Question: What are the cardiovascular complications of diabetes and how are they treated?
Answer: The cardiovascular complications of diabetes are the leading cause of death in people with diabetes, so it's very important to know what they are. They include coronary heart disease, which is a risk of having a heart attack. They also include stroke as well as peripheral arterial disease, which is impaired circulation in the arteries that supply the lower extremities.
There are really several approaches to medical treatment that can prevent all of these complications. So they include first stopping smoking, because we know that that increases the risk of vascular disease. The second is to make sure that patients are engaged in an exercise program on a daily basis as well as consuming a diet that's low in fat. The third is to make sure that they're on an aspirin each day, because we know that an aspirin helps defend the blood and prevent the risk of developing all of these vascular complications. The fourth is to make sure that the blood pressure is adequately treated, which means having a blood pressure of less than 130 over 80. And then finally, the fifth is to make sure that the cholesterol is adequately treated, and in particular, we're interested in making sure that the bad cholesterol, which is the LDL, is less than 100.
The jury is still out as to whether or not tight glucose control will prevent the cardiovascular complications of diabetes, and we'll have this information from studies over the next five years.
Now finally, if medical therapy is not helpful in preventing cardiovascular complications in diabetes, then there are surgical procedures that may help. So patients who have coronary heart disease can undergo coronary artery bypass surgery. In patients who may be at risk of having a stroke because they have blockages in their carotid artery that supplies the brain, they can do a procedure to put a graft inside the carotid artery to ensure adequate blood flow to the brain, and therefore lower the risk of stroke. And then finally in the peripheral arteries, you can also do bypass in those arteries, and in that setting that helps the lower the risk of amputations. However if patients have infections in their lower extremities that do not heal after bypass surgery in the legs, then they may unfortunately have to undergo amputation.