has any combination of these above signs or symptoms, waste no time, act fast by: Calling an ambulance on 000 for help and report a possible heart attack (if the ambulance is not readily available e.g. you live in a more regional or remote area, call the local hospital or health clinic or the person’s usual doctor asap for advice) Give the person (adult) aspirin (~300mg), if available Try to keep the person experiencing symptoms as calm and rested as possible until the ambulance arrives Awareness of signs and symptoms of a heart attack SAVES LIVES. How to reduce the risk of a heart attack When living with diabetes, managing blood glucose into the safe range is a powerful way to reduce the risk of a heart attack Lower stress and or encourage getting support to manage stress as best as possible. Stress can be a big driver of a heart attack directly, and indirectly through behaviours that people might do to help manage stress e.g. smoking, drinking alcohol, sitting more etc Lower blood pressure The safe range for blood pressure for people living with diabetes is between 130/80 to 140/90 or less. Moving more, managing stress and glucoses levels into safe levels, reducing smoking, taking blood pressure medications where needed, and eating more nutrient-rich foods (whole fresh or frozen foods e.g. vegetables, fruit etc.) can help to lower blood pressure Lower cholesterol levelsThe risk of heart disease can be reduced by lowering some blood fats. LDL-cholesterol and triglycerides can be lowered by reducing or quitting smoking, moving more, improving sleep patterns and stress management, making more healthier food and drink choices, and taking cholesterol-lowering medications where neededCurrent blood fats (lipids) recommendations are: Total cholesterol: less than 4mmol/L LDL (lousy) cholesterol: less than 2mmol/L HDL cholesterol: 1mmol/L or over Triglycerides: 2mmol/L or under Nurture and/or grow a healthy relationship with food and your body. Where able, enjoy more nourishing (nutrient-rich) foods whilst consuming less ultra-processed foods and drinks. Heart disease risk can be lowered by having a healthier relationship with food and our body, including nourishing with and or enjoying regular meals (instead of one meal a day or starving and binging). Enjoying more whole fresh or frozen foods and less ultra-processed and packaged foods where possible. Foods such as lean protein foods (e.g. fish, birds, eggs, legumes), dairy (e.g. milk, yoghurt), high fibre foods (e.g. whole grains, vegetables, legumes such as lentils and chickpeas, and fruit), healthier fats (e.g. nuts, seeds, avocado, olive oil), foods which are naturally lower in salt and added sugar, plus ample clean fresh water, are great for the heart and blood vessels. Move more, sit less Enjoying moving our bodies in whatever ways works best for us and our lives, is great for our hearts and minds. Encourage people to move more and sit less and or find enjoyable ways of moving such as walking on country, gardening, fishing etc. All these, and more ways, of sitting less are powerful as it not only lowers blood glucose and pressure levels but heart disease risk.It is also really important to know when our body and mind need rest, to listen to our amazing bodies, and not push them. Some types of exercise or movement can be felt by the body or mind as a stress, causing our blood glucose and pressure levels to increase Encourage regular or at least annual visits to see or talk to their safe and effective healthcare teams for routine checks including blood tests. Regular supportive and safe healthcare engagement saves lives Reduce or quit smokingSupport and encourage people to lower their amount of smoking or quit smoking, as this can greatly reduce the risk of high LDL-cholesterol, high blood pressure, heart attack and other diabetes complications Diabetes Australia reports that 59% of people they surveyed did not know that heart disease was the number one killer of people living with diabetes. Therefore it is really important to discuss with clients, their friends and family that heart disease is one of the most serious complications of diabetes, remind them of the signs and symptoms, what to do when a heart attack might be or is happening, and how to reduce their risk of heart disease. For more information on diabetes for the health workforce and or people living with or at risk of diabetes, please head to the Diabetes Australia website here or call the NDSS Helpline on 1800 637 700 to speak with a health professional.