Heart disease and stroke are the second and third most common causes of death for Canadians, trailing only cancer. The two combined kill more than 60,000 people in Canada every year. Scarier still, Canadians with Type 2 diabetes are at a much higher risk than the general population for both heart disease and stroke. Too often, they don’t even realize the connection.

As humans, we are infamously bad at analyzing risk. A recent survey from the American Diabetes Association indicated that people are more afraid of a shark attack than of the consequences of diabetes, despite diabetes-related deaths outnumbering shark attacks by more than 3,000 to 1. Even when Canadians consider the effects of diabetes, they often misjudge what people with diabetes should be most concerned about. “Patients are frightened of going blind, of losing a leg, and of developing kidney failure due to diabetes,” says Dr. David Fitchett, a cardiologist at St. Michael’s Hospital in Toronto. “What they aren’t aware of is that they’re much more at risk of dying from cardiovascular disease than they are of ever losing a limb or having to go on dialysis.”

Understanding the true risks

“People with diabetes should be aware that not only are they at risk of cardiovascular disease, it’s actually the most likely complication to develop,” says Dr. Fitchett. “These patients are at a greater risk of having a myocardial infarction (heart attack), having a stroke, and developing heart failure. Why? Because atherosclerosis, or a hardening of the arteries, is a more aggressive condition in people with diabetes. Independent of the other effects of diabetes — like higher blood pressure and abnormal cholesterol — diabetes itself is a risk factor for atherosclerosis.”

Atherosclerosis can remain asymptomatic for decades, only revealing itself when patients have their first cardiovascular event. And for people with diabetes, those events come earlier and are more severe. “There is a two to fourfold greater chance of a patient dying from cardiovascular disease when they have diabetes, and double the risk of a heart attack,” says Dr. Fitchett. “Patients with diabetes will have their first heart attack 15 years earlier than someone who doesn’t have diabetes, on average.”

Forewarned, forearmed

The other side of the awareness coin, of course, is prevention. When someone with Type 2 diabetes is aware of their increased risk, there are many things they can do to help offset it. Although maintaining healthy blood sugar levels remains important, lowering blood pressure and cholesterol are also vital to reducing the risk of heart disease. And properly controlling risk must go beyond even that. “Patients need to modify all the risk factors associated with cardiovascular disease,” says Dr. Fitchett. “That starts with lifestyle: quitting smoking, increasing physical activity, eating a healthy diet. These are very important things that anyone with diabetes can do.”

Recently, substantial advances have also been made in using diabetes medication to specifically reduce cardiovascular risk. “In the last 18 months, two new drugs currently available in Canada have been shown to reduce cardiovascular death,” says Dr. Fitchett. “One of these medications also reduced heart failure and stabilized diabetic kidney disease, which are very serious complications associated with diabetes.”

Diabetes is a complicated disease, and living with it requires constant attention and self-education. The most important thing is for Canadians living with diabetes to talk to their health care team and ensure they are fully aware of their own risk profile and their options for reducing it.