Fewer than one out of five Americans with diabetes are meeting the recommended targets to reduce their chances of heart disease, according to a new statement from the American Heart Association. This is especially alarming, the authors say, because cardiovascular disease (CVD) “is the leading cause of death and disability in diabetes.”
The report, which was published in the medical journal Circulation, was not a research study but a comprehensive review more than 300 articles on risk factors, treatments, and preventive measures with regard to health outcomes in people with diabetes. According to lead author Joshua J. Joseph, MD, “Far too few people — less than 20 percent of those with Type 2 diabetes [T2D] — are successfully managing their heart disease risk and far too many are struggling to stop smoking and lose weight, two key CVD risk factors.” The report said the main areas in which patients are failing to hit the recommended targets are HbA1c level (a measure of long-term blood sugar control), blood pressure, LDL cholesterol (the so-called “bad cholesterol”), and smoking. The conclusions of the report on weight was especially discouraging — if you factor in a body-mass index (BMI) under 30 (30 and up being classified as “obese”), just 2.7% of people who missed the mark on the other risk factors had a BMI below 30.
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When the researchers collected statistics on people who had both type 2 diabetes and atherosclerotic CVD (also known as “hardening of the arteries”), they discovered that only 6.8% of the subjects met the targets for HbA1c levels, blood pressure, LDL cholesterol, weight, and smoking.
The report then went on to describe needed therapies and behaviors, such as stopping smoking and alcohol use, physical activity, healthy nutrition, weight management, psychosocial care. Dr. Joseph pointed out that the last scientific statement on blood sugar control came out in 2015 and since then important discoveries have been made in the area of diabetes medications that can lower CVD risk. For example, he cited two: Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. GLP-1 receptor agonists, he said, “have been found to improve blood sugar and weight, and they have been game-changers in reducing the risk of heart disease, stroke, heart failure, and kidney disease,” he said.
The AHA statement said that statins are still the recommended therapy for lowering LDL cholesterol but add that people who don’t tolerate statins or find them ineffective might use other drugs, such as ezetimibe, bempodoic acid, bile acid resins, fibrates, and PCSK-9 inhibitors. The new analysis also reviewed studies on the efficacy of low-dose aspirin as a heart disease preventative. “Overall,” the authors commented, “aspirin has a modest beneficial effect in primary prevention in nonelderly adults (50-70 years of age) with diabetes and increased cardiovascular risk….” They added, however, that new research indicates that aspirin brings an increased risk of major bleeding that could offset aspirin’s benefits. For some people, antiplatelet medications might be more useful. When it comes to controlling high blood pressure, the analysts said, “individualized approaches” should be considered, especially to avoid “overtreating” frail patients. Dr. Joseph acknowledged that “Cost may be a barrier to taking some T2D medications as prescribed” but he pointed out that “many of these medications are now more commonly covered by more health insurance plans.” “Another barrier,” he added, “is recognition by patients that these newer [type 2 diabetes] medications are also effective in reducing the risk of heart disease, stroke, heart failure and kidney disease.”
In summary, Dr. Joseph said, “Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes…. Social determinants of health, which include health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes. People with Type 2 diabetes face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients.”
Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”