Dr. Annabelle Rodriguez-Oquendo,
Associate Professor of Medicine
and Diabetes Management Service
Director at Johns Hopkins Bayview
Dr. Rodriguez-Oquendo’s area of expertise is endocrinology.
Cardiovascular risk can occur earlier in women with diabetes
Among both men and women, diabetes is one of the strongest cardiovascular risk factors. Epidemiological studies have shown that people with diabetes have more than two times the chance of getting cardiovascular disease than people without diabetes. This includes premenopausal women, a group normally at lower risk for cardiovascular disease.
“Men generally have heart disease in their 40’s and 50’s, about a decade before women. But this is generally not true for diabetic women,” says Dr. Annabelle Rodriguez-Oquendo, Associate Professor of Medicine and Diabetes Management Service Director at Johns Hopkins Bayview Medical Center. “For diabetic women, the cardiovascular risk occurs earlier. Diabetes takes away much of the protection premenopausal women would normally get from estrogen.”
How diabetes raises risk for heart disease
The concentration of blood glucose or blood sugar, and how much it sticks to red blood cells and impedes the flow of oxygen in the blood, plays a large role in cardiovascular risk. An important measurement of sugar in the blood over a three-month period is the hemoglobin A1C test.
Hemoglobin is just one of the proteins that transport oxygen in the blood. Diabetes is a disease that impacts large blood vessels (such as the coronary arteries) and small vessels (such as arteries that carry blood to nerve endings and kidneys). Diabetes can affect the cardiovascular system by:
- Attaching glucose to (glycosylating) blood proteins and disrupting the distribution of oxygen throughout the body
- Causing the clumping of cholesterol-carrying proteins like LDL (bad) cholesterol, which leads to more plaque buildup in the vessel walls
- Producing fatty acids that can destroy proteins in the blood vessels
- Accelerating the development of atherosclerosis by playing a significant role in blood vessel inflammation
Risk factors for diabetes
A clear-cut cause for diabetes is not fully known. But there are several factors that increase the risk of getting diabetes, some factors for women in particular:
- Family history of diabetes
- Overweight or obesity
- Lack of exercise
- Age – being over 45
- Weight gain from having a large baby during pregnancy
- Polycystic ovarian syndrome (PCOS) – sometimes characterized by elevated insulin levels
- Being part of an ethnic group with a higher incidence of diabetes – including African Americans, Hispanic Americans, Asian Americans, Native Americans, and Pacific Islanders
- Metabolic syndrome – a group of simultaneously occurring conditions that can include abdominal obesity, high blood pressure, high fasting blood glucose level, high triglycerides, and low HDL (good cholesterol)
Symptoms of diabetes
Diabetes symptoms are related to high blood sugars. When symptoms and/or risk factors are present, blood sugar can be measured reliably with an oral glucose tolerance test. This is actually a series of tests taken over a few hours to ensure accurate measurement.
Depending on when it’s diagnosed, diabetes symptoms can vary from subtle to severe. Blood sugar-related symptoms may comprise:
- Unexplained weight loss
- Excessive and persistent thirst and/or hunger
- Frequent urination
- Yeast infections in both men (scrotal area) and women (vaginal area)
- Blurred vision
Symptoms related to the cardiovascular system and heart function can include:
- Nerve damage
- Shortness of breath and overall lack of exercise tolerance
- Atypical cardiac pain particularly common in women, such as pain in the jaw, back, and/or neck
- Swelling in limbs from fluid collecting in lungs
- Heart failure
Treating diabetes typically involves treating the conditions associated with it. Because many people with diabetes are overweight or obese, it’s important to carefully and consistently manage weight, diet, and exercise.
Because of the sensitivity of discussing weight issues and individual interpretations of the word “obese,” open, honest communication between the patient and the primary care physician is essential in managing diabetes and its associated disorders.
Sometimes lowering caloric, fat, salt, and sugar intake and introducing supervised exercise regimens are all that’s necessary to manage blood pressure, sugar, insulin, and cholesterol levels. In other instances, any of an array of medications may need to be introduced. It all depends on the severity of the diabetes, and the condition and medical history of the patient.
The challenge and importance of living a healthy life
High-sugar, high-calorie, high-salt packaged food is relatively inexpensive, extremely accessible, and very tempting for people with very little free time. But it’s essential to take the time to learn your genetic risks and recognize your individual condition, and make the effort to cut portion sizes, follow a healthy diet, and make physical activity part of daily life.
Dr. Rodriguez-Oquendo stresses the importance of being proactive and talking with a primary care physician about diabetes and its associated conditions, like hypertension and cholesterol disorder.
“Even if you have blood glucose levels that don’t quite qualify for diabetes, you might be in that gray area called ‘stealth diabetes,’” says Dr. Rodriguez-Oquendo. “Which means you can have all the same complications of someone with full-blown diabetes. So its important to take the oral glucose tolerance test and to stay vigilant about your health.”