Diabetes and Risk of Cardiovascular Disease - Essay Example

Type I diabetes due to increased blood glucose levels has the propensity to result in increased fatty acid deposits, especially LDL and VLDL inside the blood vessel walls, which act as a predisposing factor for the development of atherosclerosis. Type II diabetes on the other hand is associated with insulin resistance which is commonly accompanied by other cardiovascular risk factors: dyslipidemia, hypertension, and prothrombotic factors (Gray et al, 1998).

Epidemiology of CVD about metabolic syndrome and diabetes

                There is a relationship between obesity, insulin resistance, and the development of cardiovascular complications. Adipose tissue is now being recognized as an endocrine organ, capable of secreting a number of adipose tissue-specific proteins, especially cytokines, known as adipokines, which have been implicated as a cause of endothelial injury and inflammation resulting in the development of atherosclerosis and insulin resistance in obese individuals (Lau et al, 2005). Adipokines are also responsible for producing “metabolic syndrome” which acts as a further predisposing factor for the development of cardiovascular heart disease (Lau et al, 2005).

Metabolic syndrome and its association with heart disease and diabetes
Metabolic syndrome is a condition that is characterized by a constellation of metabolic abnormalities like hyperglycemia, hyperinsulinemia, hypertension, and dyslipidemia (increased levels of triglycerides, LDL, and VLDL and decreased levels of HDL). The Adult Treatment Panel III (ATP III) criterion for diagnosing metabolic syndrome, (as cited Grundy, 2005) is shown in table 1. Metabolic syndrome is present when three or more of the five criteria are present in an individual.

Reaven (2005) has postulated that insulin resistance is the underlying cause of ‘syndrome X’. Patients with insulin resistance frequently manifest several alterations in coagulation mechanisms, which predispose them to develop arterial thrombosis (Byberg et al, 1998)

Table 1. ATP III criteria for diagnosing the metabolic syndrome

Abdominal obesity

• Men: Waist Circumference(WC) >40 inches (102 cm)
• Women: WC >35 inches (89 cm)

Fasting glucose ≥ 100 mg/dL or on drug treatment for elevated glucose

Blood pressure≥130/80 mm Hg

Triglycerides ≥150 mg/dl (1.7 mmol/L)

Levels of HDL-C

• Men: < 40 mg/dl (1.04 mmol/L)
• Women:< 50 mg/dl (1.3 mmol/L)

Prevention of the development of heart disease (Grundy et al, 1998)
Modification of lifestyle is the most important public health strategy for the prevention of CVD in patients with diabetes mellitus. Therefore healthcare professionals including nursing professionals must encourage their patients to develop the following habits:

Weight control and exercises

The patient should be encouraged to control his blood glucose levels by maintaining near-normal fasting blood glucose levels and levels of glycosylated hemoglobin (HbA1C) ≤ 1% above normal through weight reduction and exercise programs. The goal of the weight reduction program should be to achieve BMI in the range of 21 to 25 kg/m2. The desirable waist circumference for men is102 cm and for women is 88 cm. The person should be encouraged to do at least 30 minutes of exercise, most days of the week. If this does not work the health care professional can prescribe oral hypoglycemic agents or even insulin therapy as the last resort.

Cholesterol reduction

           The patient should be encouraged to increase daily dietary fiber consumption to at least 14 grams of fiber for every 1,000 calories consumed and to cut down his intake of both saturated and trans fats, such that the total cholesterol in his diet remains less than 200 mg a day and total fat forms < 30% of the total dietary intake. The HDL levels should be maintained above 35 mg/dL. Drug therapy needs to be added if LDL levels are>130 mg/dL.

Quitting smoking

                Smoking doubles the person’s risk of getting heart disease by narrowing the blood vessels. To help the patient quit smoking, the health care professional should provide counseling, nicotine replacement, formal cessation programs, etc, as appropriate, to the patient.

Control of hypertension

           The goal should be to maintain blood pressure below, 130/85 mm Hg using simple lifestyle modifications including weight control, increased physical activity, moderate sodium restriction, etc. If blood pressure remains greater than140/90 mm Hg even after 3 months of lifestyle modification, or if the initial blood pressure ≥140/90 mm Hg, antihypertensive medication must be prescribed.

Conclusion

Diabetes serves as a risk factor for developing CVD. It is the prime duty of the health care professional, especially the nursing professionals to help the person reduce this risk by advising simple dietary and lifestyle modifications.