Diabetes and Heart Health

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Natalie Salvatore:

Hello, my name is Natalie Salvatore. I'm a registered nurse at the Cleveland Clinic in the Heart, Vascular and Thoracic Institute.

Dr. Bruemmer:

My name is Dr. Bruemmer. I'm one of the cardiologists in the Department of Medicine in the Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Natalie Salvatore:

And today we're going to talk a little bit about heart health and diabetes. So how is diabetes related to heart health?

Dr. Bruemmer:

So that's a very important question to a lot of our patients, and it is also a very common question because if we as cardiologists practice our daily practice and see patients, we actually see about 60 percent on average of our patients have a diagnosis of type two diabetes. So it's quite common in the patients that we see. It's also quite common that we screen for diabetes because it's a risk factor for heart problems and patients don't even know that they have this diagnosis. This does very frequently occur.

Now, diabetes is a risk factor for heart problems, and it's associated not just with the part of high blood sugar levels, but also it's associated with other risk factors. So patients with diabetes have more commonly elevated blood pressures have more commonly high cholesterol levels, high triglyceride levels, low HDL levels, so cholesterol lipid abnormalities. So those sort of together build an environment that the heart does not like very much because those are all three risk factors, diabetes, blood pressure, cholesterol, that ultimately may lead to heart attack, stroke and heart failure and complications of heart disease. So it's quite common. Statistically speaking, the risk for, for example, a heart attack in a patient with diabetes is about twice as high as in the general population. So it's an important risk factor that unfortunately frequently goes unrecognized and also frequently difficult and insufficiently treated because it's difficult to treat.

Natalie Salvatore:

Now, you mentioned some risk factors. What would prompt a patient to see a doctor?

Dr. Bruemmer:

So, patients come to us in cardiology frequently because they have had a heart problem. They may have had a heart attack, they may have been diagnosed with heart failure, and then they come to us for treatment of those risk factors. Now, we very much prefer that patients come earlier so we can do preventive cardiology, which we do in our section of preventive cardiology here in our department with our colleagues. And we like to be proactive in treating those risk factors to protect from future heart disease. And that again includes diagnosis and recognition of treatment of diabetes, blood pressure, and cholesterol problems. So if a patient feels or has been screened for these risk factors that I had just mentioned, diabetes, blood pressure, or cholesterol problems, we encourage patients to again, be proactive and be treated for all three of those because that ultimately makes a major difference in the future risk for heart disease. So early recognition and early treatment is very important.

Natalie Salvatore:

If a patient just has a diagnosis of diabetes, do you recommend that they start in cardiology, seeing a cardiologist even if they have no heart symptoms?

Dr. Bruemmer:

So, if a patient has, for example, just been newly diagnosed for diabetes, which most frequently is done by something called hemoglobin A1C testing. So a patient with diabetes should always know and ask, what is my hemoglobin A1C or my A1C? This is the number every patient with diabetes needs to know. And as a cardiologist, as I mentioned, we frequently see more of the complications of diabetes like heart problems. So we encourage patients to work with their primary care providers in the initial diagnosis and the initial testing and initial treatment. We have joint programs with our endocrinology doctors. The endocrinologists obviously see quite a bit of the spectrum of diabetes, often more later in the stages when diabetes gets treated with more complicated insulin regimens, more intensive medications that are needed.

And so initially it's a collaboration between primary care managing, primary care, family medicine, doctors managing diabetes, and then endocrinology taking on. And we have joint programs. Now, keep in mind, as I mentioned, we manage all the spectrum here in our prevention center. We are part of cardiology, but we do address diabetes. We do address blood pressure and we do address cholesterol problems. So if a patient needs help or feels that those risk factors aren't appropriately treated, this is what we do in preventive cardiology as well.

Natalie Salvatore:

And what can a patient expect when they come to preventive cardiology? What kind of testing or things might they need to have done that you will look at?

Dr. Bruemmer:

So typically, in our preventive cardiology program, our colleagues, we first do an assessment of risk factors, and that includes, again, we keep cycling back to those risk factors, blood pressure measurement, blood pressure testing, blood pressure treatment, cholesterol, lipid panel, fasting blood testing to look for those cholesterol and lipid issues that sometimes go along with diabetes. And then of course, measuring the hemoglobin A1C that I had mentioned because that defines where in the stage of diabetes do we need to start treatment and this is sort of an initial comprehensive testing. And then if the patient has any symptoms that could be concerning, we add in imaging studies, we add in testing of the heart, stress testing if needed, additional imaging procedures as they are needed to assess heart health and heart risk in patients who have those risk factors. So of course, smoking is another that goes without saying, we have smoking cessation programs available.

We also work early in weight management and obesity medicine to help patients lose weight as well. So it's sort of a comprehensive program that we provide in collaboration with colleagues for patients needing more advanced treatment of diabetes, like complex insulin, treatment, multiple daily injections, glucose monitoring, all the way to insulin pump management. We work with our colleagues from endocrinology and joint clinics, and we work with our colleagues from the pharmacy program and we work with primary care doctors in collaboration. So this is all a collaborative approach to ultimately protect patients from heart problems.

Natalie Salvatore:

Now you've mentioned that typically patients will start out with their initial diagnosis with their primary care doctor. Do you ever see it going backwards almost where you in preventive cardiology are managing some of those other heart risk factors and then discover that a patient has diabetes?

Dr. Bruemmer:

Yes. This is actually quite common because when patients, just to give you an example, when patients come to the hospital for heart problems, let's say a heart attack for example, we screen patients for diabetes. This is recommended to test and screen for risk factors. We screen for diabetes, for lipid problems, and of course for blood pressure because those are common. So in other words, sometimes a heart condition like heart attack or a stroke or heart failure is the first symptoms, so to speak, of a diagnosis of diabetes, which then when a patient comes to the hospital, we test and we diagnose as cardiologists, and then we go ahead and again, work with where in the spectrum of diabetes is the patient. We consult with endocrinology in the hospital for managing of diabetes with insulin if needed. And then sometimes the patients are referred again to us and prevention to continue to manage and treat those risk factors including diabetes. But the cardiologist does see a lot of patients with diabetes because it's quite common.

So I think in cardiology, we and our colleagues, we start to recognize that and we start to be more proactive in using the right medications. There are certain medications that we have available now which have been shown to protect from future heart problems. So we encourage to use those newer medications which are recommended again, ultimately with the goal to protect from heart problems.

Natalie Salvatore:

Well, it sounds like our patients are going to receive excellent, well-rounded care from the multidisciplinary team. So thank you so much for taking time to speak with us and our listeners today about your heart health and diabetes.

Dr. Bruemmer:

Thank you. Thank you very much, Natalie, for having me.

Announcer:

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