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Diabetes Best Way to Halt Heart Failure
Dr. David Lipschitz
A research paper in the American Journal of Cardiology reports that
during the course of our lifetimes, one in four black people and one in
three white people will develop heart failure that can lead to sudden death
or, more frequently, a progressive deterioration of heart function with
worsening symptoms including shortness of breath, abdominal pain and swelling
of the legs.
Often patients are unable to sleep flat and frequently wake up at night gasping
for breath. Heart failure accounts for 40 percent of the half million deaths
related to heart disease each year.
The common conditions that lead to heart failure are high blood pressure and
coronary artery disease. Diabetes, cigarette smoking and being significantly
overweight also increase the risk of heart problems. Chronic lung disease, including
emphysema and bronchitis, can damage the pulmonary arteries, which eventually
cause the heart to fail. More rarely, heart failure can occur because of damage
to the heart valves or damage to the heart muscle from viruses, hormonal disorders
(such as thyroid disease) or rare abnormalities of the heart muscle called cardiomyopathies.
Heart failure often occurs when the heart muscle becomes so weak that insufficient
blood is pumped out with each heartbeat. This condition is referred to as systolic
heart failure. Alternately, the heart can fail because it becomes too rigid.
After each beat, the heart relaxes and fills with blood. In this form of heart
failure, referred to as diastolic dysfunction, less blood can enter the heart
and be pumped out with each beat. Over time, the abnormality becomes so severe
that symptoms of heart failure develop.
Heart failure causes blood to back up in the lungs. Increased pressure in the
lung veins results in the seepage of fluid into the tiny lung air pockets. This
leads to a condition called pulmonary edema that frequently results in a sudden
shortness of breath. Blood also can back up in the abdomen and legs, causing
liver enlargement, abdominal pain and marked swelling of the legs.
As the heart fails, hormonal changes occur that reduce the production of urine
and result in retention of excessive fluid. A sign of impending heart failure
is a sudden increase in weight that may average as much as two or three pounds
Treatment usually involves the use of diuretics (water pills) that get rid of
excess fluid and, together with other medications, reverse most or all of the
symptoms. With treatment, the patient may remain symptom-free for extended periods
of time. In many cases, the condition gradually worsens and eventually may contribute
to the patient’s death.
As with any other illness, the most effective treatment of heart failure is prevention.
In a recent study published in the American Journal of Cardiology, the factors
influencing heart failure were studied in a group of 14,700 black and white men
and women between the ages of 45 and 64. They were followed for an average of
Five major modifiable risk factors for heart failure were identified, including
diabetes, elevated cholesterol, high blood pressure, smoking and obesity. Much
to their surprise, the most frequent risk factor leading to heart failure was
diabetes. They noted that a reduction in the risk of diabetes by a few percentage
points led to a substantially lower incidence of heart failure.
The benefits were far greater for blacks than whites, but the reason for the
ethnic difference is not clear. They suggest the small reductions in the prevalence
of diabetes has the potential to prevent 30,000 cases of heart failure annually.
Diabetes does not cause heart failure by itself. Rather, it makes all of the
other risk factors, such as high levels of cholesterol and triglyceride, hypertension
and obesity, much worse and more dangerous. Reducing the risk of diabetes reduces
the effects of all of the other risk factors.
The prevalence of heart failure is truly staggering and remains an enormous epidemic
that receives too little attention. No question staying healthy, maintaining
a reasonable weight, not smoking and treating hypercholesterolemia will together
decrease the prevalence of adverse effects of diabetes that is first and foremost
the greatest risk factor for heart failure.
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