Spotlight on stroke in type 2 diabetes: How the
risk can be potentially reduced
If you are living with type 2 diabetes, your doctor has probably
asked you to make healthy lifestyle choices to help lower your risk of
cardiovascular disease—and rightly so! We have previously discussed
the connection
between type 2 diabetes and heart disease, and this
article explains that having type 2 diabetes increases your risk
of stroke or heart attack by 2-3 times compared with someone without
type 2 diabetes.1,2
Wondering how to start a conversation with your doctor?
Here's a guide to
help you have a good conversation with your healthcare provider about
the current state of your type 2 diabetes with regards to
cardiovascular risks.
Watch the video below to discover the importance of making lifestyle
changes to support your cardiovascular health. In the video, Jean
shares her experiences of having a stroke following a diagnosis of
type 2 diabetes.
To find out more, read on.
Cardiovascular disease and where stroke comes into it
Let’s start with a recap on terminology: cardio means related to the
heart, vascular means related to the blood vessels.
The medical term for a stroke is a cerebrovascular accident. Cerebro
means related to the brain and we know that vascular means related to
the blood vessels. In this blog post, we want to explain why people
with type 2 diabetes are at increased risk of suffering a stroke and
what can be done to help prevent it from happening, including the role
that your diabetes medicine could play.
What happens during a stroke?
Although your brain is about 2% of your body weight, its intense
activity means that it consumes about 20% of the oxygen that enters
your body.
Brain facts
Oxygen reaches the brain through the blood, so to ensure normal
functioning of the brain, it’s important that its blood supply remains steady.
A stroke can have a significant effect on physical and mental
health—it can cause movement problems, pain, numbness, and problems
with thinking, remembering or speaking. Some people also experience
emotional problems, such as depression, after a stroke.
Unfortunately, when people with diabetes have a stroke, they are at
an increased risk of dying or being left with a long-term
disability, versus someone without diabetes.2,8
Why does type 2 diabetes increase stroke risk?
Our blog
post on heart disease explains that when there is damage to blood
vessels, fatty material (sometimes referred to as ‘plaque’) can build
up and obstruct the blood flow in a process known as atherosclerosis.
Atherosclerosis can build up for many years without you knowing—it is
a silent disease, and a stroke can happen suddenly, with no warning.
Uncontrolled blood sugar levels in people with diabetes damage the
walls of the blood vessels and may speed up the process of
atherosclerosis. People with diabetes also tend to have high levels of
the types of fats in their blood that get turned into plaques.
High levels of sugar in the blood also make blood more likely to
stick together to form clots. When a clot reaches the brain, it can
lead to a stroke.
How your self-care helps lower your risk
Some risk factors for stroke can be kept in check by making your
lifestyle as healthy as possible. Here are some things that you can do:
Eat a healthy, balanced diet that is low in cholesterol and
salt
Stop smoking
Only drink alcohol within
recommended limits
Exercise regularly
Maintain a
healthy weight
You can read more about lifestyle changes promoting cardiovascular
health in this blog post.
Reducing your risk further with help from your diabetes doctor
You might already know about medicines that work to reduce certain
risk factors for cardiovascular diseases, like medicines that reduce
cholesterol or high blood pressure. If you haven’t had your
cholesterol or blood pressure checked in a while, why not make a note
to ask your doctor if it’s worth checking that they are under control?
As someone with type 2 diabetes, even if your diabetes and all of
your other risk factors for cardiovascular disease are
well-controlled, you may still, unfortunately, have a higher risk of
developing cardiovascular disease than the general population. Only 6%
of people with type 2 diabetes are thought to be managing this risk well.16
Talk to your diabetes doctor to ensure you are on the right
treatment to help you manage your risks.
Here’s
a guide to help you have a good conversation with your healthcare
provider about the current state of your type 2 diabetes with regards
to cardiovascular risks.
This is general disease awareness and should not be understood as
medical advice. If you have any questions or concerns, you should
contact your healthcare professional.
References
Almdal T, Scharling H, Jensen JS, Vestergaard H. The
independent effect of type 2 diabetes mellitus on ischemic heart
disease, stroke, and death: a population-based study of 13,000 men
and women with 20 years of follow-up. Arch Intern Med 2004;
164:1422–1426.
Fox CS, Coady S, Sorlie PD, et al. Trends in
cardiovascular complications of diabetes. JAMA 2004;
292:2495–2499.
Martín-Timón I, Sevillano-Collantes C,
Segura-Galindo A, et al. Type 2 diabetes and cardiovascular disease:
have all risk factors the same strength? World J Diabetes
2014;5(4):444–470.
Lüscher TF, Creager MA, Beckman JA,
Cosentino F. Diabetes and vascular disease: pathophysiology,
clinical consequences, and medical therapy: Part ii.
Circulation 2003;108(13):1655–1661.
Marso SP, Nauck
MA, Monk Fries T, et al. Myocardial infarction subtypes in patients
with type 2 diabetes mellitus and the effect of liraglutide therapy
(from the LEADER trial). Am J Cardiol
2018;121(12):1467–1470.
Jain V, Langham MC, Wehrli FW.
MRI estimation of global brain oxygen consumption rate [published
correction appears in J Cereb Blood Flow Metab
2010;30(12):1987] [published correction appears in J Cereb Blood
Flow Metab 2011;31(5):1336]. J Cereb Blood Flow Metab
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Association for Psychological Science.
Myth: We Only Use 10% of Our Brains [online] 29 August
2018. Available from:
https://www.psychologicalscience.org/teaching/myth-we-only-use-10-of-our-brains.html.
Last accessed: January 2024.
MedlinePlus. Cerebral
hypoxia [online]. Available from:
https://medlineplus.gov/ency/article/001435.htm Last accessed:
January 2024.
American Diabetes Association.
Stroke [online]. Available from:
https://www.diabetes.org/diabetes/complications/stroke Last
accessed: January 2024.
Kaarisalo MM, Räihä I,
Sivenius J, et al. Diabetes worsens the outcome of acute ischemic
stroke. Diabetes Res Clin Pract 2005;69(3):293–298.
National Heart, Lung and Blood Institute. Atherosclerosis
[online]. Available from:
https://www.nhlbi.nih.gov/health-topics/atherosclerosis Last
accessed: January 2024.
Funk SD, Yurdagul A Jr, Orr
AW. Hyperglycemia and endothelial dysfunction in atherosclerosis:
lessons from type 1 diabetes. Int J Vasc Med
2012;2012:569654.
Dokken BB. The Pathophysiology of
Cardiovascular Disease and Diabetes: Beyond Blood Pressure and
Lipids. Diabetes Spectrum 2008;21(3):160–165.
Lemkes BA, Hermanides J, Devries JH, et al. Hyperglycemia: a
prothrombotic factor? J Thromb Haemost
2010;8(8):1663–1669.
Drenjančević-Perić I, Jelaković B,
Lombard J, et al. High-Salt Diet and Hypertension: Focus on the
Renin-Angiotensin System. Kidney Blood Press Res
2011;34(1):1–11.
Mukamal KJ, Chen CM, Rao SR, Breslow
RA. Alcohol Consumption and Cardiovascular Mortality Among U.S.
Adults, 1987 to 2002. J Am Coll Cardiol
2010;55(13):1328–1335.
Venkatasamy VV, Pericherla S,
Manthuruthil S, et al. Effect of Physical activity on Insulin
Resistance, Inflammation and Oxidative Stress in Diabetes Mellitus.
J Clin Diagn Res 2013;7(8):1764–1766.
Wright AK,
Suarez-Ortegon MF, Read SH, et al. Risk Factor Control and
Cardiovascular Event Risk in People With Type 2 Diabetes in Primary
and Secondary Prevention Settings. Circulation
2020;142(20):1925–1936.
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