August 22, 2018
Every person with type 2 diabetes lives with a greater risk of developing other harmful health conditions — especially heart disease and stroke.
But a study published in August 2018 in The New England Journal of Medicine has found that people with type 2 diabetes who keep their blood pressure, blood sugar, and cholesterol levels in line — and do not smoke — have only a slightly higher chance of early death, heart attack, or stroke compared with the general public.
“Maintaining cardiovascular risk factors within therapeutic target levels may reduce excess risk for death and cardiovascular disease among patients with type 2 diabetes,” says lead article author Aidin Rawshani, MD, a medical intern and doctoral student at the Institute of Medicine, Sahlgrenska Academy in Sweden. “Elevated levels for blood pressure, long-term blood glucose, and lipid levels can be treated by means of pharmacological therapy and changes in lifestyle factors, such as improved diet and increased physical activity.”
RELATED: What Are the Possible Complications of Type 2 Diabetes, and How Can You Avoid Them?
With Diabetes, Managing Risk Factors Pays Off in Preventing Early Death
Based on the health records of 271,174 people with type 2 diabetes and 1,355,870 control subjects without diabetes, Dr. Rawshani and his colleagues discovered that those with type 2 diabetes have risks of death and cardiovascular events that are two to four times as great as the risks experience by the general public.
The study authors reported that those with diabetes who were able to keep five known risk factors within healthy target ranges could lower the risk of premature death, heart attack, and stroke to a level that was no more than 10 percent higher than the general population.
These five factors are blood pressure, long-term blood glucose, lipid status (fats and fatlike substances in the blood known as cholesterol and triglycerides), renal (kidney) function, and smoking.
On the other hand, those who were not controlling the risk factors well or not at all were at extremely high risk. These individuals had 10 times the risk (or a 1,000 percent increase) for heart attack, heart failure, and stroke, and five times the risk for premature death compared with the control group.
“The patients with greatest risk for cardiovascular outcomes and death are those with five risk factors not within target range. They have poor risk factor control,” says Rawshani.
RELATED: A Comprehensive Guide to High Blood Pressure
Smoking Is One of the Biggest Risk Factors for Early Death in People With Diabetes
Smoking was the greatest risk factor for premature death, while a sustained high blood sugar level proved to be the most dangerous contributor for heart attack and stroke, according to the study.
“I always tell my patients with diabetes who smoke that using tobacco is like throwing gasoline on the fire,” says Sarah Samaan, MD, a cardiologist with Baylor Regional Medical Center in Plano, Texas, who wasn’t involved in the research. “If you have diabetes and smoke, cardiovascular disease is nearly inevitable. It's hard to quit, but the effort is worth it, and you should not give up trying.”
RELATED: The Best and Worst Ways to Quit Smoking
The Risk for Heart Failure Remains High for All With Diabetes
Study authors noted that heart failure remained a dangerous risk for all people with diabetes — even those who were achieving therapeutic targets. Those who were carefully controlling risk factors still had a 45 percent higher chance of heart failure compared with the control group.
“Obesity is a major risk factor for heart failure,” says Dr. Samaan, “and many diabetes patients remain obese despite control of other risk factors.”
Rawshani adds that physicians often don’t view heart failure as a traditional diabetes-related complication and therefore don’t screen for heart failure or treat relevant risk factors adequately.
RELATED: 9 Essential Facts About Atrial Fibrillation and Heart Failure
Younger People May Need a Wake-Up Call on Diabetes Complications
The research also suggests that younger people with diabetes may not be focusing on controlling their risk factors as much as older folks. Although younger people tend to be healthier than older people overall, study authors here reported that complications, especially heart failure, were greatest among those younger than age 55.
“These younger people with diabetes may be especially unhealthy compared with seniors, in whom diabetes is more common,” says Samaan.
She points out that heart disease is not unusual in younger people with diabetes, especially as the population becomes more obese, sedentary, and generally unhealthy.
“This makes it extra important to check and treat risk factors if you are younger with type 2 diabetes,” says Rawshani.
RELATED: The Younger You’re Diagnosed With Diabetes, the Greater Your Risk of Dying From Heart Disease
How to Control the Risk Factors for Diabetes Complications
The Centers for Disease Control and Prevention recommends following a healthy diet and getting regular exercise as first steps toward controlling the disease. The majority of people with diabetes will require medical treatment for blood sugar, cholesterol, and blood pressure.
“Keeping these conditions under control, especially blood pressure and blood sugar, will help to protect the kidneys,” says Samaan. “Certain blood pressure medications have a direct, protective effect on the kidneys above and beyond lowering blood pressure.”
“Careful attention to these factors can make the difference between life and death or disability,” Samaan adds.
Although the researchers did all they could to take into account similarities and differences among the participants, and to factor in other potential risks, the study was limited by being an observational investigation. Rawshani recognizes that the study authors did not have information on how people with type 2 diabetes controlled risk factors and kept them within target range.
RELATED: How to Help Prevent Kidney Disease When You Have Diabetes