In India, an estimated 89.8 million adults aged 20-79 years live with diabetes.
Studies indicate around 136 million adults are living with pre-diabetes (high risk of developing diabetes). Adults with diabetes in India have about a 2-fold increased risk of dying from ischaemic heart disease and about a 1.6-fold increased risk of dying from stroke compared with adults without diabetes.
What makes this partnership particularly deadly is its silent nature. More than 50% of people are unaware of their diabetic status, unknowingly putting their hearts at severe risk every single day.
Understanding the Diabetes-Heart Disease Connection
Why Diabetics Face Higher Cardiac Risk
When blood sugar levels remain elevated over time, diabetes triggers a cascade of harmful effects on the cardiovascular system. Clustering of risk factors for coronary artery disease such as hyperglycemia, central body obesity, dyslipidemia, and hypertension tends to occur, creating a perfect storm for heart disease.
The pathophysiological process of atherosclerosis in diabetic subjects is accelerated by several factors such as hyperglycaemia, insulin resistance, abnormal lipid profile, oxidative modification of lipoproteins, increased blood pressure, and altered rate of fibrinolysis. These changes make atherosclerotic plaques more vulnerable, precipitating early clinical events.
The Indian Context: A Unique Challenge
Indians face an even greater threat. CAD risk is two to four times higher in diabetic subjects, and in Indians, CAD occurs prematurely, one to two decades earlier than in the West. The prevalence of CAD in urban India increased from 1.0% in the 1970s to 9.7% by 1990, marking a dramatic nine-fold increase.
According to the CURES cohort study, the overall mortality rate is nearly 4-fold higher in people with diabetes compared to those without diabetes. The study also revealed that ischemic heart disease and diabetes had the highest population-attributable risk for all-cause mortality.
The Silent Heart Attack: A Diabetic’s Hidden Enemy
What Makes Heart Attacks “Silent” in Diabetics?
Perhaps the most dangerous aspect of diabetes-related heart disease is the phenomenon of silent heart attacks. Studies have shown that up to 16 percent of participants with Type 2 diabetes are also likely to have suffered a silent heart attack.
A silent heart attack occurs when the heart muscle is damaged by a lack of blood flow, but the individual does not experience the typical symptoms of chest pain or discomfort. In fact, many individuals may not even be aware that they have had a heart attack.
The Role of Diabetic Neuropathy
Autonomic neuropathy, a serious side effect of diabetes, involves damage to the autonomic nervous system, which controls several bodily functions including breathing, digestion, and heart rate. Nerve damage can reduce a patient’s ability to feel pain, including the painful symptoms associated with heart attack.
Cardiac autonomic neuropathy almost certainly plays an important role in silent heart attacks, potentially involving dysfunction at varying levels from the pain receptors, afferent neurons or gating mechanisms to the supratentorial translation of ischaemia into pain.
Warning Signs Diabetics Must Never Ignore
Atypical Symptoms of Heart Attack in Diabetics
Unlike classic heart attack symptoms, diabetics may experience:
1. Unusual Fatigue or Weakness Unusual fatigue or weakness can be a subtle indicator that diabetics should be alert to. If activities that were once easy suddenly leave you exhausted, this could signal a cardiac event.
2. Shortness of Breath The most common sign of a silent heart attack is shortness of breath or fatigue after physical activity. This symptom is often dismissed as a normal consequence of aging or poor fitness.
3. Digestive Discomfort Pain, pressure, or squeezing in the center of the chest may seem like run-of-the-mill indigestion, but persistent discomfort should never be ignored.
4. Pain in Unexpected Areas Diabetics should be alert to pain in the jaw, neck, back, or arms, which can indicate a cardiac event even without chest pain.
5. Lightheadedness or Dizziness Orthostatic hypotension, a drop in blood pressure that occurs when a person sits or stands up suddenly, is one indicator of autonomic neuropathy. New onset dizziness warrants immediate medical attention.
Emergency Action Required
Pay special attention to symptoms that appear suddenly or those that represent a change from your baseline. If you experience any concerning symptoms, don’t wait. Time is critical in treating heart attacks.
Risk Factors Multiplying Your Cardiac Danger
The Perfect Storm of Risk Factors
The incidence of cardiovascular conditions is rising due to present medical conditions such as diabetes (10%-12%), hypertension (30%), dyslipidemia (25%-30%), sedentary lifestyles (41%), obesity (20%-25%), unhealthy diet (75%), and smoking and tobacco use (29%).
Studies on the epidemiology of type-2 diabetes in India identified that genetics, family history, age, ethnicity, unhealthy diet, physical inactivity, use of tobacco and alcohol, high body mass index, raised blood sugar, and blood lipid levels are major risk factors for diabetes.
Gender-Specific Considerations
The protective female gender effect is lost in diabetic subjects, and indeed, women with diabetes are possibly more prone to develop CAD than men with diabetes. This makes diabetes particularly dangerous for Indian women, who often face delayed diagnosis and treatment.
Essential Screening Tests Every Diabetic Needs
Comprehensive Cardiac Assessment
To detect heart disease early, diabetics require regular cardiac screening beyond standard diabetes management:
Electrocardiogram (ECG/EKG) An electrocardiogram checks the electrical signals in your heart and can detect previous silent heart attacks or current rhythm abnormalities.
Echocardiogram An echocardiogram is a type of ultrasound imaging that looks at the heart, revealing structural problems, valve issues, and pumping efficiency.
Blood Tests Blood tests look for certain proteins that your heart makes when it’s been damaged, helping identify recent or ongoing cardiac injury.
Stress Testing For diabetics with multiple risk factors, exercise or pharmacological stress testing can reveal hidden coronary artery disease before symptoms appear.
Lipid Profile and HbA1c Regular monitoring of cholesterol levels and long-term glucose control (HbA1c) is essential. Over 30% of diabetes patients have HbA1c levels above 9%, indicating poor blood sugar control and a heightened risk of cardiovascular complications.
Dr. Prem Ratan Degawat’s Approach to Diabetes-Cardiac Care
Comprehensive Risk Stratification
As one of the leading interventional cardiologists in Jaipur, Dr. Prem Ratan Degawat emphasizes early detection and aggressive risk factor modification for diabetic patients. His comprehensive approach includes:
- Detailed cardiac risk assessment for all diabetic patients
- Regular screening protocols based on individual risk profiles
- Advanced imaging techniques to detect silent heart disease
- Personalized treatment plans combining medical and lifestyle interventions
Advanced Treatment Options Available
For diabetic patients with established heart disease, Dr. Degawat offers:
- Minimally Invasive Coronary Interventions: Angioplasty and stenting with diabetic-specific protocols
- TAVI (Transcatheter Aortic Valve Implantation): For diabetic patients with aortic stenosis who are high-risk for surgery
- MitraClip Therapy: Advanced valve repair option for diabetics with mitral regurgitation
- Comprehensive Medical Management: Evidence-based pharmacotherapy tailored to diabetic patients
Prevention Strategies That Work
The Five Pillars of Cardiac Protection for Diabetics
1. Aggressive Glucose Control Maintaining HbA1c below 7% significantly reduces cardiovascular risk. Work with your endocrinologist and cardiologist to achieve optimal control.
2. Blood Pressure Management In India, hypertension contributes to 57% of stroke deaths and 24% of coronary heart disease deaths. Target blood pressure should be below 130/80 mmHg for most diabetics.
3. Cholesterol Optimization Statin therapy is crucial for diabetics, even with normal cholesterol levels. LDL cholesterol should typically be below 70 mg/dL for those with diabetes and heart disease.
4. Lifestyle Modification Preventive measures such as lifestyle modification with healthy diet, adequate physical activity, and decrease in stress could help prevent the twin epidemics of diabetes and CAD.
5. Regular Cardiac Screening Annual cardiac assessments, including ECG and stress testing for high-risk diabetics, can detect problems before they become life-threatening.
When to See a Cardiologist: Don’t Wait for Symptoms
High-Risk Diabetics Requiring Immediate Evaluation
You should consult a cardiologist if you have diabetes with:
- Duration of diabetes over 10 years
- Poor glucose control (HbA1c consistently above 8%)
- Multiple cardiovascular risk factors (hypertension, high cholesterol, smoking, family history)
- Any new cardiac symptoms, no matter how mild
- Diabetic complications like kidney disease or neuropathy
- Age above 40 years, even without symptoms
The Role of Expert Cardiology Care
It is predicted that by 2025, 80.9 million will have diabetes in India. With this growing burden, access to specialized cardiac care for diabetics is more critical than ever.
Seeking care from a top cardiologist in India experienced in diabetic heart disease can make the difference between early detection and a catastrophic cardiac event. Expert cardiologists can offer advanced procedures like TAVI treatment in Jaipur for high-risk diabetic patients who need valve interventions but cannot undergo open-heart surgery.
The Cost of Inaction: Why Early Intervention Matters
Silent Damage, Serious Consequences
Compared to those without a heart attack, those who have had a silent heart attack have a three-fold greater likelihood of dying from heart disease in the future. Without proper diagnosis and treatment, silent heart attacks increase the risk of heart failure, subsequent heart attacks, and sudden cardiac death.
The Economic Burden
In India, it is estimated that a diabetic person spends a median of ₹10,000 for medical treatment annually. However, treating advanced heart disease after complications develop costs exponentially more, not to mention the loss of productivity and quality of life.
Advanced Treatment Options for Diabetic Heart Disease
Minimally Invasive Cardiac Interventions
For diabetics with established coronary artery disease, modern interventional cardiology offers hope:
Coronary Angioplasty and Stenting Advanced drug-eluting stents specifically tested in diabetic populations provide excellent long-term outcomes when combined with optimal medical therapy.
TAVI for Diabetic Patients For diabetic patients with severe aortic stenosis who are at high surgical risk, TAVI offers a minimally invasive alternative. As a best TAVI specialist in India, Dr. Degawat has extensive experience with this life-saving procedure.
MitraClip for Mitral Valve Disease Diabetics with heart failure and mitral regurgitation can benefit from MitraClip therapy, avoiding the risks of open-heart surgery while improving symptoms and outcomes.
Medical Management Revolution
Recent advances in diabetes medications have revolutionized cardiac protection:
- SGLT2 Inhibitors: Proven to reduce heart failure hospitalizations and cardiovascular death
- GLP-1 Receptor Agonists: Significant cardiovascular benefits beyond glucose control
- Dual Antiplatelet Therapy: Optimized protocols for diabetics undergoing cardiac interventions
Take Control: Your Action Plan Today
Immediate Steps for Every Diabetic
- Schedule a Cardiac Risk Assessment: Don’t wait for symptoms. Get baseline cardiac testing if you haven’t already.
- Optimize Your Diabetes Control: Work aggressively with your healthcare team to achieve target HbA1c levels.
- Know Your Numbers: Monitor and control blood pressure, cholesterol, and blood sugar regularly.
- Adopt Heart-Healthy Habits: Mediterranean-style diet, regular physical activity, stress management, and smoking cessation.
- Stay Alert to Symptoms: Learn to recognize atypical cardiac symptoms and seek immediate help when concerned.
- Regular Follow-up: Maintain regular visits with both your endocrinologist and cardiologist.
Conclusion
The diabetes-heart disease connection is a silent killer affecting millions of Indians. CAD is now the leading cause of death worldwide, and Indians face a particularly high burden. However, this partnership doesn’t have to be deadly.
With early detection, aggressive risk factor modification, and access to advanced cardiac care, diabetics can significantly reduce their cardiovascular risk. The key is awareness, action, and access to expert care.
If you have diabetes, don’t wait for chest pain to see a cardiologist. Silent heart disease is progressing every day. Take control of your heart health today.
Expert Cardiac Care for Diabetics in Jaipur
Dr. Prem Ratan Degawat, a leading interventional cardiologist in Jaipur, specializes in comprehensive cardiac care for diabetic patients. With expertise in advanced procedures including TAVI, MitraClip, and complex coronary interventions, Dr. Degawat offers world-class cardiac care right here in Rajasthan.
Don’t let diabetes silently damage your heart. Schedule a consultation with Dr. Degawat to assess your cardiac risk and develop a personalized prevention and treatment plan.
