RELATIONSHIP BETWEEN DIABETES MELLITUS AND CARDIOVASCULAR DISEASES
Abstract.
This article scientifically examines the strong link between diabetes mellitus and cardiovascular diseases. It has been established that diabetes significantly increases the risk of coronary artery disease, stroke, hypertension, and other cardiovascular complications. The article pays special attention to pathophysiological mechanisms, risk factors, diagnostic methods, and preventive strategies. Additionally, modern clinical approaches and the epidemiological situation in Uzbekistan are briefly reviewed.
Keywords: diabetes mellitus, cardiovascular system, insulin resistance, atherosclerosis, hypertension, coronary artery disease, myocardial infarction, angiopathy
Introduction
Diabetes mellitus is one of today’s most serious global health concerns, negatively affecting the quality of life and life expectancy of millions of people worldwide. This disease is characterized by severe metabolic disorders resulting from insulin deficiency or resistance, leading to disruptions in glucose metabolism. Diabetes is generally categorized into two main types: Type I (insulin-dependent) and Type II (insulin-resistant). Both types can cause complex pathological changes over time.
According to the World Health Organization (WHO), as of 2023, more than 537 million people worldwide are affected by diabetes, and this number continues to grow each year. Projections estimate that by 2045, the number will reach 783 million. This condition brings not only medical but also significant social and economic challenges, particularly due to cardiovascular complications being among the most severe outcomes.
Diabetes causes substantial damage to the cardiovascular system. People with diabetes are several times more likely than healthy individuals to experience coronary artery disease, myocardial infarction, stroke, hypertension, peripheral artery disease, and heart failure. Studies show that diabetic patients are more susceptible to heart attacks, circulatory disorders, and even sudden cardiac death. Statistics indicate that over 65% of people with diabetes die due to cardiovascular complications.
The main factors contributing to the development of cardiovascular disease in diabetics include arterial wall thickening, accelerated atherosclerosis, high blood pressure, insulin resistance, dyslipidemia, and chronic inflammation. These conditions impair heart function, disrupt circulation, and may lead to heart muscle failure.
This article explores the scientific basis of the relationship between diabetes and cardiovascular disease, including pathophysiological mechanisms, risk factors, clinical symptoms, diagnostics, and prevention and treatment strategies. It also reviews the epidemiological situation and prevention efforts in Uzbekistan.
Pathophysiological Link
Diabetes affects the cardiovascular system through several mechanisms:
- Insulin resistance – A key factor in Type II diabetes that impairs endothelial function.
- Hyperglycemia – Chronic high blood sugar causes oxidative stress in vessel walls, accelerating atherosclerosis.
- Dyslipidemia – Diabetic patients often exhibit elevated LDL (“bad”) cholesterol and reduced HDL (“good”) cholesterol.
- Inflammation – Persistent low-grade inflammation adversely affects the heart and blood vessels.
Diabetic Angiopathy
Diabetic angiopathy refers to vascular damage due to diabetes and is divided into:
- Microangiopathy – Affects small capillaries.
- Macroangiopathy – Affects large arteries, contributing directly to cardiovascular diseases.
Coronary Artery Disease and Myocardial Infarction
Diabetes increases the risk of coronary artery disease (CAD) by 2 to 3 times, making it one of the most dangerous and prevalent complications. CAD results from the narrowing or blockage of coronary arteries, which supply oxygen and nutrients to the heart muscle. This process develops more rapidly in diabetics and often leads to severe outcomes.
Chronic hyperglycemia in diabetes damages the endothelium (inner lining of blood vessels), causing dysfunction in vascular dilation and contraction. Combined with dyslipidemia, hypertension, and inflammation, this promotes the formation of atherosclerotic plaques that restrict blood flow to the heart.
Myocardial infarction (heart attack) occurs when part of the heart muscle is deprived of blood supply, leading to tissue death. In diabetic patients, heart attacks often occur without symptoms (“silent infarctions”) due to diabetic neuropathy reducing pain perception. This complicates timely diagnosis and treatment, increasing the risk of heart failure and sudden death.
Research indicates that diabetic women may be at greater risk for developing CAD than men, possibly due to hormonal factors and reduced cardiovascular protection. Additionally, asymptomatic or “silent” forms of CAD are more common in patients with Type II diabetes and are typically diagnosed only through specialized cardiac tests.
Post-infarction rehabilitation in diabetics is more complex, with slower vascular recovery, reduced cardiac contractility, and increased risk of heart failure. Thus, regular cardiac monitoring, early screening (ECG, echocardiography, stress tests), and proactive management are essential.
Preventive strategies include managing blood glucose, blood pressure, cholesterol, body weight, and physical activity. Medications such as aspirin, statins, and ACE inhibitors are widely used to prevent heart attacks. A healthy diet, stress management, and quitting tobacco also play a crucial role in maintaining heart health.
Diabetic Cardiomyopathy
Diabetic cardiomyopathy is a condition where the heart muscle is directly damaged by diabetes, impairing its ability to contract and relax. It can develop even in the absence of overt cardiovascular disease, making it a distinct complication of diabetes.
The main cause is disrupted energy metabolism in the heart. In diabetes, glucose cannot efficiently enter cells, forcing the heart to rely on fatty acids for energy. Excessive breakdown of fatty acids increases oxidative stress and leads to toxic byproducts, causing cell death (apoptosis) and structural changes in the myocardium.
Insulin resistance also affects calcium regulation in heart cells, reducing the heart’s ability to contract and relax. Calcium ions are critical for heart function, and their imbalance leads to diastolic dysfunction, where the heart cannot fill properly during relaxation.
Over time, the heart muscle thickens (hypertrophy) and the chambers (especially the left ventricle) enlarge, weakening the heart’s pumping ability. Clinically, this presents as shortness of breath, fatigue, rapid heart rate, swelling, and signs of heart failure.
Studies show that diabetic cardiomyopathy is especially common in Type II diabetics, many of whom feel asymptomatic. Functional impairments are often detected only via echocardiography or MRI. Regular heart evaluations and early attention to signs of heart failure are essential.
Treatment starts with strict glycemic control. Modern drugs such as SGLT-2 inhibitors, GLP-1 receptor agonists, and ACE inhibitors provide cardiac protection and slow the progression of cardiomyopathy. Lifestyle modifications—balanced diet, physical activity, stress reduction, and avoiding harmful habits—are key to maintaining stable heart function.
In conclusion, diabetic cardiomyopathy is a complex, direct consequence of diabetes affecting the heart. Early detection and consistent management significantly reduce the risk of heart failure and death.
The Situation in Uzbekistan
According to the Ministry of Health of the Republic of Uzbekistan, the incidence of diabetes is increasing annually. This trend contributes to the growing burden of cardiovascular diseases. Preventive efforts are insufficient, especially in rural areas where public awareness is low.
Prevention and Recommendations
- Healthy lifestyle: proper nutrition, physical activity, avoiding smoking and alcohol
- Continuous glucose monitoring
- Management of hypertension and dyslipidemia
- Annual ECG and echocardiography screening
Conclusion
Diabetes mellitus is one of the major contributors to cardiovascular damage. Coronary artery disease, hypertension, heart attacks, and other cardiac conditions are significantly more common in diabetic patients. This reality demands enhanced preventive and treatment measures from the healthcare system. Success in the fight against diabetes relies on patients’ commitment to their health, informed medical approaches, and public campaigns promoting healthy living.
References
- Abdullayeva Z., Toshmatova M. Propedeutics of Internal Diseases. – Tashkent: “Tibbiyot”, 2021. – 412 pages.
- World Health Organization (WHO). Diabetes: Key facts, 2023.
- Ministry of Health of the Republic of Uzbekistan. Diabetes-related statistical data. – 2022.
- Reaven G. M. Role of insulin resistance in human disease. Diabetes. – 1988.
- American Diabetes Association. Standards of Medical Care in Diabetes – 2023.
Mirzaolimov Mirabbos Muzaffar ogli
3rd-year student at the Faculty of Medicine, Alfraganus University
Born in Shakhrisabz district, Kashkadarya region