Women are more vulnerable than men to heart complications arising from diabetes.

Heart specialists are now actively trying to correct the passive and negligent attitude of women to getting themselves treated for various heart ailments.

There is still that prevalent misconception that women are relatively spared from heart problems.

Wives usually accompany their husbands to their heart doctors, but they don’t seek consultation for themselves—unwittingly exposing themselves to great risk, particularly if they’re diabetic.

A study published last week in the European Journal of Preventive Cardiology shows that women, more than men, are most affected by potentially serious blood vessel complications of diabetes, which can lead to heart attack, heart failure, stroke, kidney failure requiring dialysis and leg amputation.

Diabetes is a major risk factor for cardiovascular disease (CVD). It occurs 15 years earlier in patients with diabetes compared to nondiabetics.

CVD is also the main cause of hospitalization and increased health care costs, as well as deaths. The study suggests that, in women, the association between diabetes and CVD is significantly stronger than in men.

Worldwide, there are more deaths reported in diabetic women than in diabetic men. This excess risk is attributed to the higher risk of CVD-related death in women.

Blockage of the heart arteries or coronary heart disease (CHD) leading to heart attack is the most frequently reported form of CVD in diabetic women. It could be fatal. It is a fairly common cause of sudden death—the victims don’t even know what hit them.

Blockage of the leg arteries

Diabetic women have an almost two-fold risk of death from CHD compared to women without diabetes.

In contrast, men with diabetes have a lower risk of death, around 1.5-fold less, from CHD, compared to nondiabetic men.

Blockage of the leg arteries or peripheral artery disease, the most common cause of leg and foot amputation, is usually the initial manifestation of CVD in patients with diabetes. It also occurs more frequently in women, a 1.8-fold higher risk in women than in men.

Heart failure (HF), also a common initial presentation of CVD in diabetes, is also five times more likely in diabetic women compared to nondiabetic women. The risk is much more than in diabetic men whose risk for HF is two times than in nondiabetic men.

The HF in women appears to be of a different type than the one commonly seen in diabetic men. It is called HF with preserved ejection fraction, in which pump function of the heart is maintained but is characterized by increased stiffness, making the heart muscle unable to relax in between contractions.

In both women and men, the mainstay of treatment is still a healthy lifestyle to prevent diabetes, and if present already, to ward off its complications.

According to the study’s senior author, professor Joline Beulens of the Amsterdam University Medical Centre in the Netherlands: “With the increased levels of obesity in our society, we have seen an enormous rise in the prevalence of diabetes. We know that type 2 diabetes is a lifestyle-related disease, so we can halt the trajectory with better behaviors.”

Healthy lifestyle as treatment

He emphasizes that despite available modern drug treatments, lifestyle management is still the first line of treatment for patients with diabetes.

“If lifestyle doesn’t sufficiently control glucose levels and the risk of complications, then glucose-lowering treatment should be initiated as the second line of therapy,” advises Beulens.

Among the recommendations of the European Society of Cardiology diabetes guidelines are:

• Smoking cessation

• Reduction of calorie intake to lower excessive body weight

• Adopting a Mediterranean diet rich in fiber, olive oil and/or nuts to lower the risk of cardiovascular events

• Avoiding alcohol

• Moderate to vigorous physical activity, combining aerobic and resistance exercise at least 150 minutes per week but a doctor’s clearance is needed before one undertakes more vigorous exercise.

So, we strongly urge our women to heed the warning and get themselves checked, not only their husbands.

“There is an urgent need to better identify, monitor and control diabetes to prevent the devastating cardiovascular complications (especially in women),” warns Beulens.