According to the Centers for Disease Control and Prevention (CDC), persons with diabetes are twice as likely to have heart disease or stroke than someone who does not have diabetes. Cardiologist Dr. Rajiv Sharma discusses the link between diabetes and heart disease, risk factors and things you can do to help lower and manage your risk.
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Diabetes and Heart Disease
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Learn more about Rajiv K. Sharma, MD
Rajiv K. Sharma, MD
Dr. Rajiv K. Sharma is board certified in cardiovascular disease, adult echocardiography, nuclear cardiology, cardiovascular computed tomography (CT), and internal medicine. He completed his fellowship in cardiovascular disease at the University of Tennessee Medical Center in Knoxville, Tennessee. He is part of BayCare Medical Group serving the St. Petersburg, Florida area. Dr. Sharma is trained in comprehensive cardiovascular disease and experienced in the management of a full range of cardiovascular disorders such as coronary artery disease, valvular disease, heart failure, arrhythmias, and cardiac risk stratification including the management of hypertension and cholesterol abnormalities. As an invasive cardiologist, he performs procedures such as right and left heart catheterizations. Beyond medical practice, Dr. Sharma is also a seasoned author, having contributed numerous articles to peer-reviewed publications. Dr. Sharma believes in a strong patient-physician relationship akin to a being a "team" and a calming relaxed approach to the discussion of cardiovascular symptoms or issues.Learn more about Rajiv K. Sharma, MD
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Diabetes and Heart Disease
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Deborah Howell: Welcome to BayCare HealthChat. I'm Debrorah Howell and I invite you to listen as we talk about diabetes and heart disease. Today, we'll find out how to help prevent cardiovascular disease if you have diabetes.
I'm joined today by Dr. Rajiv K. Sharma, board-certified cardiologist who practices invasive non-interventional cardiology, also has board certification in echocardiography, nuclear medicine, cardiovascular CT, and internal medicine with BayCare Medical Group. Dr. Sharma, it's a true pleasure to have you on with us today.
Rajiv K. Sharma, MD: Well, thank you, Deborah. It's a pleasure to be here.
Deborah Howell: Alrighty. Let's start at the beginning. What is diabetes?
Rajiv K. Sharma, MD: So diabetes is a disorder that disrupts the way the body uses sugar. Essentially in the body, all the cells need sugar to work. And usually, they use a hormone called insulin, which pushes the sugar into cells. Now, in diabetes, there are two problems, one where there's not enough insulin to push the sugar into cells and two, where the body becomes resistant to insulin. And essentially, the same effect happens, which is sugar stays in the bloodstream.
When sugar stays in the bloodstream, you can have several deleterious effects, including damage to the blood vessels, damage to the eyes, damage to the brain, damage to the heart and the kidneys. And this essentially is the main premise of the pathophysiology for diabetes.
Deborah Howell: Okay. And why is it important with regard to heart disease?
Rajiv K. Sharma, MD: Yeah, so it's been well-documented in the literature that having high sugars can cause changes in the vascular system. Essentially, what we have shown in the data is that people with diabetes often have a two to three-fold risk as compared to their peers in terms of developing cardiovascular disease. And when I say cardiovascular disease, I mean heart attack, stroke, heart failure and kidney problems essentially. So this is the important premise because these conditions often result in quite a bit of morbidity and long-term treatment.
Deborah Howell: Sure. Well, to that end, can you tell us about some treatment targets and goals for your patients?
Rajiv K. Sharma, MD: Absolutely, Yeah, so for diabetes, the main treatment goal is actually trying to keep your blood sugar level in the normal range. And in essence, by doing so, you will prevent all the consequences of having uncontrolled sugars, which again leads to cardiovascular disease as I had mentioned prior.
There's an interesting mnemonic out there that I actually just found and it's called controlling your As, Bs and Cs. So A stands for hemoglobin A1c, and that is a blood test, which essentially gives us a barometer or an average of what a patient's sugar is over the previous three months. So this lets us know whether the sugars are too high over a prolonged period of time. So that's the first thing to control.
The second thing would be B for blood pressure. It's well-known that patients with diabetes often have co-existent blood pressure issues and blood pressure issues lead to the same end points as uncontrolled diabetes. So keeping your blood pressure controlled is also one of the main targets for treatment of patients with diabetes.
And the third thing would be C and that stands for cholesterol. So it's not just about the sugar in the blood, but it's certainly about these other facets that co-exists with it. But the main thing there is just controlling a facet of cholesterol known as the LDL. An easy way to remember that is L for lousy cholesterol. And we have a goal there of trying to keep that number less than a hundred.
So these are the three main targets for patients with diabetes in terms of trying to mitigate the overall risk of developing cardiovascular disease. And again, when I say cardiovascular disease, I mean heart attacks, stroke and heart failure predominantly.
Deborah Howell: Got it. Now, what can individuals do to stay healthy and prevent cardiovascular disease if they have diabetes?
Rajiv K. Sharma, MD: Absolutely. And this is also a multi-faceted answer. I think the most common thing ends up being medications. Naturally and fortunately, between diabetes and cardiovascular disease, we have a lot of robust data. And as a result of that, a lot of medications are very effective in controlling blood sugar. So generally, patients with diabetes will end up being on a medication to control their blood sugar on a daily basis. And it will entail checking your blood sugars multiple times a day just to make sure you're attaining those goals. That would be the first step.
The second step would be lifestyle changes. And this predominantly focuses on things such as diet. There's ideology with regards to a term we call glycemic index. So glycemic index essentially classifies foods based on their effect on blood sugar. So foods essentially that have a high glycemic index tend to cause big spikes in the blood sugar. And these naturally are not helpful in terms of controlling diabetes.
So things like that, lifestyle changes in terms of having a diet rich in fruits and veggies, whole grains, trying to avoid the non-wheat grains, bread, spaghetti, pasta, cereals, crackers, bagels, all that kind of stuff, that would be a one change in addition to medications.
The third thing would be, you know, more lifestyle aspects and this would be exercise. So generally in our guidelines, we recommend patients ought to do about 30 minutes a day, five times a week. No smoking, focusing on weight loss and achieving an ideal body weight, and then watching out for excessive alcohol. If you do all of these things, you're generally hitting all of those ABCs we talked about in terms of A1c, blood pressure and cholesterol. When you institute all these lifestyle changes, most people end up hitting those targets fairly effectively.
Deborah Howell: Sure. And what is the normal range for anyone who doesn't know?
Rajiv K. Sharma, MD: Yeah. So for A1c, the guidelines emphasize that it has to be individualized. But generally, if you look at the American College of Cardiology, the A1c target is less than 7. And again, A1c is just a barometer for the average of a patient's blood sugars over the previous three months. So it gives us an average of how well an individual is doing in controlling their sugars.
As far as blood pressure, generally, the goal is less than 140 over 90. The top number being 140, that's the systolic number and the bottom number being 90, the diastolic number. In some cases, we tend to be more aggressive and shoot for less than 130 over 80. But those are the main targets there. And with regards to the LDL or the lousy cholesterol, the main target is less than a hundred.
Deborah Howell: Now, medications can also play a big part in the whole equation as well. Can you discuss some of the different options?
Rajiv K. Sharma, MD: Absolutely. And near and dear to cardiology are some new medications that have sort of come through the pipeline. And the interesting thing about these medications is not only do they help with blood sugar control, but they've also been shown to have individual effects in terms of minimizing cardiovascular disease. So that mainly means prevention of major adverse cardiovascular events, such as death, stroke, heart attack, and heart failure.
These new medications are the GLP-1 agonists. There's a lot of new data out there that shows that, in patients with diabetes who have cardiovascular disease, these medications can move the needle significantly in terms of preventing further events. The other new medications out there are the SGLT2 inhibitors, and these are also very near and dear to cardiology. They have permeated our guidelines and they have been shown to be extremely effective in patients with diabetes and heart failure in terms of reducing heart failure exacerbations as well as major adverse cardiovascular events.
Aside from those very two new medications, metformin is the tried and true medication that is often the workhorse of diabetes management. And it has been shown to have cardiovascular as well as kidney protective effects. So those would be the main classes that actually have a direct line into cardiovascular benefit in terms of diabetes medications.
Deborah Howell: All right. True or false. Eating sugar leads to diabetes.
Rajiv K. Sharma, MD: I would say that is false. I think there are definitely gradations of that. An individual can have sugar and definitely not have diabetes, but anything in excess could certainly result in that. And it really comes down to the type of diabetes an individual has. So if you're a type 1 diabetic, essentially that means your pancreas, which is an organ inside the abdomen doesn't make insulin. So if you don't make any insulin, then certainly you have to be very careful about having high sugar meals. If you're a type 2 diabetic, then that essentially means that you've become resistant to insulin. And that usually is a result of body weight, obesity and things like that.
So even in these individuals, it's not that you have to be completely abstinent from sugar, but you just have to control the missing piece there. So in type 1 diabetics, it generally means you can have sugar, but you have to have insulin to balance it out. And in type 2 diabetics, again, you can have sugar, but at the same time, you have to hit the other targets such as weight loss and making sure that your insulin is sensitive. And that comes all with medications and lifestyle changes.
Deborah Howell: Perfect. Well, Dr. Sharma, this has been so enlightening. Thank you so much for all the good information you've given us today. A great gift.
Rajiv K. Sharma, MD: Well, thank you so much for having me, Deborah. Appreciate you.
Deborah Howell: And to learn more about diabetes, heart disease, and all the services at BayCare, please visit our website at BayCareHeart.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.
This is Deborah Howell. Have yourself a terrific day.
Diabetes and Heart Disease
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Deborah Howell: Welcome to BayCare HealthChat. I'm Debrorah Howell and I invite you to listen as we talk about diabetes and heart disease. Today, we'll find out how to help prevent cardiovascular disease if you have diabetes.
I'm joined today by Dr. Rajiv K. Sharma, board-certified cardiologist who practices invasive non-interventional cardiology, also has board certification in echocardiography, nuclear medicine, cardiovascular CT, and internal medicine with BayCare Medical Group. Dr. Sharma, it's a true pleasure to have you on with us today.
Rajiv K. Sharma, MD: Well, thank you, Deborah. It's a pleasure to be here.
Deborah Howell: Alrighty. Let's start at the beginning. What is diabetes?
Rajiv K. Sharma, MD: So diabetes is a disorder that disrupts the way the body uses sugar. Essentially in the body, all the cells need sugar to work. And usually, they use a hormone called insulin, which pushes the sugar into cells. Now, in diabetes, there are two problems, one where there's not enough insulin to push the sugar into cells and two, where the body becomes resistant to insulin. And essentially, the same effect happens, which is sugar stays in the bloodstream.
When sugar stays in the bloodstream, you can have several deleterious effects, including damage to the blood vessels, damage to the eyes, damage to the brain, damage to the heart and the kidneys. And this essentially is the main premise of the pathophysiology for diabetes.
Deborah Howell: Okay. And why is it important with regard to heart disease?
Rajiv K. Sharma, MD: Yeah, so it's been well-documented in the literature that having high sugars can cause changes in the vascular system. Essentially, what we have shown in the data is that people with diabetes often have a two to three-fold risk as compared to their peers in terms of developing cardiovascular disease. And when I say cardiovascular disease, I mean heart attack, stroke, heart failure and kidney problems essentially. So this is the important premise because these conditions often result in quite a bit of morbidity and long-term treatment.
Deborah Howell: Sure. Well, to that end, can you tell us about some treatment targets and goals for your patients?
Rajiv K. Sharma, MD: Absolutely, Yeah, so for diabetes, the main treatment goal is actually trying to keep your blood sugar level in the normal range. And in essence, by doing so, you will prevent all the consequences of having uncontrolled sugars, which again leads to cardiovascular disease as I had mentioned prior.
There's an interesting mnemonic out there that I actually just found and it's called controlling your As, Bs and Cs. So A stands for hemoglobin A1c, and that is a blood test, which essentially gives us a barometer or an average of what a patient's sugar is over the previous three months. So this lets us know whether the sugars are too high over a prolonged period of time. So that's the first thing to control.
The second thing would be B for blood pressure. It's well-known that patients with diabetes often have co-existent blood pressure issues and blood pressure issues lead to the same end points as uncontrolled diabetes. So keeping your blood pressure controlled is also one of the main targets for treatment of patients with diabetes.
And the third thing would be C and that stands for cholesterol. So it's not just about the sugar in the blood, but it's certainly about these other facets that co-exists with it. But the main thing there is just controlling a facet of cholesterol known as the LDL. An easy way to remember that is L for lousy cholesterol. And we have a goal there of trying to keep that number less than a hundred.
So these are the three main targets for patients with diabetes in terms of trying to mitigate the overall risk of developing cardiovascular disease. And again, when I say cardiovascular disease, I mean heart attacks, stroke and heart failure predominantly.
Deborah Howell: Got it. Now, what can individuals do to stay healthy and prevent cardiovascular disease if they have diabetes?
Rajiv K. Sharma, MD: Absolutely. And this is also a multi-faceted answer. I think the most common thing ends up being medications. Naturally and fortunately, between diabetes and cardiovascular disease, we have a lot of robust data. And as a result of that, a lot of medications are very effective in controlling blood sugar. So generally, patients with diabetes will end up being on a medication to control their blood sugar on a daily basis. And it will entail checking your blood sugars multiple times a day just to make sure you're attaining those goals. That would be the first step.
The second step would be lifestyle changes. And this predominantly focuses on things such as diet. There's ideology with regards to a term we call glycemic index. So glycemic index essentially classifies foods based on their effect on blood sugar. So foods essentially that have a high glycemic index tend to cause big spikes in the blood sugar. And these naturally are not helpful in terms of controlling diabetes.
So things like that, lifestyle changes in terms of having a diet rich in fruits and veggies, whole grains, trying to avoid the non-wheat grains, bread, spaghetti, pasta, cereals, crackers, bagels, all that kind of stuff, that would be a one change in addition to medications.
The third thing would be, you know, more lifestyle aspects and this would be exercise. So generally in our guidelines, we recommend patients ought to do about 30 minutes a day, five times a week. No smoking, focusing on weight loss and achieving an ideal body weight, and then watching out for excessive alcohol. If you do all of these things, you're generally hitting all of those ABCs we talked about in terms of A1c, blood pressure and cholesterol. When you institute all these lifestyle changes, most people end up hitting those targets fairly effectively.
Deborah Howell: Sure. And what is the normal range for anyone who doesn't know?
Rajiv K. Sharma, MD: Yeah. So for A1c, the guidelines emphasize that it has to be individualized. But generally, if you look at the American College of Cardiology, the A1c target is less than 7. And again, A1c is just a barometer for the average of a patient's blood sugars over the previous three months. So it gives us an average of how well an individual is doing in controlling their sugars.
As far as blood pressure, generally, the goal is less than 140 over 90. The top number being 140, that's the systolic number and the bottom number being 90, the diastolic number. In some cases, we tend to be more aggressive and shoot for less than 130 over 80. But those are the main targets there. And with regards to the LDL or the lousy cholesterol, the main target is less than a hundred.
Deborah Howell: Now, medications can also play a big part in the whole equation as well. Can you discuss some of the different options?
Rajiv K. Sharma, MD: Absolutely. And near and dear to cardiology are some new medications that have sort of come through the pipeline. And the interesting thing about these medications is not only do they help with blood sugar control, but they've also been shown to have individual effects in terms of minimizing cardiovascular disease. So that mainly means prevention of major adverse cardiovascular events, such as death, stroke, heart attack, and heart failure.
These new medications are the GLP-1 agonists. There's a lot of new data out there that shows that, in patients with diabetes who have cardiovascular disease, these medications can move the needle significantly in terms of preventing further events. The other new medications out there are the SGLT2 inhibitors, and these are also very near and dear to cardiology. They have permeated our guidelines and they have been shown to be extremely effective in patients with diabetes and heart failure in terms of reducing heart failure exacerbations as well as major adverse cardiovascular events.
Aside from those very two new medications, metformin is the tried and true medication that is often the workhorse of diabetes management. And it has been shown to have cardiovascular as well as kidney protective effects. So those would be the main classes that actually have a direct line into cardiovascular benefit in terms of diabetes medications.
Deborah Howell: All right. True or false. Eating sugar leads to diabetes.
Rajiv K. Sharma, MD: I would say that is false. I think there are definitely gradations of that. An individual can have sugar and definitely not have diabetes, but anything in excess could certainly result in that. And it really comes down to the type of diabetes an individual has. So if you're a type 1 diabetic, essentially that means your pancreas, which is an organ inside the abdomen doesn't make insulin. So if you don't make any insulin, then certainly you have to be very careful about having high sugar meals. If you're a type 2 diabetic, then that essentially means that you've become resistant to insulin. And that usually is a result of body weight, obesity and things like that.
So even in these individuals, it's not that you have to be completely abstinent from sugar, but you just have to control the missing piece there. So in type 1 diabetics, it generally means you can have sugar, but you have to have insulin to balance it out. And in type 2 diabetics, again, you can have sugar, but at the same time, you have to hit the other targets such as weight loss and making sure that your insulin is sensitive. And that comes all with medications and lifestyle changes.
Deborah Howell: Perfect. Well, Dr. Sharma, this has been so enlightening. Thank you so much for all the good information you've given us today. A great gift.
Rajiv K. Sharma, MD: Well, thank you so much for having me, Deborah. Appreciate you.
Deborah Howell: And to learn more about diabetes, heart disease, and all the services at BayCare, please visit our website at BayCareHeart.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, so we can share the wealth of information from our experts together.
This is Deborah Howell. Have yourself a terrific day.