Atherosclerosis is a disease in which arteries become dangerously narrowed by lipid deposits. People with diabetes are at increased risk for atherosclerosis.
Atherosclerosis begins when the endothelium, the inner lining of the arteries that has direct contact with the bloodstream, becomes damaged. Over time, fats, cholesterol, fibrin (the principal component of blood clots), platelets, and calcium are deposited in the arterial walls. These materials form plaque, deposits that build up and narrow or block the arteries.
Narrowing of the arteries can cause a number of problems. When atherosclerosis affects the coronary arteries, it can cause coronary heart disease, which in turn can cause angina or a heart attack. Angina pectoris, a type of chest pain, occurs when the heart cannot get enough blood and, hence, oxygen for a given amount of work. Chest pain can be a sign that someone is at risk for a heart attack. A heart attack, or myocardial infarction, occurs when blood flow to the heart muscle abruptly slows or stops. A blockage in the arteries that supply blood to the brain can result in a stroke.
Atherosclerosis can also affect blood vessels in the rest of the body, a condition called peripheral vascular disease. Peripheral vascular disease is common in people with diabetes, and it can place them at risk for developing gangrene of the feet. One symptom of peripheral vascular disease is intermittent claudication, the “on-again-off-again” leg pain that occurs while walking but not at rest. The pain results when not enough blood and oxygen reach the exercising muscles.
The risk factors for atherosclerosis include a sedentary lifestyle, advanced age (it is more common after age 50), a family history of heart disease, high levels of stress, and smoking. Other health conditions that raise one’s risk of developing atherosclerosis include high levels of low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) and low levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol), high blood pressure, obesity, and diabetes. In fact, heart attack and stroke are about twice as likely to occur in people with diabetes.
Sometimes, drugs are prescribed to delay the progression or alleviate the symptoms of atherosclerosis. In some cases, surgery may be required to improve blood flow. Prevention—including stopping smoking, treating high blood pressure, maintaining a low-fat, high-fiber diet and a healthy body weight, staying physically active, and keeping blood sugar in good control—is always the best medicine.
A contributing editor at Diabetes Self-Management, Dinsmoor is an award-winning medical journalist who has written hundreds of articles on health and medicine, including dozens related to diabetes.
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