Type 1 diabetes (insulin-dependant, also known as juvenile diabetes) is an autoimmune disease. Your immune system, instead of protecting you, destroys the insulin-producing beta cells in the pancreas. What triggers this is uncertain. Of all diabetics, ten to fifteen percent have this form. It can appear at any age, most commonly under forty. It is known as insulin dependent diabetes, because, to stay alive, daily insulin injections are required.
Type 2 diabetes, formerly known as non-insulin dependant diabetes, affects eighty-five to ninety percent of diabetics. This form of diabetes, striking later in life, is characterized by insulin resistance and relative insulin deficiency. Diet, oral medication and occasionally insulin injections are required for therapy. The disease is genetic in origin, but its development may be accentuated by overweight, inactivity, poor diet and high blood pressure.
Gestational diabetes mellitus (GDM) is diagnosed during pregnancy in about seven percent of pregnant women. It disappears after birth, but indicates that the mother is prone to developing type 2 diabetes, especially if overweight, and the baby is at risk for obesity and diabetes later in life.
Diabetes is a risk factor for heart disease because, if poorly controlled, the atherosclerotic process is accelerated and cholesterol levels rise.
Lack of exercise
Inactivity leads to weight gain, which can promote type 2 diabetes. The lack of activity plus the resulting overweight strains your heart by forcing it to pump more blood to an enlarged body. Regular physical activity can reduce the risk for heart and blood vessel disease, and can also help lower blood pressure.
Obesity
Overweight may result in diabetes. The more fatty tissue you have the more your cells become resistant to insulin. Obesity leads to inactivity with all its adverse consequences.
Stress
Intermittent stress can motivate, but when the sources are multiple and prolonged, stress can be a hazard to your health.
When you lose control of the stressful events in your life, adrenalin is released; your body develops a state of readiness to react to danger—your pupils dilate, your heart beats faster, your blood pressure rises, your breathing rate increases. You are ready for flight or fight. But you can’t flee and fighting would, in most instances, be undesirable, so you become irritable, angry and anxious, all signs suggesting you may be putting yourself at increased risk for heart disease.
So, it becomes important to cope: eliminate or reduce caffeine; exercise; eat balanced meals; learn how to meditate. Stress control is important. Get professional help if necessary.
Alcohol
Alcohol, in moderation (an average of one drink a day for women and two drinks a day for men), can have beneficial cardiac effects.
It increases HDL cholesterol and can inhibit clot formation. However, in excess, it enhances clot formation, can raise blood pressure, elevate triglyceride levels and promote visceral obesity—all cardiac risk factors.
Now, knowing all this, it is not recommended that you start drinking if you haven’t been, or if you have been, you start drinking more.
Family history
If your grandparents, parents, or siblings have had heart attacks, you may be at risk. Your family may have inherited a genetic condition that raises “bad” cholesterol and lowers “good” cholesterol.
High blood pressure also runs in families.
Smoking and/or exposure to second hand smoke as you grew up may play a role, as can poor family eating habits (high fat diets).
If your mother or grandmother or sister had heart trouble or a heart attack before age sixty-five, or your father or grandfather or brother had heart trouble or a heart attack before aged fifty-five, you are at greater risk.
Homocysteine
Homocysteine is an amino acid that has been implicated in the promotion of atherosclerosis by damaging the inner lining of arteries and promoting clot formation.
An elevated level has been postulated as increasing one’s risk for heart attack, as well as other vascular disease.
Folic acid and vitamins B-6 and B-12 break down homocysteine in the body, and, indeed, it has been shown that reduced blood levels of folic acid have been correlated with increased risk for heart attack and stroke.
Research is still being done on this correlation, so the American Heart Association has not yet called an elevated homocysteine level a cardiac risk factor, but they do endorse determining the level in those patients with a strong family history of heart disease.
If, in these patients, homocysteine is elevated, a diet high in fruits and green leafy vegetables should be consumed daily, and perhaps a multivitamin with folic acid and the B vitamins should also be taken.
C-reactive protein (CRP)
CRP is a protein found in the blood that is a marker for inflammation. In other words, an elevated CRP suggests that there is inflammation somewhere in the body. It is a non-specific test—something’s wrong someplace. It is important because inflammation has been shown to play a role in the initiation and progression of atherosclerosis and cardiac disease.
Specifically, a variation of the CRP known as highly sensitive CRP, or hs-CRP has been used to predict cardiac disease. If your hs-CRP is elevated, then you should go all out on risk factor prevention and your physician may choose to treat you with anti-clot medications such as aspirin or clopidogrel and may also consider the use of statin drugs and ace inhibitors to reduce the CRP.
In a clinical trial involving 18,000 physicians, an elevated CRP was associated with a three fold increase in heart attacks.
It has also been shown that an elevated hs-CRP applies also to an increased risk for stroke and peripheral vascular disease and the likelihood of closure of a coronary artery after angioplasty.
There are also some newer inflammatory biological markers whose worth is currently being evaluated.
Fibrinogen
Fibrinogen is a protein important in blood clotting, and too much of it may make your blood thick and sticky, an effect that you could do without.
People with levels too high are twice as likely to die of a heart attack.
Taken together with other risk factors it could add to the urgency of specific therapy such as the use of omega-3 fatty acids that have been shown to reduce fibrinogen levels, and the use of aspirin for its anti-clotting activity.
Cardiovascular disease risk factor questions
Is your blood pressure over 120/80? __Yes __No
Are you on any hypertension (high blood pressure) medication? __Yes __No
Do you have a pre-existing cardiac condition? __Yes __No
If so, are you under the care of a physician? __Yes __No
Have you ever had a heart attack? __Yes __No
Have you ever been told
