Diabetics are two to four times more likely to develop cardiovascular disease. Two out of three people with diabetes will die from cardiovascular disease, with 20 percent of such deaths due to heart attacks.

This is according to Dr. Ariel Miranda, director of the Cardinal Santos Cardiovascular Institute, one of the guest speakers at AstraZeneca’s observance of World Diabetes Day on Nov. 29.

“Cardiovascular disease and diabetes are intimately related. Heart failure is an underappreciated complication of diabetes. It is very common among diabetics,” Miranda said. “The probability of developing heart failure is 2.5 times greater than a patient without diabetes. In fact, the probability of developing heart failure is greater than the probability of suffering from a heart attack.”

Poor survival rate

Once a diabetic develops heart failure, she/he has a very poor five-year survival rate, he said. Somebody with heart failure will develop an increasing amount of cholesterol in the blood. Coupled with the effects of diabetes, this can lead to an occlusion of the blood vessels of the heart.

When an occlusion happens, a heart attack can occur or the heart becomes significantly impaired in its ability to perform.

Patients with heart failure complain of easily getting tired, shortness of breath, inability to lie flat in bed, and edema or swelling of the legs.

“One of the functions of the heart is the pumping. If the pumping function is impaired, then the ability of the heart to pump blood through the body will also decrease,” Miranda said. “This is called a heart failure with reduced performance.”

Heart failure happens when a heart is pumping normally but is unable to relax, he said, and therefore the blood will tend to pool in the lungs.

When a person suffers a heart attack, the muscle is replaced by scar tissue. “With the new understanding of heart failure, we come to realize that not all heart failure patients have reduced performance. Some have normal or mildly reduced performance,” Miranda said.

The Philippines belongs to a multimorbidity group labeled as metabolic, meaning there is a high prevalence of obesity, hypertension and diabetes—and that is a potent combination, he said. The incidence of heart failure in the Philippines is 1-2 percent, quite similar to the worldwide prevalence of heart failure.

“Use antidiabetic drugs that can address cardiovascular risk and use antidiabetic drugs that can protect the kidney,” Miranda said.

475 million diabetics

An estimated 475 million people worldwide have diabetes. This number is expected to go up in 2045 to 669 million, said Dr. Rosa Allyn Sy, head of endocrinology, diabetes, metabolism and nutrition at Cardinal Santos Medical Center.

Sy said that of the 60.3 million Filipino adults, 6.3 percent have diabetes (or 3.7 million). Thirty-eight percent will die early, at younger than 60 years old.

“Our problem is that half remain undiagnosed. Approximately 1.9 million Filipinos do not know they have diabetes. More than 50 percent of patients admitted into the ICU [intensive care unit] are diabetics, and they do not even know that they are diabetic,” she said.

Nobody will die of diabetes, but from complications such as kidney failure, cardiovascular death and stroke. Diabetes is the leading cause of nontraumatic lower-limb amputation, and the leading cause of new cases of blindness in adults, Sy said.

Type 2 diabetes is usually treated with a combination of medicines that help control blood sugar levels and reduce the risk of cardiovascular disease. SGLT2 inhibitors, such as dapagliflozin, will inhibit reabsorption of excess sugar, so a diabetic will have lower blood glucose, because it is excreted in the urine.

“SGLT2 inhibitor is a class of medicine for Type 2 diabetes associated with lower risk of death, heart attack, stroke and heart failure. It works by preventing the kidneys from reabsorbing sugar into the blood and instead promotes its elimination in the urine,” Sy said.

While metformin and comprehensive lifestyle management remain the foundational therapy recommendations, Sy said after metformin, the treatment approach is to consider the presence or absence of atherosclerotic cardiovascular disease, heart failure or chronic kidney disease.

Dr. Luc Van Gaal, professor of medicine, Department of Endocrinology, Metabolism and Clinical Nutrition at Antwerp University Hospital, Belgium discussed the results from the worldwide study Declare (Dapagliflozin Effect on Cardiovascular Events), the largest and longest study (4.2 years) involving 17,160 patients, with 337 participants from the Philippines.

He said the study showed that dapagliflozin significantly reduced the risk of hospitalization for heart failure and death due to cardiovascular causes, as well as providing heart and kidney protection.

“Eliminate excess glucose from your body. It is good for your heart,” Van Gaal said. “Having a history of heart failure is a predictor of the outcome. The important thing is a preventive approach for patients with multiple risk factors.”