The Week Health Cover Story 'Earlier the better'

Diabetes and the heart
Earlier, the better

By Dr D.K. Sriram
Indians are known to have a predilection for heart disease and the prevalence of diabetes is an important risk factor. What is worrisome is that this trend of increased incidence of heart disease seems to be occurring at a young age. The sight of patients in their thirties and forties being wheeled into the emergency room with chest pain has become common.
The reasons for this rather dramatic increased risk include diabetes, hypertension, high cholesterol levels, dietary factors, lack of exercise and other genetic factors that give rise to an exaggerated effect in Indians when compared to other races. It is postulated that our genetic makeup, used to a more frugal diet, has yet to adapt to the change in dietary habit to high fat and carbohydrate food.
The need of the hour is an increased awareness of the risks, especially in patients with diabetes. In dealing with such patients, a review of associated risks and adequate medication and lifestyle modification is important. Current evidence points to a large number of patients with diabetes and pre-diabetes, who have not had tests to confirm the diagnosis and allow early intervention of the disease process. We also have good evidence to suggest that if we deal with the associated risk factors such as high blood pressure and elevated cholesterol levels in diabetes adequately, then we find a significant decrease in the development of heart disease and other complications. This timely intervention will result in a healthier society with lesser need for invasive and expensive management at a later date.
The author is consultant diabetologist at Apollo Hospitals, Chennai.