Cardiovascular Tests For Diabetes

People with diabetes, which includes both type 1 and type 2 diabetes as well as prediabetes, are at higher risk for cardiovascular disease and circulatory problems. Diabetics are at particular risk for heart attack, stroke, atherosclerosis, microvascular and macrovascular disease as well as hypertension. These health conditions are typically attributed to the high levels of LDL (the low density lipoproteins) and VLDL (or very low density lipoproteins) and a low HDL (the good cholesterol levels). In fact in studies the LDL and VLDL particle in people with type 2 diabetes are actually physically smaller and different in shape than the LDL seen in non-diabetics. Coupled with this imbalance in the HDL:LDL ratio is the high triglyceride levels that are also very common.

What Is Cardiovascular Disease?

Cardiovascular disease, also sometimes labeled as heart disease, is actually a group of conditions that include the blood vessels, the veins, arteries and capillaries, as well as the heart which make up the cardiovascular system. Heart disease is considered to be the leading cause of death over all forms of cancer.

The major risk factors for developing cardiovascular disease include advanced age, family history of cardiovascular disease, being male, hypertension, cigarette smoking, obesity, dyslipidemia and diabetes. However, in studies of autopsies of children and youth who died of accidental causes, it was found that atherosclerosis was present in teens and young adults. High body mass index, irregular blood pressure and high levels of LDL were also found in these studies in youth and young adults. 2

Cardiovascular disease can include any of a number of different conditions. Commonly associated with both type 1 diabetes and type 2 diabetes are hypertension (high blood pressure), peripheral arterial disease (PAD), stroke and heart attack. Coronary artery disease, also known as hardening of the arteries, is caused by the plaque from fatty deposits stopping the normal blood flow to the heart. This can, over time, lead to a complete stoppage of the blood supply. The result is a myocardial infarction, more commonly known as a heart attack.

A stroke occurs when pieces of the plaque break off from the walls of the arteries that travel from the body to the brain. Small pieces of debris enter the brain and, in the gradually narrowing blood vessels, lodge the smaller blood vessels that feed the brain.  This stops blood flow beyond the blockage, which can lead to permanent brain damage. Brain cells do not regenerate, but other areas of the brain can compensate for the dead cells with therapy, time and training.

Cardiovascular disease risks can be minimized with weight loss and healthy weight management, regulation of blood sugar, taking medications to reduce cholesterol if needed, quitting smoking, and maintaining a physically active lifestyle. Talking with a doctor about options to reduce the risk of cardiovascular disease is important if you have a diagnosis of diabetes or if there is a family history of cardiovascular disease or diabetes.

Cardiovascular Testing

Individuals that have prediabetes, hypertension, a family history of diabetes or coronary disease or that are diagnosed with diabetes should have routine cardiovascular testing. This will help determine the degree of any damage or decrease in blood flow and prevent serious complications that can occur.

There are many different cardiovascular tests available and different tests are more commonly used once a diagnosis of some type of cardiovascular disease has been made. In general, most people with a diagnosis of diabetes will be required to have regular annual cardiovascular tests.

  • Blood pressure tests – regular blood pressure testing is simple with a battery operated blood pressure monitor that is available at the drug store. While not always completely accurate, any changes in blood pressure are easily tracked using the device and can signal to the individual that a trip to the doctor is necessary. Research shows that early and intensive blood pressure reduction can have positive effects on the risk for stroke, causing reductions of up to 31% in a large group study of over 73,000 patients. 3
  • Cholesterol levels  – checking cholesterol levels through a full lipid profile is important. This is because this will determine levels of bad and good cholesterol as well as the triglycerides in the blood. Most adults will have one of these tests every five years, but it can be more often if diabetes or cardiovascular disease is a concern.
  • Electrocardiogram – this is a non-invasive test that allows the doctor to “see” the heart rate and the rhythm of the heart in real time through the electric current produced in the heart. Irregularities are distinctive and indicate damage to the heart muscle.
  •  Exercise stress test – using the same technology used in an electrocardiogram, the patient’s heart is monitored during physical activity. The patient runs and walks on a treadmill and the heart’s ability to handle increased blood volume is measured. Patients that are not able to use a treadmill can still take an medication stress test where specific drugs are used to increase the rate of heartbeat and blood volume.
  • MRI or CT scan – these are imagining options that allow the doctor to see the heart in action in the body. The tests create 2D and 3D images that can also trace the blood flow through the heart and in the large veins and arteries.

When abnormalities are present in these exams, more invasive options are possible if there is a concern for blockage of the heart or the blood vessels. Angiograms or angioplasty can be used to determine the extent of the blockage and to correct appropriate restrictions in the blood vessels.

References

1 Bloomgarden, Z. T. (2002). Cardiovascular Disease and Diabetes . Diabetes Care , 1230-1237.

2 Daniels, S. R., Pratt, C. A., & Hayman, L. L. (2011). Recent Advances in Preventive Cardiology and Lifestyle Medicine. Circulation , 1673-7686.

3 Reboldi, G., Gentile, G., Fabiob, A., et al. (2011). Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73 913 patients. Journal of Hypertension , 1253-1269.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.