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Type 2 Diabetes, Heart Attacks, Stroke and Heart Failure - How Can I Reduce My Risk?

These are busy days for studies about diabetes and metabolism; more and more people are overweight or obese in the developed world, (and increasingly in some populations in the developing world) and it is associated with an increased risk of type 2 diabetes which is associated with early and widespread cardiovascular disease and premature death.

Type 2 diabetes is a cardiovascular disease, where people die of heart attacks before their time, and it is associated with a high blood sugar.

I have briefly commented before on the brilliant STENO studies from Scandinavia, showing dramatic, long term improvements in cardiovascular mortality and morbidity with multifactorial interventions for diabetes and here in the August 16th New England Journal of Medicine, in an observational study we see the most heartening results, that I hope say to so many patients - it really is worth it! The study is funded by the Swedish Association of Local Authorities and Regions and other non-profit organisations, receiving no money from industry at all.

The study assessed death from any cause, fatal or nonfatal acute myocardial infarction, fatal or nonfatal stroke, and hospitalization for heart failure.

It is so important in diabetes and metabolism to remember the things that happen to people, the events that matter. It is not the blood glucose, HbA1c, blood pressure, or cholesterol that are ultimately important; we have to use these things as surrogates for other more important things, we need these signposts to tell us how we are doing.

The study looked at over a quarter of a million patients with diabetes and compared them to over one and quarter million matched controls, following them for a median of 5.7 years, so enough people for a sensible amount of time, to consider what happens to other people.

The authors studied the outcomes in relation to these five variables::

  • HbA1c

  • LDL cholesterol

  • albuminuria

  • smoking

  • blood pressure

For patients who had all five variables in the target range the risk of death from MI was barely increased compared to the control/ normal population.


and a real indication of the rewards that are available for all the hard work patients, their doctors and carers put in to improve their lifestyle.

For detail - the strongest predictors regarding the risk of:

  • acute myocardial infarction were

  • HbA1c

  • systolic blood pressure

  • LDL cholesterol level

  • physical activity

  • smoking

  • stroke

  • HbA1c

  • systolic blood pressure

  • duration of diabetes

  • physical activity

  • atrial fibrillation

  • Hospitalization for heart failure

  • atrial fibrillation

  • body-mass index outside the target range

  • a low estimated glomerular filtration rate and high HbA1c were also strong predictors

Across every situation smoking was the strongest predictor of death and HbA1c the strongest or second strongest predictor of adverse outcomes..

If you have diabetes and sometimes doubt whether you are making a difference to your health talk to your doctor or nurse about where your priorities are.

Stop smoking if you can, control the blood glucose with a mixture of dietary modification, exercise and medication, this will also tend to improve your weight and body fat distribution, take a statin to lower your LDL cholesterol and take a blood pressure tablet to lower the systolic blood pressure, protect the heart and reduce the pressure through the kidneys - )usually this will be an angiotensin receptor blocker or an ACE inhibitor).

If this blog post is useful please leave comments and do share it (but please make sure it is attributed appropriately).

Dr Philip Kelly is a consultant endocrinologist, general and metabolic physician at King's College Hospital who practices within the NHS and on the Guthrie Wing. He sees a wide variety of patients with and/ or at high risk of cardiovascular disease. He managed the King's Hypertension Clinic until April 2017 and now runs a monthly specialist hypertension clinic seeing patients from across South East London, Kent and beyond. He manages patients cardiovascular risk within both his inpatient and outpatient work at King's and in those with diabetes, dyslipidaemia, renal disease, hypertension and works closely with colleagues in renal medicine, endocrinology, biochemistry and diagnostic imaging at King's, and clinical genetics at Guy's if appropriate, to ensure patients have an accurate diagnosis and receive tailored therapy for them. If you would like a referral please go to or call 020 3299 3848 or book directly from the website.

The information in this blog post is not personal medical advice and must never replace an individual consultation with an appropriately trained doctor. Dr Philip Kelly will not be responsible for the use of this post to consider therapy for individual patients.

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