New recommendations for people with diabetes and heart disease

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Cambridge (Massachusetts, USA): “Asharq Al-Awsat”



Eating a healthy diet and sticking to regular exercise are among your first priorities if you have heart disease. These healthy habits can help you reach or maintain a healthy weight while lowering blood pressure and cholesterol levels.

It is also possible that you will need to take drugs to further improve common heart-related risk factors. But if you also have diabetes, you may need more aggressive treatment, according to recent advice from the American Heart Association.

Recent recommendations

These recommendations – which were published on May 12, 2020 in the medical journal “Circulation” – illustrate the latest guidelines for treating people who suffer from heart disease and diabetes. Diabetes affects about one in 10 adults and doubles the risk of heart attacks or strokes.

Dr. Francine Welty, a cardiologist at Harvard University’s House of Israel Medical Center and co-author of the New Health Recommendations, says: “Over the past few years, we have seen compelling evidence regarding the benefits of new pharmaceutical drugs that reduce blood sugar levels. It also reduces the risk of death – not only from heart disease, but from any other cause. ”

These drugs are known as SGLT2 inhibitors. They include canagliflozin (Invokana), dapagliflozin (Farxiga), and Jardigliflozin (Jardigliflozin). Taken in the form of pills, they stimulate the kidneys to release more sugar into the urine. This not only reduces blood sugar, but also reduces those extra calories, which leads to modest weight loss with a slight drop in blood pressure.

Another class of pharmaceutical drugs that help reduce blood sugar, called GLP-1 receptor agonists, also help reduce the risk of heart attacks and the problems associated with them.

These drugs, which are administered by injection, include liraglutide (Saxenda, Victoza) and semaglutide (Ozempic), and there is a version of the pill available known as semaglutide (Rybelsus). It mimics the effects of a substance naturally produced by the gut in order to stimulate the pancreas to produce more insulin. These medicinal drugs would make patients feel full for a longer period of time and thus lead to weight loss.

Many relevant experts now suggest that patients with diabetes and heart disease should take either SGLT2 inhibitors or GLP1 receptor antagonists, completely regardless of their A1c value. (The A1C value reflects the average blood sugar level for the past few months, and recent guidelines recommend that the reading value be less than 7 percent).

Control of blood fats

People with diabetes tend to have high levels of cholesterol and triglycerides in the blood. Dr Francine Welty says the Mediterranean diet – which focuses primarily on vegetables, fruits, whole grains, nuts, fish and low-fat dairy products – will help reduce these levels. She adds, “I also advise my patients to stay away from white sugar, white bread, white rice, and white potatoes,” as these simple carbohydrates tend to raise triglyceride levels in the blood, just as alcoholic drinks do, which should also be reduced. Or avoid it altogether.

Any diabetic with a cholesterol level higher than 70 milligrams per deciliter of blood should take cholesterol-lowering statins. Although these prescription drugs may slightly increase blood sugar levels, their cardioprotective powers far outweigh this downside, says Dr. Francine Welty.

In order to reach the desired cholesterol level, some people may also need additional prescription drugs such as: alirocumab (Praluent), ezetimibe (zetia), or evolocumab (Repatha).

Those with high levels of triglycerides in the blood above 135 milligrams per deciliter may be candidates for the drug “icosapent ethyl” (Vascepa), which reduces triglycerides, and also reduces heart attacks and stroke risks.

Blood pressure considerations

Most guidelines guide patients with diabetes to reach a blood pressure reading below 80/140 mm Hg. However, some people at risk of heart disease may benefit from having a blood pressure reading lower than 80/130 mm Hg. However, the patient should discuss achieving this goal with his treating physician, as it may differ based on his age and other health conditions. Some drugs for high blood pressure would be better for people with diabetes than others. For example, classes of prescription drugs known as “ACE inhibitors and angiotensin-receptor blockers” help protect against kidney problems that are more common in people with diabetes.

Among the blood pressure drugs known under the name “beta blockers”, there are two; Metoprolol (Lopressor, Toprol-XL) and atenolol (Tenormin) appear to have unwanted effects on blood lipids and blood glucose levels in patients with diabetes, while “blockers Other beta such as carvedilol (Coreg) and labetalol (Normodyne, Trandate) do not have this effect.

What are the causes of the “harshness” of diabetes on your heart?

> The high blood sugar level – the first characteristic of diabetes – leads to damage to the inner walls of major arteries throughout the body, which makes these arteries more vulnerable to the accumulation of fatty platelets. The high blood sugar also leads to stiffness in the arteries, so that they cannot expand and expand normally, and it also leads to an increase in the viscosity of platelets, which increases the risk of exposure to blood clots.

In addition, diabetes causes chronic inflammation (which stimulates the immune system in the body), which also has similar harmful effects on the arteries in the body.

– Harvard’s message to the heart Tribune Media Services.

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