About all

Heart disease and diabetes diet: The request could not be satisfied

Содержание

Diabetes and Your Diet | American Heart Association

If you have diabetes, you may juggle a lot of concerns. Eating a healthy diet is a big part of the balancing act.

Unmanaged diabetes can increase your risk of developing heart disease. People living with diabetes are also at risk for blindness, amputation and kidney failure. Find out more about why treating diabetes matters. 

Shop smart

When grocery shopping, plan ahead for the week and always bring a list — and a full stomach.

Stock up on seasonal produce that’s on sale. When fresh isn’t available, choose canned or frozen vegetables and fruits without added sugars and sodium.

Look for whole-grain, high-fiber foods, and limit your time on the aisles where there are boxed foods that may not be healthy. Take a close look at serving size and sodium and sugar content.

Limit packaged, processed, take-out foods that tend to be high in saturated fat, sodium and added sugars. And avoid products with too much sugar. Look for its other names in the ingredient list such as sucrose, honey and high fructose corn syrup.

Be wary of buy-one, get-one free deals. If they’re not healthy foods, you’re getting more than you bargained for.

Balance your plate

Ready for dinner? Your best bet is to start with a small plate. Fill half of it with vegetables such as roasted squash, grilled asparagus or a salad.

For the next quarter, consider a complex carb, such as a small, plain sweet potato, brown rice, whole-wheat couscous or whole-grain pasta.

Finish off your plate with a lean protein, such as a piece of non-fried fish or poultry without the skin.

Dining out

When dining out, call ahead or look online to find out what’s on the menu. Avoid buffets because the value to your pocketbook won’t be felt in your waistline. Portion control is important for everyone, but especially for people living with diabetes. 

Consider ordering a salad and an appetizer for your meal. If you get an entrée, split it with a companion or have half of it boxed up to go.

Keep a polite distance from the bread, but make friends with your water glass. Watch out for the calories in other beverages — both alcoholic and non-alcoholic.

Start off with a small portion and wait 20 minutes. Give your stomach enough time to tell your brain that you’ve eaten and are getting full.

More tips

Whether you’re at home or on the go, it’s not always easy to make the right food choices.

That’s why it’s important for people with diabetes to see a registered dietitian. It’s best to have someone who can guide you through your own individual eating plan and give you advice on how to make better food choices.

The American Heart Association has delicious recipes for people living with diabetes.

Searching for healthy snack ideas?

Try these:

  • Small apple with tablespoon of peanut butter
  • ½ cup baby carrots with two tablespoons of low-fat cottage cheese or hummus
  • Small handful (about an ounce) of unsalted nuts
  • Two whole-grain crackers with low-fat, low-sodium string cheese
  • ½ whole-wheat English muffin topped with low-fat shredded cheese and fresh tomato and broiled.
  • ½ cup plain low-fat or fat-free Greek yogurt, topped with ½ cup blueberries and a sprinkle of cinnamon

5 Lifestyle Fixes for Head-to-Toe Health

with Christos S. Mantzoros, MD 

Diabetes and heart disease worsen with obesity, affecting nearly every organ in the body. Here’s what you can do to avoid these diseases and improve your overall health.

Nearly 8 in 10 people will reach the age of 50 years with obesity, or as cigarette smokers, or both.1 The impact that lifestyle behaviors can have on both the length and quality of your life can be worsened or improved simply by the choices you make.

Even making adjustments to be in better control of your blood sugar can go a long way in reducing your risk of developing diabetes and assuring you good heart health for years to come.

Learn valuable way you can improve your heart health and reduce your risks of diabetes, obesity, and cancer. Photo: marilyna @ iStock

Diabetes,Obesity, and Heart Disease: A Matter of Living

When facing this trifecta of chronic systemic conditions, there is a disconcerting array of medical problems that typically develop over—some you may know about and others may be news to you:

  • high blood pressure (hypertension)
  • high cholesterol (dyslipidemia)
  • heart attack (congestive heart failure)
  • stroke
  • peripheral artery disease including foot ulcers and amputation
  • kidney disease and renal failure
  • vision loss (retinopathy)
  • nerve damage (neuropathy)

“Since genetics plays only a minor role in obesity, the way we live is the root cause of obesity for the vast majority of us. This typically leads to hormone changes, and ultimately to diabetes, hypertension, and elevated lipids (cholesterol), and yet is overlooked,” says Christos S. Mantzoros, MD, professor of medicine and chief of endocrinology, diabetes and metabolism at Harvard Medical School in Boston, Massachusetts, during his presentation at the 2nd annual Heart in Diabetes Medical Conference in Philadelphia, Pennsylvania. 2

While we may not know the precise underlying mechanisms of obesity that lead to the myriad of complications encompassing diabetes and heart disease, what we can say is that in more than 96% of the population, these conditions are driven by lifestyle and environmental factors,” says Dr. Mantzoros. 

As such, you can improve your health and reduce your disease risks just by adopting a vegetable-based heart-healthy diet and committing to daily physical activity.

5 Lifestyle Actions to Side-Step Common Chronic Diseases

“As worrisome as having heart disease, diabetes, and obesity may be, there is a sure way to avoid or lessen the risks from these co-existing conditions: Consider your lifestyle,” Dr. Mantzoros tells EndocrineWeb. “The answer may not be glamorous or exciting, but it is achievable IF you are willing to revisit five critical lifestyle factors: your diet, level of exercise, alcohol use, cigarette smoking, and body weight.

What will you gain by making better food choices, moving more, reconsidering your relationship to drinking and smoking, and above all, finding your way to a healthy weight?

“A middle-aged person, say a 50-year-old man, has the potential to live to 93 years of age if all recommended lifestyle changes are adopted otherwise his life expectancy may be reduced by as much as 43 years.” says Dr. Mantzoros, “so there is potential 16-year net gain in life expectancy by adopting a healthy lifestyle that aims to:

  1. Have good blood sugar control;
  2. Achieve good blood cholesterol (lipids) levels;
  3. Be sure your blood pressure is not too high;
  4. Strive for a waist circumferance and body mass index (BMI) in the healthy range;
  5. Take the medications your doctor prescribes.”

Aim for Mediterranean--Style Lifstyle
By adopting food choices that fit a Mediterranean approach to eating and living, you will be able to achieve the first 4 lifestyle goals. We have solid evidence that people who embrace a a mostly plant-based diet that delivers the following on a daily basis lessen the risks of diabetes, obesity, and heart disease:1-4

  • Have a handful of nuts (such as walnuts but any kind will do) as a snack, with yogurt, in your salad or stir-fry.
  • Choose monounsaturated fats such as extra virgin olive oil.
  • Rely on beans, lentils, chick peas for good fiber and protein
  • Plan your meals with the focus on vegetables, vegetables, vegetables, and fruit.

And fitting in some physical activity most every day, even just walking (with the aim of 10,000 steps to maintain your current weight or 12,000 to 15,000 to lose weight, if that’s your goal, throughout the day), enjoy one drink when having alcohol if you are a woman, and 2 drinks if you are a man, and commit to giving up cigarettes—once and for all—if you haven’t already done so. 

How Do You Go About Making Needed Behavior Changes?

Admittedly, changing any longheld behaviors is hard; on that, we can all agree. If you (or a loved one) haven’t been successful in sticking to a goal, may you can approach it another way so you don’t have to deal with the consequences of having a heart attack, losing kidney function, or requiring an amputation, says Dr. Mantzoros.

This time, choose just one or two of lifestyle factors to focus on. This can mean the difference between improving your long-term quality of life. After all, your choices are a matter of life or death, he says.

Sure, you’ve heard this before and can’t resist the temptation to roll your eyes.

“These messages are so important that it can’t hurt to keep hearing them until you heed them,” Dr. Mantzoros says.

Here are a few more lifestyle consideration that may assist anyone who would welcome a bit of extra help with overweight or obesity:

  • Do a daly weigh-in (preferably at the same time each day)  
  • Work with a dietitian to design a personalized diet and exercise plan 
  • Seek peer support (someone who will join you for walk, and cheer you on).
  • Take your medications as prescribed every day

When Facing Both Diabetes and Heart Disease 

If you already have a diagnosis of type 2 diabetes (T2D), then you are no doubt already learning ways to of making adjustments to your diet and considering what works to be more active.

“Maybe you’ve been told that you have high blood cholesterol and/or high blood pressure but you don’t have any symptoms; you should still be concerned. The answer to lessening all the risks associated with diabetes and heart disease are summarized in one word—lifestyle,” says Dr. Mantzoros.

In fact, tweaking your food choices and adding some steps is the surest way to both prevent further weight gain, and manage all the factors that may reveal possible trouble in your blood (ie, glucose, lipids, bood pressure) that will impact your long-term health, he says.

Going it alone is so much harder 
Hopefully, you have the support of a friend or two who is striving to make these changes too. Being in good company, and have (and giving) steady, positive support, makes all your efforts easier to achieve and increases the likelihood that you’ll be motivated to stick with it.

You should also have the support and guidance of a medical team led by your primary doctor. If you are at risk for (prediabetes), or have type 2 diabetes, maybe you can consult with a certified diabetes educator, or dietitian, and other health care team members who can help you to identify ways you might address obstacles to your success. For example, showing you how to reduce your salt if you have high blood pressure or findings satisfying eating out  when you too busy to cook. If not, let your doctor know you could use some help.

Sure, you know that you should take the medications but make sure that you understand why you are taking them, and can afford them, says Dr. Mantzoros. Otherwise, discuss your concerns with your doctor so you medication can be tailored to fit your circumstances best.

No Matter What You’ve Tried, You Can’t Lose the Weight 

By adopting these key strategies, you may notice that your weight will begin trending down too. 

A diet that is built around vegetables, heart healthy (monounsaturated) fats, and a little lean protein, and making sure you are moving more than sitting, sets up the basics of a healthier weight. However, most people who have tried and failed may need more than reminders of what to eat.2,3

“The truth is, diet and exercise are a necessary first step, but for many, this is simply not enough to prompt you to achieve sufficient weight loss. There are a variety of medications that may help to control your blood sugar and lessen your heart disease risk, while promoting desirable weight loss,” says Dr. Mantozoros.

There are also medications specifically designed to address the reasons for your past weight struggles, which can help reduce your appetite, address your carb craving, and help you to feel full when you are eating the requisite heart-healthy meal.

Also, there are medical nutrition therapy programs, such as liquid meal replacements and protein-rich meal plans that may be worth considering in order to kick-start needed but elusive weight loss.

For others, this may miss the mark, or just not be enough. Research supports the value of bariatric surgery to reverse diabetes, reduce weight, and lessen the risks for heart disease.5

“Don’t feel shy or hesitate about discussing these options with your doctor, or a weith management specialist,” he says. It’s time to embrace every possible means to manage your health, including the elusiveness of weight loss.

Lifestyle Choices and Medications Reduce Diabetes and Heart Disease Risks      

At least 68% of people who reach age 65 and have type 2 diabetes will likely die from heart disease.6 And if that isn’t reason enough for you to want to adopt a more heart-healthy lifestyle, having diabetes can increase your risk for certain cancers, too. 7

“So, as much as you might wish to attribute your predicament to genetics, the simple and honest reality is that improving your quality of life—by reducing the systemic expanse of diseases commonly arising with diabetes—is achievable with a Mediterranean-style diet and attention to other major lifestyle factors (ie, body weight, exercise, smoking, and alcohol),” Dr. Mantzoros says. That, and taking your medications consistently and without fail. 

Here’s to a long and healthy life!

Last updated on 02/13/2020

Best Diet for Weight Loss, Your Choice: Low Carb vs Low Fat

Heart-Healthy Foods to Include in Your Diabetes Diet

Although diabetes is known for affecting your blood sugar, the condition actually affects your whole body — including your heart. In fact, people with diabetes are almost twice as likely to die from a heart attack or stroke as people who don’t have diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. “High blood sugars damage nerves and blood vessels throughout the body,” says Megan Porter, RD, CDE, a dietitian and certified diabetes educator in Portland, Oregon. “When these become damaged, they are unable to perform their normal functions.” This can lead to heart-related problems such as high blood pressure, high cholesterol, and heart disease.

The good news is that because diabetes and heart health are so closely linked, there are many steps you can take to help improve both health conditions. In addition to monitoring your diabetes, taking any prescribed medications for diabetes and heart issues, and getting regular exercise, eating a healthy diet can help you manage your diabetes and your heart health.

A Well-Balanced Diet for Diabetes and Heart Health

While there’s no specific diet for people with diabetes, an overall balanced diet similar to the Mediterranean diet can help you keep your blood sugar within a healthy range.

In fact, in a study published in 2013 in the New England Journal of Medicine, researchers found that when people at high risk for heart disease — including some with diabetes — followed a Mediterranean diet, their risk of stroke or cardiovascular death was cut by 30 percent compared with that of a similar group that followed a low-fat diet. Those who followed the Mediterranean diet included olive oil and nuts, while those who followed the low-fat diet did not. Results showed that the Mediterranean diet had a favorable effect on blood pressure, weight, insulin sensitivity, cholesterol, and inflammation.

Porter recommends that you keep the following dietary guidelines in mind when managing diabetes and heart health:

  • Eat 5 or more fruits and vegetables daily
  • Aim for most of your grains to be whole grains, such as whole-grain bread and whole- grain cereal
  • Enjoy legumes and beans weekly
  • Have nuts and seeds around for an easy snack between meals
  • Substitute oily fish and skinless poultry for most meat selections
  • Aim for only 1 to 2 high-fat, red meat servings weekly
  • Enjoy 2 to 3 servings of low-fat or fat-free dairy choices daily, such as a glass of milk, yogurt, or low-fat cheeses
  • Limit or avoid processed foods, meats, and items with added sugars, such as baked goods, sodas, and other drinks with added sugars

Heart-Healthy Foods to Look For

When it comes to getting the most benefit for both diabetes and heart health, foods high in fiber and healthy fats are the winners. Foods that are particularly beneficial include:

  • Legumes such as lentils, split peas, and beans These are high in soluble fiber, which is great for both diabetes and heart health. “Foods high in soluble fiber help remove cholesterol from the blood and also break down into sugar slowly,” says Porter, “making a person feel fuller for longer and leading to a slower rise in their blood sugars.”
  • Oatmeal Like legumes, oatmeal is high in soluble fiber. Fruits and vegetables also contain fiber, so for an extra boost, try slicing some fruit, like a banana, and adding it to your oatmeal.
  • Fatty or oily fish such as salmon, sardines, and tuna These fish are high in omega-3 fatty acids, a type of unsaturated fatty acid that can help reduce inflammation in the body.
  • Flaxseed This type of seed, which comes from the flax plant, is high in fiber and alpha-linolenic acid, a type of omega-3 fatty acid. Flaxseed can be a good way to get omega-3s if you don’t like fish. However, it’s best to check with your doctor before adding flaxseed to your diet, as it can affect diabetes medication such as insulin, according to the University of Maryland Medical Center, in Baltimore.
  • Walnuts, almonds, and macadamia nuts In general, nuts are packed with protein, and these particular nuts are also high in omega-3 fatty acids and unsaturated fats, which can help lower bad cholesterol. But since nuts are high in calories, be sure to eat them only in small portions.
  • Avocados Putting avocado on toast may be trendy these days, but the health benefits of this fruit have long been known. Avocados contain fiber and healthy fats, as well as vitamins and minerals. A study published in 2013 in Critical Reviews in Food Science and Nutrition found that avocados had heart-health benefits similar to those of nuts but with less than half the calories.
  • Berries Not only can blueberries and strawberries satisfy your sweet tooth, but they may help your heart as well. A study published in 2013 in Circulation found that women who ate three or more servings of blueberries and strawberries each week lowered their risk of heart attack by 32 percent.
  • Olive oil, vegetable oil, and canola oil Cooking with these types of oil can help boost your intake of healthy fats. They are rich in monounsaturated and polyunsaturated fats, which, Porter says, can help reduce cholesterol.

Filling up on these healthy foods and following healthy-eating guidelines, with plenty of fruits and vegetables, can help you feel more satisfied — all while improving your health. “Heart-healthy foods can help reduce overall blood sugars,” says Porter, “and a diet rich in plant-based foods can also assist in keeping blood pressure under control.”

Diabetes diet: Create your healthy-eating plan

Diabetes diet: Create your healthy-eating plan

Your diabetes diet is simply a healthy-eating plan that will help you control your blood sugar. Here’s help getting started, from meal planning to counting carbohydrates.

By Mayo Clinic Staff

A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes.

A diabetes diet is a healthy-eating plan that’s naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone.

Why do you need to develop a healthy-eating plan?

If you have diabetes or prediabetes, your doctor will likely recommend that you see a dietitian to help you develop a healthy-eating plan. The plan helps you control your blood sugar (glucose), manage your weight and control heart disease risk factors, such as high blood pressure and high blood fats.

When you eat extra calories and fat, your body creates an undesirable rise in blood glucose. If blood glucose isn’t kept in check, it can lead to serious problems, such as a high blood glucose level (hyperglycemia) that, if persistent, may lead to long-term complications, such as nerve, kidney and heart damage.

You can help keep your blood glucose level in a safe range by making healthy food choices and tracking your eating habits.

For most people with type 2 diabetes, weight loss also can make it easier to control blood glucose and offers a host of other health benefits. If you need to lose weight, a diabetes diet provides a well-organized, nutritious way to reach your goal safely.

What does a diabetes diet involve?

A diabetes diet is based on eating three meals a day at regular times. This helps you better use the insulin that your body produces or gets through a medication.

A registered dietitian can help you put together a diet based on your health goals, tastes and lifestyle. He or she can also talk with you about how to improve your eating habits, such as choosing portion sizes that suit the needs for your size and activity level.

Recommended foods

Make your calories count with these nutritious foods. Choose healthy carbohydrates, fiber-rich foods, fish and “good” fats.

Healthy carbohydrates

During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into blood glucose. Focus on healthy carbohydrates, such as:

  • Fruits
  • Vegetables
  • Whole grains
  • Legumes, such as beans and peas
  • Low-fat dairy products, such as milk and cheese

Avoid less healthy carbohydrates, such as foods or drinks with added fats, sugars and sodium.

Fiber-rich foods

Dietary fiber includes all parts of plant foods that your body can’t digest or absorb. Fiber moderates how your body digests and helps control blood sugar levels. Foods high in fiber include:

  • Vegetables
  • Fruits
  • Nuts
  • Legumes, such as beans and peas
  • Whole grains
Heart-healthy fish

Eat heart-healthy fish at least twice a week. Fish such as salmon, mackerel, tuna and sardines are rich in omega-3 fatty acids, which may prevent heart disease.

Avoid fried fish and fish with high levels of mercury, such as king mackerel.

‘Good’ fats

Foods containing monounsaturated and polyunsaturated fats can help lower your cholesterol levels. These include:

  • Avocados
  • Nuts
  • Canola, olive and peanut oils

But don’t overdo it, as all fats are high in calories.

Foods to avoid

Diabetes increases your risk of heart disease and stroke by accelerating the development of clogged and hardened arteries. Foods containing the following can work against your goal of a heart-healthy diet.

  • Saturated fats. Avoid high-fat dairy products and animal proteins such as butter, beef, hot dogs, sausage and bacon. Also limit coconut and palm kernel oils.
  • Trans fats. Avoid trans fats found in processed snacks, baked goods, shortening and stick margarines.
  • Cholesterol. Cholesterol sources include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. Aim for no more than 200 milligrams (mg) of cholesterol a day.
  • Sodium. Aim for less than 2,300 mg of sodium a day. Your doctor may suggest you aim for even less if you have high blood pressure.

Putting it all together: Creating a plan

You may use a few different approaches to create a diabetes diet to help you keep your blood glucose level within a normal range. With a dietitian’s help, you may find that one or a combination of the following methods works for you:

The plate method

The American Diabetes Association offers a simple method of meal planning. In essence, it focuses on eating more vegetables. Follow these steps when preparing your plate:

  • Fill half of your plate with nonstarchy vegetables, such as spinach, carrots and tomatoes.
  • Fill a quarter of your plate with a protein, such as tuna, lean pork or chicken.
  • Fill the last quarter with a whole-grain item, such as brown rice, or a starchy vegetable, such as green peas.
  • Include “good” fats such as nuts or avocados in small amounts.
  • Add a serving of fruit or dairy and a drink of water or unsweetened tea or coffee.
Counting carbohydrates

Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. To help control your blood sugar, you may need to learn to calculate the amount of carbohydrates you are eating so that you can adjust the dose of insulin accordingly. It’s important to keep track of the amount of carbohydrates in each meal or snack.

A dietitian can teach you how to measure food portions and become an educated reader of food labels. He or she can also teach you how to pay special attention to serving size and carbohydrate content.

If you’re taking insulin, a dietitian can teach you how to count the amount of carbohydrates in each meal or snack and adjust your insulin dose accordingly.

Choose your foods

A dietitian may recommend you choose specific foods to help you plan meals and snacks. You can choose a number of foods from lists including categories such as carbohydrates, proteins and fats.

One serving in a category is called a “choice.” A food choice has about the same amount of carbohydrates, protein, fat and calories — and the same effect on your blood glucose — as a serving of every other food in that same category. For example, the starch, fruits and milk list includes choices that are 12 to 15 grams of carbohydrates.

Glycemic index

Some people who have diabetes use the glycemic index to select foods, especially carbohydrates. This method ranks carbohydrate-containing foods based on their effect on blood glucose levels. Talk with your dietitian about whether this method might work for you.

A sample menu

When planning meals, take into account your size and activity level. The following menu is tailored for someone who needs 1,200 to 1,600 calories a day.

  • Breakfast. Whole-wheat bread (1 medium slice) with 2 teaspoons jelly, 1/2 cup shredded wheat cereal with a cup of 1 percent low-fat milk, a piece of fruit, coffee
  • Lunch. Roast beef sandwich on wheat bread with lettuce, low-fat American cheese, tomato and mayonnaise, medium apple, water
  • Dinner. Salmon, 1 1/2 teaspoons vegetable oil, small baked potato, 1/2 cup carrots, 1/2 cup green beans, medium white dinner roll, unsweetened iced tea, milk
  • Snack. 2 1/2 cups popcorn with 1 1/2 teaspoons margarine

What are the results of a diabetes diet?

Embracing your healthy-eating plan is the best way to keep your blood glucose level under control and prevent diabetes complications. And if you need to lose weight, you can tailor it to your specific goals.

Aside from managing your diabetes, a diabetes diet offers other benefits, too. Because a diabetes diet recommends generous amounts of fruits, vegetables and fiber, following it is likely to reduce your risk of cardiovascular diseases and certain types of cancer. And consuming low-fat dairy products can reduce your risk of low bone mass in the future.

Are there any risks?

If you have diabetes, it’s important that you partner with your doctor and dietitian to create an eating plan that works for you. Use healthy foods, portion control and scheduling to manage your blood glucose level. If you stray from your prescribed diet, you run the risk of fluctuating blood sugar levels and more-serious complications.

March 25, 2021

Show references

  1. Evert AB, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37:S120.
  2. Eating patterns and meal planning. American Diabetes Association. http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html. Jan. 29, 2019.
  3. Create your plate. American Diabetes Association. http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/. Accessed Jan. 28, 2019.
  4. Wheeler ML, et al. Choose Your Foods: Food Lists for Diabetes. Alexandria, Va.: American Diabetes Association/Academy of Nutrition and Dietetics; 2014.
  5. Traditional American cuisine: 1,200 calories. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/educational/lose_wt/eat/menus_tac_1200.htm. Accessed Jan. 29, 2019.
  6. Bone health for life: Health information basics for you and your family. NIH Osteoporosis and Related Bone Diseases National Resource Center. https://www.bones.nih.gov/health-info/bone/bone-health/bone-health-life-health-information-basics-you-and-your-family. Accessed Jan. 16, 2019.
  7. Preventing type 2 diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes. Accessed Jan. 15, 2019.
  8. 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://health.gov/dietaryguidelines/2015/guidelines. Accessed Jan. 29, 2019.
  9. Diabetes diet, eating, and physical activity. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity. Accessed Jan. 29, 2019.
  10. American Diabetes Association. 5: Lifestyle management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42:S46.

See more In-depth

Products and Services

  1. Book: The Essential Diabetes Book


.

Diabetes and heart disease: What is the connection?

Research suggests a strong link between diabetes and heart disease. The conditions share many of the same risk factors, including obesity, high blood pressure, and high cholesterol.

Research has also discovered specific biological mechanisms associated with diabetes that increase the risk of heart disease.

Heart disease and stroke are the leading causes of death in people with diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Indeed, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. High blood sugar levels in people with diabetes may damage blood vessels, increase inflammation, and disrupt the normal blood flow in the heart.

Therefore, it is important for people with diabetes to reduce heart disease risk by managing their blood sugar, blood pressure, and cholesterol levels, eating a healthy diet, getting regular exercise, and taking medications as prescribed.

Heart disease refers to a group of conditions that affect the heart. It is the leading cause of death in the United States. In fact, it is responsible for roughly 1 in every 4 deaths, according to the Centers for Disease Control and Prevention (CDC).

The most common type of heart disease is coronary artery disease. It develops over time as the arteries that supply blood to the heart fill with plaque, which is made up of cholesterol and other substances.

Plaque causes the arteries to harden and narrow. This is known as atherosclerosis.

Narrowing of the arteries reduces blood supply to the heart, starving it of oxygen and nutrients. This causes the heart muscle to weaken over time, increasing a person’s risk of heart failure, heart attack, and other heart issues.

According to the American Heart Association (AHA), adults with diabetes are two to four times more likely to die from heart disease than those without diabetes.

People with diabetes often have many of the same risk factors associated with heart disease, including:

  • Having high blood pressure (hypertension): The AHA also say that having both hypertension and diabetes doubles a person’s risk of heart disease.
  • Having unhealthy cholesterol and triglyceride levels: This contributes to a buildup of plaque in the arteries and is a major factor in developing insulin resistance.
  • Having obesity, or a body mass index (BMI) over 30: Weight loss in people who have both obesity and diabetes can reduce cardiovascular risk and increase insulin sensitivity.
  • Not getting enough physical activity: Exercise helps:
    • maintain a moderate body weight
    • reduce blood pressure
    • support healthy blood sugar levels and lower A1C levels
    • reduce the risk of type 2 diabetes, heart attack, and stroke
  • Eating an unhealthy diet: Diets associated with both heart disease and diabetes are high in:

High sugar levels in the blood of people with uncontrolled diabetes can damage blood vessels over time. It can also damage nerves throughout the body, including those that control the heart and blood vessels.

Some studies suggest high blood sugar may increase inflammation in the blood vessels and disrupt normal blood flow in the heart. Long-term inflammation in the arteries results in a buildup of cholesterol and plaque. This means that the heart has to work harder to pump blood.

The longer a person has uncontrolled diabetes, the higher their risk of heart disease. Managing blood sugar levels reduces a person’s risk of complications.

Research in mice also suggests that people with diabetes may have lower levels of two enzymes that work to control the production of nitric oxide. Nitric oxide is a gas that relaxes the blood vessels.

These findings could eventually lead to new drugs for heart disease and diabetes aimed at preventing vascular damage. For now, however, more research is necessary.

Eating for diabetes and heart disease prevention involves choosing foods that reduce blood pressure, overall cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and fasting blood sugar levels.

In general, foods that are best for managing heart disease and diabetes are:

  • low in:
    • sodium
    • cholesterol
    • saturated fats (and free of trans fats)
  • high in:
    • antioxidants
    • vitamins
    • minerals
    • fiber

When grocery shopping, try to choose plenty of fresh, whole foods. Also, try to limit processed or packaged foods, which may be high in salt or sugar.

Some examples of good food choices include:

  • fresh fruits
  • fresh vegetables
  • low fat dairy
  • brown rice
  • legumes, such as chickpeas or lentils
  • whole grain bread or pasta
  • healthy fats, such as those in olive oil, avocados, nuts, and seeds
  • lean protein, such as skinless chicken, lentils, eggs, and fish

A registered dietitian can offer advice to manage weight and eat healthily for heart disease and diabetes.

There is no single test that diagnoses heart disease. A doctor will likely conduct a variety of tests to understand a person’s overall metabolic health. These tests may include:

  • Blood tests: These check total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides (a type of fat in the blood).
  • Echocardiograms: These use sound waves to produce images of the heart to see how well blood moves through it.
  • Transesophageal echocardiography (TEE): This also uses sound waves to get a picture of the heart. With TEE, a doctor can assess a person’s heart valves and check for blood clots.
  • Electrocardiograms (EKG): These measure the electrical activity of the heartbeat to look for any irregularities. With an EKG, a doctor can understand if a person’s heart is working too hard or if they’ve recently had a heart attack.
  • CT or CAT scans: These use a computer to produce cross-sectional images of the heart.
  • Stress tests: These can assess the heart’s response to exercise.

Managing blood sugar, blood pressure, and cholesterol levels is the most important way for a person with diabetes to take care of their heart. They can usually achieve this through diet, medication, exercise, and other lifestyle modifications.

Diet is essential in managing blood sugar levels. A person should try to focus on eating lots of fresh fruits, vegetables, whole grains, legumes, lean protein, and low fat milk. They should also try to limit processed, sugary, and fatty foods.

Medication is also recommended for some people. In clinical trials, many newer diabetes medications have significantly reduced the risk of heart disease and stroke.

For people with type 2 diabetes who are at higher risk of heart disease, the recently updated American Diabetes Association guidelines recommend that doctors prescribe sodium-glucose cotransporter 2 inhibitors, such as empagliflozin (Jardiance), or glucagon-like peptide 1 receptor agonists, such as liraglutide (Victoza).

A doctor may also recommend medications such as aspirin to reduce blood pressure, lower cholesterol, and prevent blood clots.

It is also critical for those who currently smoke to stop smoking.

For overall heart health, the AHA recommend getting at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous aerobic activity per week.

Moderate intensity aerobic activity includes such activities as:

  • brisk walking
  • dancing
  • tennis
  • cycling at a speed slower than 10 miles per hour (mph)

Examples of vigorous activities include:

  • hiking uphill
  • jogging
  • cycling at a speed faster than 10 mph
  • swimming laps

People should also aim to do a full-body muscle-strengthening activity, such as weight lifting or Pilates, at least 2 days per week.

Overall, a person should try to spend less time sitting. Over time, the goal is to increase the amount and intensity of physical activity.

There is a strong link between diabetes and heart disease. These conditions share common risk factors, including high blood pressure, high cholesterol, obesity, and more.

Over time, uncontrolled high blood sugar can damage the blood vessels and nerves that control the heart.

People with diabetes can significantly reduce their risk of heart disease by losing weight (if they have obesity or overweight), increasing physical activity, eating fresh, healthy foods, and taking prescribed medications.

Go Heart-Healthy | ADA

Even small changes to your cooking can help you reduce your risk for heart disease. You can protect your heart and blood vessels by:

  • Making food choices that include healthy fats and cutting back on those with less healthy fats.
  • Getting to and maintaining a healthy weight; it’s hard work, but well worth it.
  • Especially if you have high blood pressure, cutting down on foods that are high in sodium can make a difference.

Choose the right fats—in moderation

Foods like packaged (store bought) snacks, sweets, baked goods, fried foods, red meat and processed meats like bacon and sausage are high in saturated fat that raises your bad cholesterol.

Fresh vegetables, whole grains, and fruit are low in fat and high in vitamins, minerals and dietary fiber that can reduce your risk of heart disease. Nuts, avocados, and plant-based oils (like olive, peanut and safflower oils to name a few) provide you with healthy fats. When cooking, pay attention to the amount of oils and butter you add to lower the total calories to help with weight management. Butter is high in saturated fat, so try to cut back on the amount you use.

Include those omega-3s

Foods high in omega-3 fats are especially beneficial for your heart health and include “fatty” fish like salmon, albacore tuna, herring, rainbow trout, mackerel and sardines.

Other foods that provide omega-3 fatty acids include soybean products, walnuts, flaxseed and canola oil. Try to include these in your eating plan on a regular basis, but do pay attention to your portions because a small amount goes a long way.

Choose a healthy cooking method

You can cut down on the calories and unhealthy fats in your meals by broiling, baking, roasting, steaming, or grilling foods. When you fry foods, it increases the unhealthy fat and overall calorie content.

It is okay to use some fat when cooking, but don’t overdo it.

Homemade and fresh is best

Preparing foods at home gives you more control over what you are eating. Restaurant foods are almost always larger portions with more fat, sugar, and salt added to them.

Use the Diabetes Food Hub to get some ideas for healthy foods you can cook at home. It doesn’t have to be complicated, and it can save time and cost less, too.

More flavor with less fat, sugar and salt

Try using herbs and spices for flavor instead of salt, butter, lard, or other unhealthy fats. Here are a few ideas to add flavor to your food:

  • Squeeze fresh lemon juice or lime juice on steamed vegetables, broiled fish, rice, salads or pasta.
  • Try a salt-free herbs and spices. Fresh herbs are also a great choice.
  • Onion and garlic add lots of flavor without the bad stuff.
  • Try marinades for meat with healthy plant based oils, herbs and spices.

Trim the fat

Cut away visible fat from meat and poultry. Roast food on a rack to let the fat drip off. Choose cuts of meat that are lean and peel the skin off poultry before you eat it.

Substitute healthier ingredients in your favorite recipes

Regular ground beef | Try 90% lean ground beef or better yet, try lean ground turkey breast.

Lean ground beef is fewer calories, less saturated fat and less cholesterol.

Sour cream on tacos or in dips | Try plain yogurt (regular or Greek).

Plain yogurt has fewer calories and less saturated fat.

Butter or margarine when cooking | Try oils like olive, safflower, and other plant-based oils or reduce how much butter you use.

These oils have less of the bad fats and more heart-healthy fats.

Snack foods like crackers, chips, candy or baked goods | Try fruit with  plain yogurt, fresh vegetables and hummus, a slice of whole wheat toast and natural peanut butter, or nuts.

These options have less sodium, less saturated fat and zero trans fat.

Regular mayonnaise | Try mustard on sandwiches, or try yogurt or a combination of yogurt and less mayonnaise if used in dressing, sauces, and dips.

These options have fewer calories and more nutrients.

Bologna, salami or pastrami | Try sliced low-sodium turkey or roast beef. Or better yet, cook fresh chicken or turkey on the weekend and use throughout the week for meals.

These options have less total fat, less saturated fat and less sodium.

Diabetes and Heart Disease – familydoctor.org

People who have diabetes are more likely to get heart disease. When you have diabetes, your blood sugar level is often much higher than it should be. Too much sugar in the blood can cause damage to many parts of the body, including blood vessels. Some lifestyle habits may also raise the risk of heart disease.

Path to improved health

There are many things you can do to be proactive about your health. Taking care of yourself is especially important when you have diabetes. Some of the things you would do to control diabetes will also lower your risk for heart disease.

  1. Keep your blood sugar level under control.

Controlling your blood sugar level will lower your risk of heart disease. Many people who have diabetes check their blood sugar level every day. This confirms their medicines and/or insulin, diet, and exercise are working to keep their blood sugar in a normal range.

  1. Lose weight—and keep it off.

Diabetes, being overweight, and heart disease often go together. Losing weight helps a lot of health problems. For example, if you’ve been told your blood pressure is too high, losing weight can bring it down. If your blood sugar level has been hard to control, losing weight can help.

Weight loss is important if you have a lot of extra weight around your waist and abdominal area. People who tend to carry extra weight around their waist are more at risk for heart disease than people who have extra weight in the hips or thighs.

You don’t have to lose a huge amount of weight to lower your risk for heart disease. Losing even 10 pounds can help.

If you need help losing weight, ask your family doctor for advice. He or she can help figure out a safe and healthy plan for you.

  1. Lower your cholesterol level.

Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues, and produce certain hormones. All the cholesterol your body needs is made by your liver. Cholesterol in the food you eat (such as eggs, meats, and dairy products) is extra. Too much cholesterol in your blood can clog your arteries.

You’ve probably heard about “good” and “bad” cholesterol. “Bad,” or LDL (which stands for low-density lipoprotein), cholesterol can clog your arteries and lead to heart disease. “Good,” or HDL (which stands for high density lipoprotein), cholesterol carries unneeded cholesterol away from body tissues. This lowers your risk of heart disease.

If your doctor says your cholesterol level is too high, what can you do about it? It helps to lose weight and eat a healthy diet.

You should limit the amount of fatty and cholesterol-rich foods you eat. There are many cookbooks available that contain low-fat, low-cholesterol recipes and meal suggestions. If you need help figuring out how to change your diet, your doctor might refer you to a dietitian. A dietitian has special training in planning healthy diets.

If diet alone doesn’t lower your cholesterol, cholesterol-lowering medicines can help do that. You and your doctor can talk about these medicines. The medicine that’s best for you depends on your special needs and medical condition.

  1. Increase your physical activity.

Along with diet, exercise is very important for people who have diabetes. Diet and exercise work together to help your body work properly. If you’ve changed your diet to lose weight, exercising can help you lose weight faster.

You and your doctor can plan exercises that will work best for you and are safe for you. You don’t need a gym or expensive equipment to get good exercise. Brisk walking is great exercise. Climbing stairs instead of taking an elevator is another good thing to do.

Like eating a healthy diet, exercise will help keep your blood sugar level normal and can lower your risk of heart disease.

  1. Control your blood pressure.

People who have diabetes often also have high blood pressure. High blood pressure is a big risk factor for stroke. It also increases your risk for heart disease and kidney disease.

The same lifestyle changes that control blood sugar levels and lower your risk of heart disease may also keep your blood pressure at safe levels. Weight loss and exercise are important. The more weight you lose, the more you lower your blood pressure. It’s also important not to drink very much alcohol.

If your blood pressure doesn’t come down enough with diet and exercise, your doctor might have you take medicines to help.

  1. If you smoke, stop smoking.

Smoking is bad for everyone, but it’s even worse for people who have diabetes. That’s because it damages the blood vessels. If you have diabetes and you also smoke, you double your risk of getting heart disease. Worse still, if you keep smoking while you try to reduce other risks (such as losing weight), you won’t be able to exercise as much. This means you probably won’t lose the weight you need to.

Remember:

Diabetes and heart disease are related. Diabetes, being overweight, and having high blood pressure are related. But you can do a lot to help by your own efforts. Diet and exercise are good ways to control your blood sugar level, lower your blood pressure, and cut your risk of getting heart disease. When diet and exercise don’t help enough, medicines can help control blood sugar levels, lower cholesterol levels, and control blood pressure.

Things to consider

The higher your blood sugar, the higher your risk for developing heart disease. This means if your blood sugar is left uncontrolled, it can really damage your heart. If you have other risk factors, your risk increases even more. These risk factors include smoking or being overweight. Having these risk factors likely means you’ll develop heart problems sooner. And your heart problems will be more severe.

When to see a doctor

If you have diabetes, talk to your doctor about the best way to manage your blood sugar. Ask the doctor to recommend an exercise program for you. Ask your doctor to refer you to a dietician.

Questions for your doctor

  • Do I have risk factors that increase my likelihood for developing heart disease?
  • If I have type 2 diabetes, can I manage it with diet and exercise alone?
  • If I take medicine to control my blood sugar, do I really need to diet and exercise?
  • Should I also see a cardiologist if I have diabetes?

Resources

American Diabetes Association: Nutrition, Eating Doesn’t Have to Be Boring

American Heart Association: Healthy Eating

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

90,000 Diabetes mellitus and cardiovascular diseases

What are the most common heart complications from diabetes mellitus? Please tell us what type of patients (weight, age, gender, any other concomitant diseases) each of them is typical for.

Diabetes is a common so-called “popular disease” that poses a high risk to human health. It causes many serious complications. First of all, it should be noted the effect of this disease on the blood vessels of the whole body, and in particular the heart.

The state of metabolism in diabetes mellitus is such that high sugar significantly affects the blood vessels of the heart. Complications of blood vessels due to diabetes are classified as macro- and microvascular (diabetic micro- and macroangiopathy). Microvascular diseases are diseases of small diameter vessels, for example, capillaries (small vessel desease), and macrovascular diseases are diseases of veins and arteries.

Macrovascular pathologies lead to various cardiovascular diseases, the most common of which are atherosclerosis, coronary heart disease (ischemic heart disease), heart attack and stroke.Almost three quarters of patients with diabetes die due to the consequences of macrovascular pathologies.

Another typical problem of patients with diabetes mellitus is high blood pressure, which can result in heart failure and, which has been increasingly diagnosed in recent years, atrial fibrillation. 40-50% of diabetics suffer from atrial fibrillation. It depends on both age and gender. With age, the risk of cardiovascular disease increases, and statistics by gender depend on the specific disease.

65% of patients die from heart attacks or other cardiovascular diseases. Conversely, according to statistics, 75% of patients suffering from cardiovascular diseases have diabetes mellitus. Thus, diabetes mellitus is one of the most important factors affecting the development of cardiovascular diseases. According to WHO statistics, many more patients die from heart failure than from cancer. Every second diabetic is diagnosed with a heart attack, and some patients do not even know that they had this condition.This is due to the fact that diabetes mellitus affects the nerve endings, including those that are on the surface of the heart, diabetic neuropathy of the heart (cardiac neuropathy) occurs, as a result of which patients do not feel a heart attack, which can become even more dangerous. In another way, it is called silent myocardial ischemia. It can only be diagnosed by cardiac sonography or ECG. Due to massive damage to the heart nerves, patients do not feel like they have had a heart attack.

With regard to atrial fibrillation, the causes of its occurrence are not entirely clear. However, it is known that diabetes mellitus plays a huge role in the occurrence of atrial fibrillation. Also, such a serious disease as a stroke cannot be ruled out. Patients suffering from diabetes mellitus, unfortunately, often develop stroke, which, as we know, is also a very dangerous complication.

A recent report to the German Diabetes Society stated that atrial fibrillation and heart failure are now the most dangerous for people with diabetes.This is true?

Yes, that’s right. These diseases are very dangerous, however, you should not underestimate the role of stroke and heart attack, as mentioned above. Atrial fibrillation is the most common heart rhythm disorder and one of the most common causes of outpatient and inpatient hospital stays (among cardiovascular diseases). Diabetes mellitus is an additional risk factor for atrial fibrillation and heart failure.

What happens to the walls of blood vessels and to the heart itself in chronic hyperglycemia? What are these processes like?

A large amount of sugar in the body leads to the deposition of cholesterol on the walls of blood vessels.The vascular lumen gradually narrows, which over time can lead to atherosclerosis. The blood becomes thicker, which increases the risk of thrombosis. Diabetic cardiac neuropathy is another typical complication of the heart in patients with diabetes mellitus, which was mentioned earlier. With this violation, the function of the heart muscle suffers. Thus, patients suffering from diabetes for a long time are even more susceptible to cardiovascular pathologies, since the vessels are affected by improper metabolism for a long time.

Is there a relationship between the “experience” of diabetes mellitus and sugar compensation and the severity of diseases of the cardiovascular system?

Yes, there is undoubtedly a dependency. The approach to the treatment of patients with diabetes mellitus has changed markedly in recent years. Previously, it was believed that it is necessary to reduce sugar in all patients and this will lead to an improvement in the condition and help to avoid the consequences of diabetes. Recent studies have shown that lowering blood Hba1c (glycated hemoglobin) is not a viable therapy for all patients.Advance Accord VADT studies have shown that it makes sense to treat only a specific group of patients. Thus, an intensive decrease in glycated hemoglobin is necessary only for patients with a low “experience” of diabetes who do not suffer from cardiovascular diseases. In addition, if you intensively reduce glycated hemoglobin in the blood in patients with long-term diabetes mellitus, the risk of heart failure increases. Therapy for patients with diabetes mellitus is increasingly striving for individualization.Treatment of long-term diabetes should be carried out with “mild” methods, with great care, since due to the fact that sugar has been increased for many years, many internal organs are damaged. In patients with newly-onset diabetes mellitus, it is possible to achieve healthy person’s performance levels by applying the method of intensively lowering blood sugar.

Is it possible to avoid complications in the heart and blood vessels at all if diabetes is well compensated?

On average, patients with diabetes mellitus live 10-15 years less.Cardiovascular diseases play an important role in these statistics. However, if the diabetes is well compensated, it is always a great benefit for the patient. It is especially important to diagnose this disease in the early stages. This allows you to significantly minimize the risks of complications, both on the heart and blood vessels, and on other internal organs. Statistics show that patients with well-compensated diabetes tend to have the same life expectancy as healthy people.

What effect does poorly compensated diabetes have on the heart and blood vessels?

As mentioned above, diabetes mellitus poses a huge risk for the occurrence of cardiovascular disease.This risk increases if diabetes is poorly compensated. Most often, patients with diabetes mellitus are overweight and obese internal organs. This suggests that lipids will be elevated in the blood. This is detrimental to blood vessels. Sugar, which is deposited in blood vessels, plus lipids, platelets – all this leads to the formation of vascular plaques, which narrow or even clog the blood vessels, and this, in turn, already leads to various cardiovascular pathologies.

How are drugs to support heart function and drugs to lower blood sugar combined? Can they be taken at the same time, are there any other admission rules?

It is more correct to talk about the compatibility of medicines for diabetes mellitus and cardiovascular diseases in principle.In recent years, many studies have emerged aimed at identifying the interaction of diabetes medications and cardiovascular diseases. 10 years ago there were only 3 medications that were prescribed for diabetes mellitus, today there are many of them. All of them, of course, are tested for the effect on internal organs and compatibility with other medicines. The most popular drug is GLP 1. It is compatible with many medicines that patients take in the presence of heart failure or heart attack and has almost no contraindications.One of the most important benefits of this drug is the weight loss factor. Therefore, it is very popular with patients. However, there are also medications that are contraindicated in patients with heart failure. For example, Pioglitazone can make the condition worse if you have this condition.

As far as heart medications are concerned, here it is more likely to pay attention not to how they affect sugar and are combined with medications for diabetes mellitus, but to the kidneys, which are very often damaged in patients with diabetes.This applies, for example, to medicines for high blood pressure, which, due to their diuretic effect, exert a strong stress on the kidneys.

Have any innovative methods of treating the cardiovascular system in people with diabetes appeared recently? If so, please tell us more about this.

As we mentioned above, the choice of drugs for diabetes mellitus today is much wider than, for example, 10 years ago. More improved insulin pumps, devices for determining or monitoring sugar levels.For example, non-contact glucometers have appeared, which allow you to control blood sugar without taking blood. These devices can be connected to smartphones, which allows the patient to constantly monitor the state of sugar. Control is always very important and is an integral part of therapy. As for the latest methods, I will once again mention the GLP-1 medication, which needs to be injected depending on the doctor’s prescription – once a week, month or daily. It is a non-insulin drug, so it doesn’t contribute to weight gain, or even weight loss.This is of course a huge advantage, as the risks of complications are reduced. GLP-1 is compatible with all other medications for lowering blood sugar, and research is underway to find its compatibility with insulin.

Austria is in one of the first places in the world for scientific developments in the treatment and diagnosis of diabetes mellitus.

Are there any typical misconceptions about the state of the heart and blood vessels in people with diabetes?

I rarely had to deal with the misconceptions of patients about the state of the heart and blood vessels, rather with a lack of information or its complete absence.Patients underestimate the complications of diabetes on the heart and blood vessels. It is important here to mention common common misconceptions when it comes to diabetes. For example, that patients develop diabetes mellitus solely through their own fault, when they “start themselves up”, lead an immobile lifestyle, and eat improperly. It is not always so. Obesity and lack of movement are significant risk factors, but genetic factors still play a decisive role. Or many people think that diabetes is a disease of the elderly, which is also a misconception.Type 2 diabetes is common in people who are in their 40s or even younger. Many misunderstandings are encountered when type 1 diabetes is distinguished from type 2. Some believe that the most “terrible” diabetes is type 1 diabetes, which occurs in childhood, from which patients die early. This is not entirely true. Type 1 diabetes is an autoimmune disease in which cells in the pancreas that are responsible for the production of insulin are destroyed. It is assumed that this may be due to the fault of some viruses.Life expectancy and prognosis of the disease still depend on the correct therapy and discipline of the patient with all types of diabetes mellitus.

What will help patients with diabetes maintain heart and vascular health? Vitamins, dietary supplements or giving up some habits

Prevention plays a huge role, both for patients with diabetes mellitus and for healthy people. This avoids many unpleasant consequences both on the cardiovascular system and on other organs.Prevention of diabetes mellitus is complex: it consists in maintaining a healthy lifestyle – giving up bad habits, healthy eating, physical activity, as well as in conducting systematic preventive examinations to identify the risks of cardiovascular diseases. These preventive examinations include extended laboratory tests, cardiac ultrasound, ECG, ergometry, 24-hour pressure monitoring and cadiogram, vascular diagnosis, and a visit to a cardiologist.We offer all this to patients at the Döbling Private Clinic.

What changes should people with diabetes make in their diet to help their heart without raising their glucose at the same time?

There is a so-called “food pyramid” that is recommended for all patients with diabetes mellitus. In this pyramid it is written what foods and their quantity are recommended to be eaten.

The basis of such a pyramid is products from grains or cereals – 6-11 servings per week, then vegetables – 3-5 servings, dairy products – 2-3 servings, and at the very top of the pyramid are fruits and sugar-containing foods, which either should be avoided. or use in very small portions with extreme caution.

If you have any complaints or questions, please contact our specialists and make an appointment!

Pin

Döbling Private Clinic
Tel .: +43 1 360 66-8001 or -7755
E-mail: [email protected]

We speak Russian!

Send request

Do you have any questions? – Write to us!
You can ask a question in Russian. The answer will also be sent to you in Russian.

90,000 Ischemic heart disease in diabetes mellitus

Diabetes mellitus, which is characterized by high blood sugar levels, can, over time, cause various disturbances in the normal functioning of the body, including damage to the blood vessels. If this damage occurs in the coronary arteries, it increases the likelihood of developing coronary heart disease. At the initial detection of type II diabetes mellitus, it turns out that about 50% of these patients already suffer from an asymptomatic form of coronary heart disease.The presence of diabetes mellitus (both the first and the second type) increases the risk of coronary heart disease by 4-6 times.

The heart is a hollow muscular organ that pumps blood throughout the body. Coronary arteries are vessels that directly supply blood to the heart. These arteries can narrow or become completely blocked due to the gradual growth of fatty deposits (called plaques) on the vessel wall. This phenomenon, called atherosclerosis, is the cause of coronary artery disease.When the lumen of the artery becomes too narrow, blood flow decreases and the heart does not receive the required amount of oxygen. This is called cardiac ischemia. The painful sensations experienced in this case are called angina pectoris or angina pectoris. In this case, there is a risk of a heart attack, which develops in the event of a critical lack of oxygen in the heart muscle.


Symptoms of coronary heart disease

About one third of patients with coronary artery disease may not experience any symptoms.Others may be disturbed by the following symptoms:

  • chest pain;
  • pain in the arm, lower jaw, back;
  • 90,099 shortness of breath;

  • nausea;
  • excessive sweating;
  • palpitations or cardiac arrhythmias 90 100

Risk factors for coronary heart disease

The exact cause of coronary artery disease is unknown, but certain risk factors can be identified.One of them is diabetes mellitus, the others include:

  • high blood pressure;
  • overweight;
  • high blood cholesterol levels;
  • 90,099 smoking;

  • eating fatty foods;
  • insufficient physical activity 90 100

Diagnosis of ischemic heart disease

You may have done some tests before, such as electrocardiography (EKG) to measure heart rate and electrical activity at rest, exercise ECG, chest x-ray and blood tests, all of which can reveal possible heart disease.

Coronary angiography

Your doctor may recommend coronary angiography (an X-ray of the blood vessels of the heart). This procedure is done by catheterizing the arteries. Catheterization is performed under local anesthesia in an angiographic laboratory equipped with a special angiographic unit and monitors. On the monitors, the doctor can see exactly where and to what extent the coronary arteries are affected, and choose the most effective method of treatment for you.

During this procedure, a very thin, flexible tube called a catheter is inserted into an artery in your arm or leg and advanced towards your heart. A contrast medium is then injected through the catheter to make the coronary vessel visible under X-rays. X-rays show how well your heart is working.

Catheterization is performed in an angiographic laboratory equipped with a special angiographic unit and monitors. The day before your procedure, you may be asked to refrain from eating or drinking after midnight.

Your skin will be shaved at the catheter insertion site (groin or arm). Small electrodes for monitoring your heart rate will be attached to your shoulders and side during the procedure. Then you will be covered with sterile sheets. Do not touch them in order not to break sterility. It is important that you remain awake during the procedure and are ready to move or take a deep breath as requested by the doctor, which will make the image clearer.

After treatment of the catheter insertion site with an antiseptic, local anesthesia of this area is performed.The doctor will then pass the catheter to your heart. You will not feel it, but you will be able to see the catheter on the monitor. When the catheter is in the heart, the heart rate may change: slow down or become faster. This is normal, no need to worry.

The contrast agent is injected through the catheter and helps the doctor see how well your heart is working. You may feel a flush of heat immediately after the contrast medium is injected. This is a normal reaction and it goes away quickly.The doctor will scan the arteries from multiple angles. Depending on the results, the doctor may decide whether to perform the treatment procedure immediately or schedule a re-examination at a later date.

Treatment of coronary heart disease (balloon angioplasty, coronary stenting)

Balloon angioplasty

This procedure, also called percutaneous transvascular coronary angioplasty (PTCA), uses a special balloon catheter to open a narrowed blood vessel.The balloon inflates in the area of ​​constriction and, pressing the plaque into the vessel wall, opens the lumen of the coronary artery. This reduces the risk of myocardial infarction.

The procedure usually takes no more than an hour, and patients are discharged in the evening of the same day or in the morning of the next.

Balloon angioplasty

  • The first stages of angioplasty look the same as in the diagnostic procedure (preparation, catheter placement and contrast medium injection).
  • The doctor passes the guide through the catheter to the damaged area of ​​the artery, observing this on the monitor (a) 90 100
  • The balloon is inserted along the guide and installed at the site of the vessel blockage (b).
  • The balloon inflates, pressing the plaque into the artery wall. The balloon may inflate several times before being removed (c).
  • On the monitor, the doctor can see and evaluate the result. After removal of the balloon, fat deposits remain pressed into the arterial wall, which allows the blood supply to the heart to be restored (d).

According to statistics, re-narrowing of the artery in the same place occurs in about half of patients. This phenomenon is called restenosis and manifests itself mainly in the period from 3 to 6 months after balloon angioplasty.

Coronary stent implantation

To reduce the risk of restenosis, your doctor may recommend a procedure called coronary stenting.

Coronary stent implantation

  • In this procedure, a small, balloon-expandable, wire-mesh steel tube called a stent is placed in the affected area of ​​the artery.The stent supports the walls of the artery, thereby improving the blood supply to the heart.
  • A stent attached to a balloon catheter is inserted into the artery and placed at the site of the vessel blockage (a).
  • The balloon is then inflated. The stent expands and presses tightly into the arterial wall (b).
  • One or more stents may be required depending on the length of the constriction. The doctor can use X-rays to make sure that the stent is in place. To be sure that the stent has expanded correctly, the balloon can be inflated several times.Finally, the balloon is deflated and removed from the artery along with a guidewire and a guide catheter. The stent remains in the vessel permanently, keeping the artery open (c).
  • After the procedure, the doctor will press the catheter access site into the artery with his hand.

In case the access was made through the arm, the doctor can suture. Nurses will closely monitor your vital signs. If the catheters were inserted in the groin, you will be advised to rest in bed for a few hours.After returning to the room, you will be able to eat and drink as usual. Due to the fact that the contrast agent used in the study is excreted through the kidneys, urination may be more frequent than usual.

The length of stay in the hospital depends mainly on the rate of healing of the puncture site of the artery. Most patients are discharged the day after the procedure.

After returning home, you must strictly follow the doctor’s recommendations. Take all your prescribed medications and see your cardiologist regularly.Eat a low fat diet. It is also very important to quit smoking and exercise regularly. The above lifestyle changes can help reduce the risk of heart disease.

Diabetes mellitus and coronary heart disease

Unfortunately, cardiovascular diseases are more common in people with diabetes. Of course, such complications, like all others, only develop if diabetes is not controlled.

We have already said that with a long-term chronic increase in blood glucose, variability in blood glucose levels (that is, with “jumps” from high to low glucose values ​​and vice versa), nerves that regulate the work of the heart can be damaged. In this case, various violations of the heart rhythm develop and even the absence of pain in heart attacks can be observed. And pain is a signal for action, if it is not there, the person does not know that something bad is happening and you need to seek help.

Many people think that coronary artery disease occurs only in middle-aged and elderly people. However, diabetic patients under the age of 30 can develop serious cardiovascular disease. The risk of developing heart disease is increased in both type 1 and type 2 diabetes. It is 5 times higher in middle-aged men and 8 times higher in women with diabetes.

Why is there pain in the heart at all and what does it mean?

  • With a long-term elevated blood glucose level, not only nerves are damaged, but also vessels, both small (capillaries) and large (aorta and large arteries that carry blood to the heart, kidneys, legs and other organs and tissues).The vascular wall changes, thickens.
  • Excess cholesterol in the blood leads to the formation of cholesterol (atherosclerotic) plaques, which narrow the lumen of the vessel.
  • Also, blood clots can form in the vessels – blood clots. They arise at the site of damage to the vessel and atherosclerotic plaque. A thrombus also narrows the lumen of the vessel, but when the vessel is loaded (for example, with high blood pressure), it can break off and close the lumen of another, smaller blood vessel.
  • For the heart to function properly, it needs a sufficient amount of oxygen and nutrients. If the lumen of the supplying vessels is narrowed, then the amount of blood flowing to the heart decreases.
  • During physical exertion, strong emotions, stress, heat, cold, and sometimes even at rest, the heart in such “limited” conditions cannot cope with work, there is a spasm of the cardiac vessels, which further impairs the nutrition of the heart muscle. This is how pain arises. This condition is called coronary artery disease.Ischemia is a lack of nutrition.

What are the symptoms?

Angina – chest pain. Angina pectoris is a symptom of coronary artery disease and can take two forms: stable and unstable.

• People with stable angina may notice dull, severe pain or discomfort in the chest, as if someone is pressing on it (the people call this condition “angina pectoris” for a reason). The same painful sensations may occur in the hand, shoulder blade, neck, lower jaw.The pain can be caused by physical activity, stress or cold weather, and it will go away within a few minutes.


Tell your doctor immediately if you notice signs of angina pectoris!


• With unstable angina, long-term pain occurs that does not go away for more than 5 minutes or may even appear at rest. In this case, you need to see a doctor as soon as possible.

• A blood clot can completely block the lumen of the vessel, thereby blocking the flow of blood to a larger or smaller area of ​​the heart.This situation is very dangerous and leads to the development of myocardial infarction – the death of the heart muscle or part of it.

Shortness of breath – shortness of breath, heavy, rapid breathing

Arrhythmia – heart rhythm disturbance

Swelling legs in the evening

Changes in the ECG – your doctor will tell you about them in detail

The main thing to remember is that such terrible changes in blood vessels and heart can be prevented!

90,000 What people with diabetes and heart disease need to know

Type 2 diabetes can increase the risk of cardiovascular disease by two to four times; statistics also show that more than half of patients with type 2 diabetes mellitus die from cardiovascular diseases.What to do? Effectively treat the underlying disease and minimize the risk of diabetes and cardiovascular disease!

Diabetes mellitus is a chronic metabolic disease characterized by high blood sugar (glucose) levels and associated health problems. Normal glucose levels are between 3.5 and 5.5 mmol / L. In the case of diabetes, the blood glucose level is very high. The cells of the body use glucose for energy. In order for cells to receive energy, glucose from the blood must enter the cell.This process requires insulin. Insulin is a hormone produced by the β cells (beta cells) of the pancreas. Without insulin, glucose remains in the blood.

There are two clinical forms of diabetes mellitus. Type 1 diabetes mellitus is characterized by a complete absence of insulin, since the pancreas does not produce insulin. Type 1 diabetes mellitus is more likely to develop in childhood or adolescence, although manifestation is possible later. Type 2 diabetes, in turn, is characterized by insulin resistance and impaired insulin secretion in the pancreas, which causes blood sugar levels to rise.This type of diabetes mellitus occurs most often (in 90–95% of cases).

In the development of type 2 diabetes mellitus, heredity plays an important role, but often this disease develops in people with a sedentary lifestyle, with increased body weight, high blood pressure and high blood cholesterol levels, as well as in smokers. The combination of these risk factors and elevated blood sugar levels contributes to the development of atherosclerosis, thus causing calcification and vasoconstriction (stenosis) (see table).picture).

Vascular changes in coronary heart disease.
Source: WikiJournal of Medicine 1 (2): 10.

Such narrowing can be in any vessel, but most often develop in the coronary, or coronary, arteries of the heart, which supply blood to the heart, allowing it to work. This is called coronary heart disease. Because of this disease, the heart muscle does not receive enough oxygen, which can cause exertional angina (chest pain during exertion), myocardial infarction, when the affected vessel is completely blocked and causes death (necrosis) of the heart muscle, or even sudden death.

People with diabetes mellitus have a 6–8 times higher risk of heart failure than the average population. The most common causes of heart failure in patients with diabetes mellitus are coronary heart disease, especially previous myocardial infarction, and diabetic cardiomyopathy, which develops in about 12% of patients with diabetes.

Type 2 diabetes, which has remained untreated for a long time, can also contribute to vision problems, neurological diseases, and kidney failure.Diabetes complications increase overall morbidity by 3–5 times, cause progressive disability and reduce quality of life.

How can I help myself?

First, you need to know the risk factors for cardiovascular disease and diabetes and, if necessary, change your lifestyle and take the necessary medications. Most of the risk factors for cardiovascular disease and diabetes mellitus can be changed, so they can be reduced or eliminated.

  • Smoking is strictly prohibited !!! In the last century, smoking-related diseases have killed about 100 million people. Smoking raises the heartbeat, raises blood pressure, and damages the walls of the arteries. In Latvia, about 1,500 leg amputations are performed among smokers per year. When a person quits smoking, the risk of cardiovascular disease and stroke is halved in a year. The risk continues to decrease and over time reaches the same level as in people who have never smoked.
  • Control your blood sugar! To reduce the risk of cardiovascular disease and diabetes, the level of glycated hemoglobin in the blood (HbA1c) in people with diabetes should be below 7.0%. If a person is newly diagnosed with type 2 diabetes and no cardiovascular disease, the doctor may set a stricter target for HbA 1c : 6.5% or lower. A wide variety of medications are available for glycemic control today, but not all of them are safe for patients with cardiovascular disease.Ask your doctor about the appropriate treatment.
  • Control your blood cholesterol levels! In people with diabetes and a very high risk of cardiovascular disease, low-density lipoprotein cholesterol (LDL), or “bad” cholesterol, should be below 1.8 mmol / L, or it should be reduced by 50% of the starting LDL level. if it was equal to 1.8-3.5 mmol / l. For people with diabetes and a high risk of cardiovascular disease, the LDL target is 2.6 mmol / L or less; if the initial LHNP level is 2.6–5.1 mmol / L, it should be reduced by 50%.The doctor determines the risk of cardiovascular diseases for each person individually. Effective drugs are available to lower cholesterol levels – statins, which lower lipid levels and at the same time reduce the risk of developing cardiovascular diseases. The doctor decides on the most effective treatment and dosage.
  • Monitor your blood pressure! The blood pressure of a healthy person is 120/80 mm Hg. Art. or less. To reduce the risk of cardiovascular disease in patients with diabetes mellitus, the blood pressure must be below 140/85 mm Hg.Art. Blood pressure can be measured quickly and easily at home, at the pharmacy, or at your family doctor. To reduce blood pressure, you need to quit smoking, eat less salt, increase the amount of physical activity, and reduce weight. Medication or combination antihypertensive therapy may be needed to lower blood pressure. Only the doctor decides on the appropriate treatment.
  • Physical activity – not less than 30 minutes a day! Vigorous walking and exercise not only significantly reduce weight, but also reduce the risk of developing cardiovascular disease.It is important to move actively, to walk quickly or to run slowly (so that you can talk with the running side by side) for at least 30 minutes a day!
  • Maintain a healthy weight! Overweight and obesity are a serious risk factor for cardiovascular disease and diabetes. You can determine the body mass index using the formula: BMI = weight (kg) ÷ height (m) 2. If the index is 18.5-24.99, then a person’s weight is normal. If 25-29.99, then the person is overweight. And if more than 30 – then a person is obese, which poses a serious danger to the health of the heart and blood vessels, and even life!
  • Eat Smaller and Smarter! You need to eat more vegetables, fruits, oily sea fish, whole grains, lean meat, low-fat dairy products.Avoid fatty meats, whole milk and fatty dairy products, cakes, rolls, and foods high in sugar. Reduce your salt intake! It is better to eat less than too much. You need to drink 6-8 glasses of water a day. If you drink alcohol, then only high quality and in small quantities!

Examination and treatment

Since there is no absolute insulin deficiency in type 2 diabetes, the person will not have complaints for many years.In order to notice changes in the body on time, you need to take blood tests less than once a year (unless the doctor said otherwise). Blood pressure, exercise tests, and echocardiography should be checked regularly, as often as your doctor prescribes.

There is no one-size-fits-all treatment for all people with cardiovascular disease and diabetes or their risk factors. Therefore, close cooperation is very important not only between doctor and patient, but also between different specialists – family doctor, endocrinologist, cardiologist.It is important to individually assess the risks of each person, set a goal and find the most appropriate treatment.

When choosing medications, the physician takes into account the extent to which the medication effectively controls a certain factor and whether the medication has been clinically proven to be effective, as well as whether the medication reduces the risk of myocardial infarction, stroke or cardiovascular death.

Be careful – listen to your doctor, ask if the goals or methods of treatment are unclear, be responsible, change your habits and take medications as the doctor prescribed.In case of complaints, contact your doctor and together make a decision and change therapy. Good luck!

Facts

  • More than 360 million people worldwide have type 2 diabetes.
  • More than 85,000 people have been diagnosed with type 2 diabetes mellitus in Latvia.
  • 90–95% of patients with diabetes mellitus in Latvia have type 2 diabetes mellitus.
  • In Latvia, 5,000 people are diagnosed with type 2 diabetes every year.
  • At least 50% of people with diabetes do not know they are sick.▪

The author of the article is Iveta Bayare. Materials prepared by Prof. Adreis Erglis, Associate Professor Karlis Trushinsky, Dr. Sandra Jaegera and Dr. Evija Knoka

were used
90,000 Nutritional therapy for ischemic heart disease

Ischemic heart disease (CHD) is extremely widespread and is the leading cause of death in men over 35 and all people, regardless of gender, over 45. Among the risk factors for the development of cardiovascular diseases, in addition to hyperlidemia (elevated cholesterol levels – low-density lipoprotein cholesterol and cholesterol), obesity, eating disorders, and smoking are most common.Low physical activity, alcohol, diabetes mellitus, postmenopausal women, etc.

Excessive consumption of animal fats, refined carbohydrates, excess calories negatively affect the metabolism, exerting a pronounced hyperlipidemic (increased levels of cholesterol and triglycerides in the blood) effect, increasing blood clotting.

On the contrary, vegetable fats, rich in polyunsaturated fatty acids (PUFA), have a beneficial effect on lipid metabolism.

Principles of diet therapy

  • The total fat content should be about 70-80 g / day (vegetable oils account for 20-30 g of this amount).
  • Limit foods containing a large amount of cholesterol (offal, fish roe, egg yolk, fatty meats, poultry, high-fat dairy products, etc.).
  • Use sources of PUFA of the oimega-3 family: sea fish (mackerel, sardine, herring, ivasi, halibut, etc.) and vegetable oils (flaxseed, soybean, rapeseed, mustard, sesame, walnut, etc.), which reduce the increased level of lipids in serum (especially triglycerides).
  • Eat more plant-based foods such as grains, legumes, vegetables, fruits, nuts, which are a source of plant protein (mainly legumes).
  • Use products containing vitamins B6 (soy, bran bread, seafood, etc.), C (rose hips, black currants, strawberries, gooseberries, oranges, apples, cabbage, bell peppers, parsley, dill, green onions, etc.) …
  • It is necessary to limit the diet of table salt to 3-5 g per day.
  • Eat foods rich in potassium (dried apricots, raisins, prunes, peaches, bananas, apricots, pineapples, rose hips, potatoes, cabbage, eggplants), magnesium (soy, oatmeal, buckwheat, millet; walnuts, almonds; bran), iodine , especially with increased blood clotting (seaweed, squid, scallop, shrimp, mussels, etc.)).
  • The total volume of free fluid should be 1.5 liters per day. The distribution of the diet during the day should be even, the number of meals should be 5-6 times a day. The last meal is no later than 2-3 hours before bedtime. Ensuring the correct technological processing of products and medical dishes (removal of extractive substances, exclusion of fried, canned foods, hot spices, table salt for culinary purposes).
  • Depending on the severity of hyperlipidemia in ischemic heart disease, recommendations for the use of products are built in accordance with the 1st and 2nd stages of the lipid-lowering diet.
  • Overweight patients with coronary artery disease should limit or exclude from the diet bread, sugar, cereals, pasta and potatoes. By agreement with the doctor, 1-2 times a week, different contrasting (fasting) days are used (fish, cottage cheese, apple, vegetable, etc.).

Type 2 diabetes mellitus, arterial hypertension and the risk of cardiovascular complications | Kislyak

Diabetes mellitus (DM) is one of the most common chronic diseases and represents a serious public health problem, since diabetes is associated with a decrease in the quality of life, early disability and high mortality.In all countries, there is an increase in the incidence of diabetes mellitus. The number of patients with diabetes mellitus is currently approaching 200 million people, and the bulk (90%) of patients are patients with type 2 diabetes. According to forecasts, if such growth rates are maintained, by 2010 the number of patients with diabetes mellitus on the planet will reach 221 million people, and by 2025 more than 300 million people are expected to have diabetes mellitus [1].

Type 2 diabetes mellitus is characterized by the development of severe disabling complications leading to complete disability and premature mortality.According to the Cost of Diabetes in Europe – Type 2 (CODE-2) study, which studied the prevalence of various diabetic complications in patients with diabetes mellitus (the average age of the surveyed is 67 years), 59% of patients had complications, and 23% of the surveyed had 2, and 3% – 3 complications of type 2 diabetes. Cardiovascular pathology was found in 43%, cerebrovascular – in 12% of patients. It was found that with existing type 2 diabetes mellitus, the risk of developing cardiovascular pathology is 3-4 times higher than in its absence.Patients with type 2 diabetes mellitus have the same degree of risk of premature death as patients who have had myocardial infarction without diabetes mellitus. In most developed countries of the world, diabetes mellitus ranks 3-4th in the overall structure of mortality, is the leading cause of blindness and visual impairment in the adult population.

Despite the advances in medicine, diabetes mellitus remains one of the priority diseases, the social and medical significance of which is obvious. The main cause of mortality in diabetes mellitus is vascular complications, in the pathogenesis of which the main role is played by hyperglycemia and its metabolic effects.The risk of macro- and microangiopathy in patients with type 2 diabetes mellitus directly depends on the level of glycemia [2]. An analysis of the results of the United Kingdom Prospective Diabetic Study (UKPDS) showed that an increase in the level of glycated hemoglobin by only 1% increases the risk of mortality associated with diabetes by 21%, myocardial infarction – by 14%, peripheral vascular disease – by 43%, microvascular complications – by 37%, the development of cataracts – by 19% [3]. The incidence of any complications of diabetes mellitus, including death of patients, increases in proportion to the average level of glycated hemoglobin HbA1c.

The mortality rate from cardiovascular diseases among patients with type 1 and 2 diabetes mellitus is 35 and 75%, respectively. Life expectancy in patients with type 2 diabetes mellitus is shorter, and mortality (taking into account age) is almost two times higher than in patients without this disease.

The high cardiovascular risk in diabetes is due to several factors. First, many risk factors for cardiovascular disease (CVD) are present in patients already at a stage prior to diabetes (Fig.one). It is known that insulin resistance (IR) plays a leading role in the development of type 2 diabetes mellitus. In the modern interpretation, insulin resistance should be understood as a primary selective and specific violation of the biological action of insulin, accompanied by a decrease in glucose consumption by tissues (mainly skeletal muscles) and leading to chronic compensatory hyperinsulinemia. In conditions of insulin resistance, there is a decrease in the supply of glucose to insulin-dependent tissues (muscle, adipose), an increase in the production of glucose by the liver, which contribute to the development of hyperglycemia.With an adequate ability of β-cells to compensate for the increase in glucose levels by excess production of insulin, the state of normoglycemia remains. However, subsequently, with an increase in the severity of insulin resistance, the insulin-secretory capacity of β-cells is depleted and they cease to cope with the increasing glucose load. Initially, this is manifested by the development of hyperglycemia in the postprandial (after eating) period. An example of postprandial hyperglycemia is impaired glucose tolerance.With further progression of disorders of insulin secretion by β-cells of the pancreas and persisting insulin resistance, impaired glucose tolerance turns into type 2 diabetes mellitus. It was found that annually impaired glucose tolerance turns into type 2 diabetes mellitus in 4–9% of patients. Thus, macrovascular complications, which are a manifestation of CVD, occur much earlier than the development of a complete picture of diabetes mellitus.

Secondly, factors such as obesity, arterial hypertension and dyslipidemia can play a decisive role in the development of complications of diabetes mellitus caused by atherosclerosis.Many people with type 2 diabetes have multiple risk factors for cardiovascular disease before diagnosis, including, in addition to diabetes, hyperlipidemia, hypertension, and overweight. So, every second patient with diabetes mellitus is diagnosed with dyslipidemia, and almost all patients in this category are overweight. This “polygenic syndrome”, which includes hypertriglyceridemia, a decrease in the level of high density lipoproteins, abdominal obesity, arterial hypertension (AH), impaired fasting glucose, as a separate concept was first introduced into scientific use under the names “metabolic trisyndrome”, “abundance syndrome” and later as “metabolic syndrome”.At first, the possible connection between the components of this syndrome was ignored by many until in 1988 G.M. Reaven et al. did not put forward a hypothesis about insulin resistance as the root cause of the development of the so-called metabolic syndrome. The great interest in the problem of metabolic syndrome in the last decade is explained by its wide distribution in the population (up to 20%), as well as by the fact that all its components belong to the established risk factors for cardiovascular diseases, including acute coronary syndrome and stroke.An increase in the total individual cardiovascular risk by several times with a combination of its factors determines the high medical and social significance of the metabolic syndrome [4]. Moreover, the presence of metabolic syndrome is currently considered as the main cause of the high global cardiometabolic risk, which combines the risk of CVD and the risk of developing diabetes (Fig. 2).

Arterial hypertension is most common in patients with type 2 diabetes mellitus.So, in the UKPDS study, it was analyzed what cardiovascular diseases were already sick in patients who were first diagnosed with diabetes mellitus. It turned out that arterial hypertension occurred in almost 65% of patients, quite often patients had already suffered myocardial infarction in the past (34%) or had ECG changes (33%). Diseases of peripheral vessels (macroangiopathy) were recorded in 46% of patients, and stroke – in 38% of patients.

Arterial hypertension occurs in approximately 75–80% of patients with type 2 diabetes mellitus and is the cause of death in more than 50% of patients.It has been proven that the association of diabetes mellitus and arterial hypertension significantly increases the risk of an unfavorable outcome in patients [5]. The combination of these diseases is to a certain extent natural. Arterial hypertension and diabetes mellitus are pathogenetically related. Their frequent coexistence is facilitated by the interaction of common hereditary and acquired factors. Among them, the following are considered the most important: genetic predisposition to high blood pressure and diabetes mellitus; sodium retention in the body, as well as angiopathy and nephropathy, which contribute to an increase in blood pressure and the development of diabetes mellitus; obesity, especially abdominal obesity, which can cause or intensify the state of insulin resistance.

Analyzing the causes and frequent coexistence of hypertension and diabetes, many researchers paid attention to the possible general mechanisms of their development, namely, to a similar complex of metabolic disorders. Several factors are involved in the pathogenesis of arterial hypertension against the background of insulin resistance in patients with type 2 diabetes mellitus. Normally, insulin causes vasodilation, which in healthy individuals, against the background of increased sympathetic activity, also caused by the action of insulin, is not accompanied by a change in blood pressure.In patients with insulin resistance, the vasodilating effect of insulin is blocked, and the development of hyperinsulinemia activates a number of mechanisms that increase the tonic tension of the vascular wall. Insulin resistance is accompanied by activation of the sympathetic nervous system. Activation of the sympathetic system leads to an increase in the contractility of cardiomyocytes and vascular smooth muscle cells. This is accompanied by an increase in cardiac output, an increase in total peripheral vascular resistance (OPSR) and blood pressure levels.In conditions of hyperglycemia, an increase in the filtration of glucose in the renal glomeruli is accompanied by an increase in its reabsorption together with sodium in the proximal tubules of the nephron. As a result, hypervolemia occurs, leading to an increase in TPR, cardiac output and blood pressure. Endothelial dysfunction plays an important role in the development of arterial hypertension in type 2 diabetes mellitus. With hyperinsulinemia, the production of vasoconstrictor substances by the endothelium, in particular endothelin-1, thromboxane A2, and a decrease in nitric oxide and prostacyclin, which have vasodilating effects, increase.In addition, patients with diabetes mellitus have an increased sensitivity to angiotensin II and norepinephrine, which have a vasoconstrictor effect. These changes can also be associated with insufficient production of nitric oxide. It is believed that impaired vasodilation and increased vasoconstriction lead to an increase in vascular tone, an increase in total peripheral vascular resistance and, as a consequence, to arterial hypertension. The activation of glucose metabolism in the insulin-sensitive cells of the ventromedial hypothalamus, induced by hyperinsulinemia, is accompanied by an increase in the activity of the sympathetic centers of the brain.In addition, suppression of inhibitory effects from the baroreceptor apparatus of large vessels leads to an increase in the central activity of the sympathetic nervous system. But, perhaps, the central link in the pathogenesis of hypertension in diabetes mellitus is the high activity of the renin-angiotensin-aldosterone system (RAAS) [6].

The daily profile of blood pressure in patients with diabetes mellitus has its own characteristics and differs from the daily profile of patients with arterial hypertension without metabolic disorders.So, against the background of metabolic disorders, a higher average level of both systolic and diastolic blood pressure is revealed per day, in the daytime and at night. In a significantly larger number of patients, there is an insufficient decrease in blood pressure at night and nocturnal hypertension. Another feature of the daily blood pressure profile in patients with diabetes mellitus is an increase in the variability of systolic and diastolic blood pressure during the day and night hours. Patients with type 2 diabetes mellitus and arterial hypertension are also characterized by a large value and speed of the morning rise in blood pressure.Regardless of the mean blood pressure level, excess blood pressure variability and a higher rate of morning blood pressure rise correlate with more severe total target organ damage and is considered as a factor of poor prognosis in patients with arterial hypertension. On the other hand, it has been shown that diabetes mellitus (regardless of arterial hypertension and obesity) is combined with hypertrophy of the left ventricular myocardium (LVH) and increased stiffness of the arterial wall (Fig. 3).

The frequent coexistence of arterial hypertension and diabetes mellitus, associated with a high risk of cardiovascular events, dictates the need to determine the principles of management of patients with arterial hypertension and diabetes mellitus 2.

Many studies have shown that tight blood pressure control is essential for preventing cardiovascular complications in patients with diabetes. The importance of effective blood pressure control to prevent cardiovascular complications in diabetic patients has been proven in many completed studies. According to the UKPDS multicenter randomized trial in patients with type 2 diabetes mellitus and high blood pressure, tight glycemic control significantly reduces the incidence of microvascular complications, and tight blood pressure control (less than 144/82 mm Hg).Art.) significantly and reliably reduces the risk of any clinical complications associated with diabetes by 24%; diabetes-related mortality by 32%; stroke by 44%, diabetic retinopathy and renal failure by 37%, decreased visual acuity by 47%. One of the most important conclusions of this study is that the risk of mortality and the development of micro- and macrovascular complications of diabetes was significantly reduced with tight control of blood pressure compared with control of blood glucose [10, 12].The HOT (Hypertension Optimal Treatment) study proved that achieving a lower target blood pressure (diastolic blood pressure less than 80 mm Hg) in patients with diabetes mellitus 2 was accompanied by an additional reduction in cardiovascular risk by 51% [7]. No less impressive results were obtained in the ADVANCE study (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation). The results of the ADVANCE study showed that intensive antihypertensive therapy reduced overall mortality by 14% and the risk of cardiovascular mortality by 18%.In addition, the likelihood of cardiovascular complications decreases by 14% and renal complications by 21% [8].

Currently, the guidelines for the treatment of arterial hypertension of the European Society of Arterial Hypertension and the European Society of Cardiology 2007 formulated the basic principles of managing patients with hypertension and diabetes [9]:

  • In all diabetic patients, where applicable, intensive non-drug interventions should be used, with particular attention to weight loss and salt reduction.

  • The target BP should be <130/80 mm Hg. Art., and antihypertensive treatment should begin already at a high normal level of blood pressure.

  • All effective and well-tolerated drugs can be used to lower blood pressure. Combinations of two or more drugs are often needed.

  • Available evidence suggests that lowering blood pressure has a protective effect on the onset and development of nephropathy. Some additional nephroprotection can be achieved by using blockers of the renin-angiotensin system (angiotensin receptor antagonists or angiotensin-converting enzyme inhibitors).

  • Blockers of the renin-angiotensin system should be the main component of combination therapy and are preferred for monotherapy.

  • The presence of microalbuminuria requires the use of antihypertensive therapy even with a high normal baseline blood pressure. Blockers of the renin-angiotensin system have a pronounced antiproteinuric effect, and their use should be preferred.

  • Treatment strategy should address all cardiovascular risk factors, including statin use.

  • Due to the many cases of orthostatic hypotension, blood pressure measurements should also be performed in an upright position.

Thus, the most important principle that should be observed when choosing an antihypertensive agent for diabetes is the appointment of drugs that block the RAAS. At present, the drug effect on the RAAS can be considered an established therapeutic technique used for the treatment of arterial hypertension and the prevention of cardiovascular morbidity and cardiovascular mortality (CVM).Both angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), which reduce the effects of angiotensin II, have been shown to be effective in controlling hypertension. At the same time, ACE inhibitors reduce the effects of ATII by blocking the last stage of the conversion of angiotensin I to ATII, and ARBs (also known as sartans) do not interfere with the formation and circulation of ATII, but specifically inhibit the binding of the peptide to AT1 receptors. In addition to the distinct hypotensive effect, both of these classes of drugs have the ability to exert an organoprotective effect and prevent the development of new cases of diabetes.

The history of the development of ARBs is associated with the clarification of the role of various ATII receptors, in connection with which approaches to blockade of RAAS through the AT1 receptor system, alternative to ACE inhibitors, have appeared. It is now known that ATII realizes its effects through two types of receptors – AT1 and AT2. The main properties of AT1 receptors are mediation of vasoconstriction and an increase in blood pressure, sodium reabsorption in the renal tubules, cell proliferation, including smooth muscle cells in blood vessels and the heart, which leads to all the adverse effects in the process of the cardiovascular continuum.Of interest are the data that in abdominal obesity and arterial hypertension there is an increase in the expression of genes for AT1 receptors, which, apparently, contributes to the enhancement of the negative effects of AT II.

The properties of AT2 receptors are in many ways opposite. Their activation promotes cell differentiation, tissue regeneration, apoptosis and possibly vasodilation, suppresses cell growth. Therefore, the use of ARBs blocks AT1 receptors while maintaining the ability of circulating angiotensin II to interact with AT2 receptors, which contributes to additional organoprotective effects.The fundamental differences between ARBs and ACE inhibitors are precisely in the preservation of the function of AT2 receptors. Therefore, this new group of drugs has taken a leading place in the range of antihypertensive drugs in many countries and every year is becoming more widespread. For this group of drugs in a number of clinical studies (LIFE, RENAAL, DETAIL, AMADEO, IRMA-2, etc.), pronounced organoprotective properties have been demonstrated, which is manifested in the regression of target organ lesions associated with diabetes and metabolic syndrome, such as hypertrophy left ventricle and microalbuminuria.

ARBs are not only effective, pathogenetically justified means for controlling blood pressure in diabetes, but they can affect not only blood pressure, but also other components of the metabolic syndrome and diabetes (violation of fat and carbohydrate metabolism). This effect is more or less characteristic of most ARBs. It is known that the process of adipocyte differentiation to a large extent depends not only on the influence of ATII, but also on the activity of PPARγ (receptors activated by the proliferator γ peroxisome), which have recently been given great importance.It is well known that peroxisome proliferator-activated receptors γ (PPARγ) are an established therapeutic target in the treatment of insulin resistance, diabetes mellitus and metabolic syndrome. Currently, PPARγ receptor agonists (pioglitazone, rosiglitazone) are increasingly used in diabetes and metabolic syndrome. The ability of a drug from the ARB group telmisartan (Mikardis) to significantly activate PPARγ receptors has been established. It turned out to be the only ARB capable of activating PPARγ receptors at physiological concentrations (Fig.four).

Recent studies show that telmisartan has a pronounced positive effect on insulin resistance and carbohydrate metabolism characteristics (Fig. 5). There is evidence of a clear positive effect of telmisartan on lipid metabolism. So, in our study of the effects of telmisartan in patients with metabolic syndrome, it was found that telmisartan at a dose of 80 mg for 8 weeks had a pronounced effect on lipid metabolism, namely on the level of total cholesterol, VLDL and, most importantly, on the level of triglycerides. (fig.6). If, before the start of the study, the TG level> 1.69 mmol / L was determined in 77% of patients, then after 8 weeks of treatment with telmisartan, the increased TG level remained only in 45% of patients. These positive metabolic effects of telmisartan were accompanied by its distinct and full-fledged antihypertensive effect. In our study, it was found that even monotherapy with telmisartan at a dose of 80 mg per day had an antihypertensive effect in women with both mild and moderate arterial hypertension and metabolic syndrome.Not only the average numbers of SBP and DBP in all periods of the day decreased significantly, but also the pressure load according to the IV indicator (hypertension time index), which, as you know, is especially important in terms of the effect of increased blood pressure on the state of target organs. And finally, we revealed a significant and significant decrease in the level of microalbuminuria in the examined patients, which indicated its pronounced organoprotective effect.

The ONTARGET program, which investigates the effect of telmisartan-based RAAS blockade on many components of the cardiovascular continuum, and is expected to end in 2008., will provide new data on the results of treatment of patients with cardiovascular diseases and diabetes.

1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025. Prevalence, numerical estimates, and projections. Diabetes Care 1998; 21: 1414-31.

2. Stratton IM, Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes: prospective observational study (UKPDS 35) …BMJ 321: 405-412, 2000.

3. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. Br. Med. J. 1998, 317, 705-713.

4. Chazova IE, Mychka VB Metabolic syndrome. MEDIA MEDICA, Moscow, 2004, 163 p.

5. Mancia G. The association of hypertension and diabetes: prevalence, cardiovascular risk and protection by blood pressure reduction. Acta Diabetol. 2005; 42: S17-S25.

6. Shestakova M.V. Diabetes mellitus and arterial hypertension. In the book: A guide to arterial hypertension. Edited by Academician E.I. Chazov, Professor I.E. Chazovoy. MEDIA MEDIKA, Moscow, 2005, 415-433.

7. Hansson L, Zanchetti A, Carruthers SG et al. Effects of intensive bloodpressure lowering and low dose aspirin in patient with hypertension: principal results of the HOT randomized trial. Lancet 1998; 351: 1755-62.

8. ADVANCE trial study group rationale and design of the study: ADVANCE randomized trial of blood pressure lowering and intensive glucose control in high-risk individuals with type 2 diabetes mellitus.J Hypertens 2001; 19: S21-S28.

9. Guidelines for the management of arterial hypertension. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens 2007, 25, 1105-1187.

INFLUENCE OF TYPE 2 DIABETES MELLITUS ON THE MYOCARDIAL OF PATIENTS WITH ISCHEMIC HEART DISEASE | Vorozhtsova

1.Dedov I.I., Shestakova M.V., Vikulova O.K. Epidemiology of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal Register of Diabetes Mellitus. Diabetes. 2017; 20 (1): 13–41. DOI: 10.14341 / DM8664 [Dedov I. I., Shestakova M. V., Vikulova O. K. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes mellitus. 2017; 20 (1): 13–41. DOI: 10.14341 / DM8664] (In Russ).

2.International Diabetes Federation. Diabetes Atlas 7 Edition. 2015. 3. Leskova I. V., Mazurina N. V., Troshina E. A., Ermakov D. N., Didenko E. A., Adamskaya L. V. Socio-medical aspects of old age: obesity and professional longevity. Obesity and Metabolism. 2017; 14 (4): 10–15 [Leskova I. V., Mazurina N. V., Troshina E. A., Ermakov D. N., Didenko E. A., Adamskaya L. V. Social and medical aspects of elderly age: obesity and professional longevity. Obesity and metabolism. 2017; 14 (4): 10-15] (In Russ).DOI: 10.14341 / OMET2017410-15.

3. Ametov AS, Demidova T. Yu., Kochergina II The effectiveness of metformin preparations in the treatment of type 2 diabetes mellitus. Medical advice. 2016; 3: 30–37 [Ametov A. S., Demidova T. Y., Kochergina I. I. The efficacy of metformin in the treatment of type 2 diabetes. Medical Council. 2016; 3: 30-37]. (In Russ). DOI: 10.21518 / 2079-701X-2016-3-30-37.

4.Sharonova L.A., Verbovoy A.F. Features of cardiovascular pathology and the role of self-control in patients with type 2 diabetes mellitus. Medical advice. 2015; 11: 72–75 [Sharonova L. A., Verbovoj A. F. Features of cardiovascular pathology and the role of self-control in patients with type 2 diabetes mellitus. Medical Council. 2015; 11: 72-75] (In Russ).

5. Tregubenko E. V., Klimkin A. S. Features of the course of ischemic heart disease in patients with type 2 diabetes mellitus.Difficult patient. 2015; 13 (7): 26-29 [Tregubenko E. V., Klimkin A. S. The course of coronary heart disease in patients with type 2 diabetes. Difficult patient. 2015; 13 (7): 26-29] (In Russ).

6. Kochergina II Glycemia control in patients with diabetes mellitus and cardiac pathology. Consilim Medicum. 2017; 1: 56-60 [Kochergina I. I. Control of glycemia in patients with diabetes mellitus and cardiac pathology. Consilim Medicum.2017; 1: 56-60] (In Russ).

7. Rana J. S., Liu J. Y., Moffet H. H., Jaffe M., Karter A. J. Diabetes and Prior Coronary Heart Disease are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events. J. Gen. Intern. Med. 2016; 31 (4): 387-393. DOI: 10.1007 / s11606-015-3556-3.

8. Mondesir F. L., Brown T. M., Muntner P., Durant R. W., Safford M. M., Levitan E. B. Diabetes, diabetes severity and coronary heart disease risk equivalence Reasons for Geographic and Racial Differences in Stroke (REGARDS). Am. Heart J. 2016; 181: 43-51. DOI: 10.1016 / j.ahj.2016.08.002.

9. Ametov AS Diabetes mellitus and cardiovascular diseases. Russian medical journal. 2014; 13: 954–959 [Ametov A. S. Diabetes mellitus and cardiovascular diseases.Russian medical journal. 2014; 13: 954–959] (In Russ). https://www.rmj.ru/articles/mnenie_eksperta/sakharnyydiabet-i-serdechno-sosudistye-zabolevaniya/ (05.08.2017).

10. Rubin J., Matsushita K., Ballantyne C. M., Hoogeveen R., Coresh J., Selvin E. Chronic Hyperglycemia and Subclinical Myocardial. Injury. J. Am. Coll. Cardiology. 2012; 59 (5): 484-489. DOI: 10.1016 / j.jacc.2011.10.875.

11.Fiorentino T. V., Prioletta A., Zuo P., Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Current Pharmaceutical Design. 2013; 19 (32): 5695-5703. DOI: 10.2174 / 1381612811319320005.

12. Casella S., Bielli A., Mauriello A., Orlandi A. Molecular Pathways Regulating Macrovascular Pathology and Vascular Smooth Muscle Cells Phenotype in Type 2 Diabetes.Arai T., ed. Inter. J. Molec. Scie. 2015; 16 (10): 24353-24368. DOI: 10.3390 / ijms161024353.

13. Mkrtumyan AM The role of hyperglycemia in the development of cardiovascular complications of type 2 diabetes mellitus. Diabetes mellitus. 2010; 3: 80–82 [Mkrtumyan A. M. The role of hyperglycemia in the development of cardiovascular complications of type 2 diabetes mellitus. Diabetes mellitus. 2010; 3: 80–82] (In Russ).

14.Goto A., Arah O. A., Goto M., Terauchi Y., Noda M. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013; 347: f4533. http: // www.bmj.com/content/347/bmj.f4533.long (date accessed: 05.07.2017).

15. Shatskaya OA, Kukharenko SS The role of glycemic self-control in the prevention of cardiovascular diseases in patients with diabetes mellitus. Medical advice. 2017; 11: 166-169 [Shatskaya O.A., Kukharenko S. S. The role of self-control of glycemia in the prevention of cardiovascular disease in patients with diabetes mellitus. Medical Council. 2017; 11: 166-169] (In Russ). http://www.med-sovet.pro/jour/article/view/1935.

16. Wang A., Liu X., Xu J., Han X., Su Z., Chen S., Zhang N., Wu S., Wang Yo., Wang Yi. Visit-to-Visit Variability of Fasting Plasma Glucose and the Risk of Cardiovascular Disease and All-Cause Mortality in the General Population.J. Am. Heart Association: Cardiovasc. Cerebrovasc. Disease. 2017; 6 (12): e006757. DOI: 10.1161 / JAHA.117.006757.

17. Pochinka IG, Strongin LG, Struchkova Yu. V. Glycemic variability and ventricular arrhythmias in patients with chronic heart failure suffering from type 2 diabetes mellitus. Cardiology. 2013; 53 (9): 47-51 [Pochinka I. G., Strongin L. G., Struchkova Yu. V. Variability of glycemia and ventricular rhythm disturbances in patients with chronic heart failure suffering from type 2 diabetes mellitus.Cardiology. 2013; 53 (9): 47-51] (In Russ).

18. Klimontov VV, Myakina NE Glycemic variability in diabetes mellitus: a tool for assessing the quality of glycemic control and the risk of complications. Diabetes. 2014; 2: 76–82 [Klimontov V. V., Myakina N. Ye. Variability of glycemia in diabetes mellitus: a tool for assessing the quality of glycemic control and the risk of complications. Diabetes mellitus. 2014; 2: 76–82] (In Russ).DOI: 10.14341 / DM2014276-82.

19. Lupanov VP Ischemic heart disease and diabetes mellitus: issues of diagnosis, drug and surgical treatment, prognosis (review). Medical advice. 2013; 3–2: 52–61 [Lupanov V. P. Ischemic heart disease and diabetes mellitus: issues of diagnosis, drug and surgical treatment, prognosis (review). Medical advice. 2013; 3–2: 52–61] (In Russ).

20.Chong C.-R., Clarke K., Levelt E. Metabolic remodeling in diabetic cardiomyopathy. Cardiovasc. Res. 2017; 113 (4): 422-430. Doi: 10.1093 / cvr / cvx018.

21. Fillmore N., Mori J., Lopaschuk G. D. Mitochondrial fatty acid oxidation alterations in heart failure, ischaemic heart disease and diabetic cardiomyopathy. Br. J. Pharmacol. 2014; 171 (8): 2080-2090. DOI: 10.1111 / bph.12475.

22.Kruljac I., Ćaćić M., Ćaćić P., Ostojić V., Štefanović M., Šikić A., Vrkljan M. Diabetic ketosis during hyperglycemic crisis is associated with decreased all-cause mortality in patients with type 2 diabetes mellitus. Endocrine. 2017; 55 (1): 139-143. DOI: 10.1007 / s12020-016-1082-7.

23. Guryeva IV, Onuchina Yu. S. Modern approaches to the definition, diagnosis and classification of diabetic polyneuropathy. Pathogenetic aspects of treatment.Consilim Medicum. 2016; 12: 103-109 [Guryeva I. V., Onuchina Yu. S. Modern approaches to the definition, diagnosis and classification of diabetic polyneuropathy. Pathogenetic aspects of treatment. Consilim Medicum. 2016; 12: 103-109] (In Russ).

24. Krasilnikov AV Experience of non-drug correction of diabetic cardioneuropathy. Bulletin of the North-Eastern Federal University named after M.K. Ammosov. 2014; 11 (6): 151-155 [Krasilnikov A.V. Experience of nonpharmacological correction of diabetic cardio-neuropathy. Vestnik of the North-Eastern Federal University M. K. Ammosov. 2014; 11 (6): 151-155] (In Russ).

25. Beshlieva DD, Kalashnikov V. Yu., Smirnova OM Cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus and coronary heart disease: diagnosis and assessment of severity. Therapeutic archive. 2015; 87 (10): 11–18 [Beshlieva D.D., Kalashnikov V. Yu., Smirnova O. M. Cardiovascular autonomic neuropathy in patients with type 2 diabetes and ischemic heart disease: diagnosis and evaluation of severity. Ther. archive. 2015; 87 (10): 11-18] (In Russ). DOI: 10.17116 / terarkh3015871011-18.

26. Levin OS Diabetic polyneuropathy: modern approaches to diagnosis and pathogenetic therapy. Clinician. 2013; 2: 54–63 [Levin O. S. Diabetic polyneuropathy: modern approaches to diagnosis and pathogenetic therapy.Clinicist. 2013; 2: 54–63] (In Russ). DOI: http: //dx.doi. org / 10.17650 / 1818-8338-2013-7-2-221-235.

27. Straznicky NE, Grima MT, Sari CI, Eikelis N., Lambert EA, Nestel PJ, Esler MD, Dixon JB, Chopra R., Tilbrook AJ, Schlaich MP, Lambert GW Neuroadrenergic Dysfunction along the Diabetes Continuum: A Comparative Study in Obese Metabolic Syndrome. Subjects. Diabetes. 2012; 61 (10): 2506-2516.DOI: 10.2337 / db12-0138.

28. Lysenkova NO, Rumyantsev MI, Kratnov AE The role of the autonomic nervous system in the development of fatal cardiac arrhythmias in patients with coronary heart disease. Doctor.ru. 2016; 11 (128): 33–35 [Lysenkova N. O., Rumyantsev M. I., Kratnov A. E. The role of the autonomic nervous system in the development of fatal cardiac arrhythmias in patients with coronary heart disease. Doktor.ru. 2016; 11 (128): 33–35] (In Russ). http://info.rusmg.ru/images/ fat.pdf.

29. Khafaji H. A. H., Suwaidi J. M. A. Atypical presentation of acute and chronic coronary artery disease in diabetics. World J. Cardiol. 2014; 6 (8): 802-813. DOI: 10.4330 / wjc.v6.i8.802.

30. Koshlya V. I., Martynenko A. V. Painless myocardial ischemia in type 2 diabetes mellitus.Zaporozhye medical journal. 2015; 6 (93): 88–92 [Koshlya V. I., Martynenko A. V. Painless myocardial ischemia in type 2 diabetes mellitus. Zaporozhye Med. J. 2015; 6 (93): 88–92] (In Russ). DOI: 10.14739 / 2310-1210.2015.6.56304.

31. Bogdanova EA, Shustov SB, Svistov AS, Kitsyshin VP Peculiarities of myocardial ischemia in patients with type 2 diabetes mellitus in combination with coronary heart disease according to daily monitoring of an electrocardiogram.Bulletin of the Russian Military Medical Academy. 2012; 1 (37): 44–48 [Bogdanova E. A., Shustov S. B., Svistov A. S., Kitsyshin V. P. Features of myocardial ischemia in patients with type 2 diabetes combined with coronary heart disease according to 24-hour monitoring of the electrocardiogram. Bulletin of the Russian Military Medical Academy. 2012; 1 (37): 44–48] (In Russ). https://www.vmeda.org/wp-content/uploads/2016/pdf/44-48.pdf.

32.Mardanov B.U., Korneeva M.N., Akhmedova E. B. Heart failure and diabetes mellitus: some issues of etiopathogenesis, prognosis and treatment. Rational pharmacotherapy in cardiology. 2016; 12 (6): 743-748 [Mardanov B. U., Korneeva M. N., Akhmedova E. B. Heart failure and diabetes: selected issues etiopathogenesis, prognosis and treatment. Rational Pharmacotherapy in Cardiology. 2016; 12 (6): 743-748] (In Russ). DOI: http://dx.doi.org/10.20996/1819-6446-2016-12-6-743-748.

33.Gilca G.-E., Stefanescu G., Badulescu O., Tanase D.-M., Bararu I., Ciocoiu M. Diabetic Cardiomyopathy: Current Approach and Potential Diagnostic and Therapeutic Targets. Journal of Diabetes Research. 2017: 1310265.DOI: 10.1155 / 2017/1310265.

34. Yan B., Ren J., Zhang Q., Gao R., Zhao F., Wu J., Yang J. Antioxidative Effects of Natural Products on Diabetic Cardiomyopathy. Journal of Diabetes Research. 2017; 2017: 2070178.DOI: 10.1155 / 2017/2070178.

35. Miki T., Yuda S., Kouzu H., Miura T. Diabetic cardiomyopathy: pathophysiology and clinical features. Heart Failure Reviews. 2013; 18 (2): 149-166. DOI: 10.1007 / s10741-012-9313-3.

36. Poltorak VV The phenomenon of ischemic preconditioning: the effect of glucose imbalance and antidiabetic therapy.International Endocrinological Journal. 2013; 2 (50): 68–74 [Poltorak V. V. The phenomenon of ischemic preconditioning: the effect of glucose imbalance and antidiabetic therapy. International Endocrinology Journal. 2013; 2 (50): 68–74] (In Russ). DOI: 10.22141 / 2224-0721.

37. Rezende P. C., Rahmi R. M., Uchida A. H., Alves da Costa L. M., Scudeler T. L., Garzillo C. L., Eduardo Gomes Lima E. G., Segre C. A. W., Girardi P., Takiuti M., Silva M. F., Hu W., Franchini Ramires J. A., Filho R. K. Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients. Cardiovasc. Diabetol. 2015; 14: 66. DOI: 10.1186 / s12933-015-0228-x.

38. Malfitano C., de Souza Junior AL, Carbonaro M., BolsoniLopes A., Figueroa D., de Souza LE, Silva KA, Consolim-Colombo F., Curi R., Irigoyen MC Glucose and fatty acid metabolism in infarcted heart from streptozotocin-induced diabetic rats after 2 weeks of tissue remodeling.Cardiovasc. Diabetology. 2015; 14: 149. DOI: 10.1186 / s12933-015-0308-y.

39. Ghosh S., Standen N. B., Galinãnes M. Failure to precondition pathological human myocardium. J. Am. Coll. Cardiol. 2001; 37: 711-718. DOI: 10.1016 / S0735-1097 (00) 01161-x.

40. Rezende P. C., Rahmi R. M., Hueb W. The Influence of Diabetes Mellitus in Myocardial Ischemic Preconditioning.Journal of Diabetes Research. 2016; 2016: 8963403.DOI: 10.1155 / 2016/8963403.

41. Bilinska M., Potocka J., Korzeniowska-Kubacka I., Piotrowicz R. ‘Warm-up’ phenomenon in diabetic patients with stable angina treated with diet or sulfonylureas. Coronary Artery Disease. 2007; 18 (6): 455-462. DOI: 10.1097 / mca.0b013e3282a30676.

42.Lee T.-M., Chou T.-F. Impairment of myocardial protection in type 2 diabetic patients. J. Clin. Endocrinol. Metab. 2003; 88 (2): 531-537. DOI: 10.1210 / jc.2002-020904.

43.