According to the American Heart Association, heart disease and stroke are the most common causes of death of diabetic patients, accounting for 65 percent of all deaths in this group of patients. CAD, which stands for Coronary Artery Disease, is the narrowing of blood vessels supplying the heart muscles with vital nutrients, usually leading to heart attacks and death.
Diabetes and CAD
In all kinds of diabetes, there is a deficiency of function of insulin. This deficiency results in secondary effects that have a direct bearing on the development of CAD. Most importantly, the deficiency results in the inability of glucose to enter cells and act as fuel for energy. In this situation of relative fasting in the cells, fat is mobilized to act as fuel by the cells. The mobilized free fatty acids and triglycerides find their way into the bloodstream where they form deposits in the arteries, leading to atherosclerosis or plaque formation. When these affect the coronary circulation, CAD is the result. Secondly, the absence of insulin action in the cells removes the strongest inhibition of fat mobilization, letting fat mobilization continue unchallenged.
Hardened arteries from fat deposits, usually increased by the peculiar situation in diabetes, lose their ability to stretch, contributing to an increase in blood pressure. Diabetic damage to the kidneys also leads to a raised blood pressure. Raised blood pressure is the singular most important risk factor in heart disease and, together with continuing plaque buildup, work synergistically to worsen the risks of CAD.
Obesity
Diabetes is more prevalent amongst the obese and overweight. There is some demonstrable insulin resistance in the obese. There is also an increased incidence of hypertension and atherosclerosis in the obese. Thus, an obese diabetic is at a very high risk of CAD.
