Monthly or so, Dr. Dieter Lubbe sees another woman in her 30s with heart disease.
The cardiologist at Providence Sacred Heart Medical Center often takes his patients to a catheter lab, where he does an angioplasty – inflating a balloon inside the patient’s blood vessel to squeeze the accumulated plaque against the arterial wall – and then inserts a stent to keep the passage clear. Some of the women’s hearts are significantly damaged by the time Lubbe sees them.
The frustrating part, the cardiologist will relay to his audience at an upcoming talk about women’s risk for heart disease: “All of this is preventable. Most of these young women, it’s either smoking or, often, the consequences of obesity. They develop high blood pressure, high cholesterol and diabetes at an age that you didn’t see 50 years ago.”
More than a third of U.S. adults are obese, after a dramatic rise in rates in the past 20 years, according to the Centers for Disease Control and Prevention. And obesity is directly related to major risk factors for heart disease, now the No. 1 killer of women.
That diabetes ranks among the major causes of heart disease often surprises newly diagnosed patients, said Dr. Molly Carlson, an endocrinologist who has served in the American Diabetes Association’s leadership council.
While diabetics are significantly more likely to have heart disease than people without it, “most people are very unaware of the correlation,” said Carlson, who works at the Polyclinic, which has offices scattered around the Seattle area. “They think diabetes is just about blood sugar. Most people with diabetes worry about neuropathy in the feet and kidney damage and eye damage.”
As a cause of heart disease, diabetes has garnered more attention in the past decade because of the obesity epidemic, but also as doctors and researchers look to the next hurdle as patients are able to use drugs to reduce other risks, such as high cholesterol, said Dr. Joshua Buckler, board president of the American Heart Association’s Puget Sound district.
“Arguably (diabetes) ranks just behind smoking as one of the highest risk factors, probably on par with high cholesterol,” said Buckler, a cardiologist at Pacific Medical Centers in Seattle.
While they can’t control some factors, such as genetics, many patients at risk of heart disease are making strides in other areas – smoking less, eating better, controlling their cholesterol and blood pressure. Diabetes is undercutting improvements in heart disease rates, Buckler said.
“Without the increase in diabetes, we would see a much more dramatic reduction in heart disease in the country,” he said.
The link between diabetes and heart disease has to do with the way patients’ extra blood sugar affects their vessels’ ability to do their job.
While blood vessels used to be viewed as simple conduits, Lubbe said, “we now know that the inner lining of the blood vessel is a very intricate, essentially, organ by itself. It secretes about 100 different chemicals to try and prevent plaque from building in the blood vessel.”
Diabetes makes it more difficult for blood vessels to resist plaque formation, making patients more prone to the buildup that leads to reduction or blockage of blood flow to the heart, Lubbe said.
Diabetes also makes heart disease more “diffuse,” Lubbe said, leading to the presence of plaque throughout a vessel rather than in one or two spots. That makes it harder to use stents to treat diabetics, so they’re more likely to require bypass surgery.
Lubbe’s goal at his upcoming talk is to make women aware of the factors that raise their risk of heart disease – especially their risks related to type 2 diabetes and other obesity-related problems – so they’ll work to protect their hearts.
“(When) I get called at 2 in the morning to do a stent on a young woman having a heart attack, I can help them, but it really misses the ball,” Lubbe said.
He said he’ll also talk about screening for heart disease.
Stress tests – when doctors monitor patients’ heart rates during strenuous exercise – are recommended only for people at very high risk of heart disease, because the tests are prone to false positives, he said.
For most women, he said, it’s more important to get screened for the risk factors of heart disease. That means having a health care provider gauge patients’ weight, blood pressure, blood-sugar and cholesterol – and then help them fix the problems that make heart disease more likely.
“It’s cheap, and clearly it’s effective,” Lubbe said. “If you (address) these risk factors early on, you can prevent disease.”