Women, Diabetes, and Heart Disease
By Juan Dionisio Foronda, MD
Are women from Venus and men from Mars? Are females somewhat different from males even in heart disease? The answer is yes!
Why are women with diabetes at risk for heart disease?
Diabetes alone already imparts twice the risk for heart disease as someone who does not have diabetes. Women with diabetes are at least twice as much at risk for developing heart disease than non-diabetic women. This holds true even for younger diabetic women who are not menopausal yet. It seems that diabetic women lose the protective benefits of estrogen even before menopause.
Diabetes makes the arteries age faster. Hypertension is also a disease commonly occurring together with diabetes and both work like a tag-team to wreak havoc and damage your arteries. Complications like heart attacks, strokes (brain attack) and kidney disease (leading to dialysis) occur 15 to 20 years after its onset.
Why is it under-diagnosed?
Diabetes is a silent killer. Both diabetes and heart disease are frequently asymptomatic. Patients do not usually feel anything at the start. Diabetes also modifies the way patients perceive pain. That’s why some diabetic patients having a heart attack do not feel the typical chest pains but instead, may just complain of some shortness of breath.
How can it be detected and managed?
The presence of diabetes in a woman should trigger a high index of suspicion for the presence of heart disease. Screening includes simply checking blood pressure to rule out hypertension (high blood pressure) and checking for weak pulses in the legs. Common tests like an ECG, and if warranted, a treadmill stress test (doing an ECG while walking) can check for ischemia or signs of poor circulation in the heart.
Controlling blood sugar cuts the risk for complications like stroke and heart attack by half. So good diabetes control is key and you should work closely with your endocrinologist or diabetes specialist.
Preventive measures like taking aspirin, BP-lowering, and cholesterol-lowering medications (statins) are known to prevent or delay the progression of heart disease.
Of course this is all on top of eating a balanced diet and doing regular walking exercise.
A visit to your friendly, neighborhood doctor can help guide you through treatment. Always remember a ounce of prevention is always better than a pound of cure.