THERE is a high rate of diabetes in Jamaica with a prevalence of 11.9 per cent. More females are affected compared to males (14.6 per cent versus nine per cent for males). This translates to about one in eight Jamaicans with diabetes.

The prevalence of diabetes in Jamaica has increased by more than 40 per cent over the past 20 years. Diabetes and complications related to diabetes can be disabling, life-threatening, and can lead to serious health complications. The Jamaican Health and Lifestyle Survey III (2016-2017) indicated that approximately four out of 10 Jamaicans are unaware that they have diabetes which delays receiving health care, resulting in many Jamaicans experiencing major complications of diabetes. Patients with diabetes are at increased risk of major complications, including heart and cardiovascular diseases, kidney diseases, vision loss, and peripheral vascular diseases with resultant limb amputations. These complications lead to frequent hospital visits, repeat hospitalisations, and increased health-care costs. Furthermore, these complications exert profound psychological and economic costs on diabetics and their families.

Diabetes, heart attack, stroke, and heart failure

Cardiovascular diseases, such as heart failure, heart attack and stroke, remain the main cause of death and disability in people with diabetes. Diabetic patients are four times more likely to have a heart attack or stroke than people without diabetes. Diabetic patients are also more likely to progress to heart failure compared to those without diabetes. An estimated one in three people with type 2 diabetes also have cardiovascular disease and the longer you have been diagnosed with diabetes, the more likelihood of developing cardiovascular disease. There is evidence supporting the role of high blood sugar from diabetes in damaging heart blood vessels and promoting the development of fatty deposits. Over time, sustained increase in blood sugar levels, even slightly high, can lead to damage to the integrity of the blood vessels and this can lead to serious heart complications. This is because your body can’t use all this sugar properly so more of it sticks to your red blood cells and builds up in your blood. This build-up can block and damage the vessels carrying blood to and from your heart, starving the heart of oxygen and nutrients. For an individual with diabetes, the likelihood of dying from heart disease is high and estimated to be the same as someone who has already had a heart attack.

Blood pressure, cholesterol, diabetes, and cardiovascular disease

According to published literature, if you have diabetes, you are more likely to have other risk factors and promoters of heart disease, such as hypertension, high cholesterol, or obesity. Most people with diabetes have high blood pressure and high cholesterol, key risk factors for heart disease. In fact, many of the complications you can get from having diabetes come from damage to your blood vessels because of high blood pressure, high cholesterol, and smoking. If your cholesterol is too high, then the extra fat deposits in your blood sticks to the inner walls of your blood vessels. Over time, this fat deposit hardens and is known as plaque. Hard plaque can obstruct the blood vessels, which makes the space narrower and leaves less room for blood to flow, limiting the ability of the blood vessels to supply oxygen and nutrients to the heart muscles. This is called arteriosclerosis and is the most common cause of chest pain (angina), and when the plaques rupture, heart attack occurs. High blood pressure in diabetic patients increase the workload required for transit of blood or flow through the blood vessels. This is compounded over time with the development of atherosclerosis which makes the blood vessel walls rigid. The loss of elasticity of the blood vessel walls from hypertension adds extra strain on your blood vessels on top of the strain from high blood sugar and high cholesterol. Smoking further worsens the picture.

Gestational diabetes and future risk

Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects how your cells use sugar. Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Gestational diabetes can lead to a greater future risk of developing type 2 diabetes, heart disease, and stroke compared to women who have not had this condition. However, most women who have had gestational diabetes during their pregnancy will no longer have diabetes after their baby is born. It is important that women who have experienced gestational diabetes talk to their doctor about monitoring their heart health and managing their future risk with respect to heart disease and stroke.

Reducing your risk of developing heart disease if diabetic

Individuals living with diabetes can learn to manage or reduce their chances of developing heart disease. If you’re living with diabetes, it’s important to work closely with your health-care providers to manage your diabetes effectively and maintain a healthy lifestyle.

Some simple but proven ways to do this include:

• Taking your medication as prescribed by your health-care provider to ensure effective control of your diabetes

• Maintaining a healthy and balanced diet

• Exercising for at least 30 minutes, three days per week or staying physically active

• Maintaining ideal body weight and normal blood pressure and blood cholesterol levels

• Avoidance of smoking and pollution

• Be in the know about your HbA1c and how to lower it if it’s too high. (Even mildly raised blood sugar levels can, over time, put you more at risk). The haemoglobin A1c (HbA1c), also known as glycated haemoglobin, test measures the amount of blood sugar (glucose) attached to your haemoglobin. The haemoglobin A1c test tells you your average level of blood sugar over the past two to three months

• Limit your alcohol intake

Summary and key takeaways

• Diabetes is an ongoing health condition in which your blood sugar levels are higher than normal.

• Diabetes is a common health problem in Jamaica and can lead to severe health, social, and economic consequences for patients and their families.

• Having blood sugar levels that are consistently above the normal range can lead to serious complications, such as kidney disease, leg amputations, and an increased risk of stroke and heart disease, including heart attacks and heart failure.

• Cardiovascular disease (CVD) is the biggest cause of death among people with diabetes.

• Diabetes can lead to rapid progression of heart disease and development of heart failure or heart attack.

• Protecting the heart from damage in diabetes patients can be accomplished by maintaining good blood sugar control, good blood pressure and cholesterol levels, a healthy and balanced diet, exercising and physical activity, and avoidance of smoking.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107.