- Elevated blood sugar levels have been strongly correlated with endothlial dysfunction, a condition in which the endothelial lining (inner lining) of the blood vessels is not functioning normally. Endothelial dysfunction plays a major role in the development of atherosclerosis.
- High blood sugar levels also make the blood platelets (the clotting elements in the blood) "sticker," and increase the coagulation potential of the blood plasma. These effects make diabetics more prone to abnormal blood clotting. Clot formation (or thrombosis) within the coronary arteries plays a major role in acute coronary syndrome (ACS).
- There is evidence that in diabetics, the plaques that form within blood vessels during the process of atherosclerosis may differ from plaques seen in non-diabetics. Plaques in diabetics tend to contain more lipids than usual, and more macrophages (inflammatory cells) than is typical. These differences appear to make plaques in diabetics more prone to rupture, the event that triggers ACS.
So if you have diabetes, you have these built-in risk factors for CAD. This means that if you have additional risk factors, your risk becomes especially high. Unfortunately, additional risk factors for CAD are extremely common in people with type II diabetes or metabolic syndrome, both of which are associated with being overweight and physically inactive.
As important as controlling risk factors is in anybody, it is especially important for you if you have diabetes or metabolic syndrome. You will need to work hard to control your blood sugar levels, of course, but but in addition you will need make sure you and your doctor are doing everything you can to reduce your other risk factors. This means aggressively managing hypertension and lipid abnormalities, maintaining a healthy weight, getting plenty of physical activity -- and no smoking!
Despite the elevated cardiovascular risk that is associated with diabetes or metabolic syndrome, there's a lot you can do to stay healthy. Learn everything you can about cardiovascular risk reduction, and take whatever steps are necessary, in your particular case, to keep that risk low.
Grundy, SM, Benjamin, IJ, Burke, GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999; 100:1134.
Kannel, WB, McGee, DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59:8.
Emerging Risk Factors, Collaboration, Sarwar, N, Gao, P, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375:2215.