“If you break a bone, you have pain. If you have malaria, you’ll have a fever, but one in two people living with diabetes don’t even know it,” remarks Dr Sai Satish, a cardiologist from Apollo Hospital on Greams Road in Chennai. Among other health risks, the doctor notes that undetected diabetes is one of the leading causes of coronary artery disease (CAD) in India and has been known to cause a ‘silent heart attack,’ in many. What is a ‘silent’ heart attack and how can it be precipitated by diabetes?
A ‘silent’ heart attack occurs when an individual has suffered a heart attack which they may not even be aware of. In some cases, this may be fatal and the diagnosis made only after the death of the individual. However, in the increasingly common clinical picture, more diabetics are going to the doctor only to find out that they have had a heart attack, but were not necessarily aware of it.
“Studies show that Indians who develop CAD are generally affected with an extremely aggressive form of heart disease. We have the evidence to show that this has been precipitated by the skyrocketing incidents of diabetes,” states Dr Sai.
CAD, or coronary artery disease, is a disease that affects the coronary arteries, which are the blood vessels that provide blood supply to the heart. In CAD, these vessels become blocked or narrowed which causes blood circulation to the heart to be cut off. Complete cessation of blood supply to the heart results in a myocardial infarction, or a heart attack. The most common symptoms of a heart attack are right-sided chest pain, pain radiating to the opposite arm, nausea, acidity, and excessive sweating.
In a silent heart attack, these symptoms are absent or are so mild that the individual doesn’t notice them. It may be fatal or may aggravate an individual’s existing CAD and pose a threat to them at a later time.
A recent study, which was presented in Paris called the PURE study, analysed data from five countries (including India) around the world. This study proved that cardiovascular disease (heart disease) is a growing concern, with most cases of CAD occurring in individuals with diabetes.
“We’ve seen a new transition, the old transition was infectious diseases giving way to noncommunicable diseases. Now we’re seeing a transition within noncommunicable diseases,” stated Dr Salim Yusef, one of the principal investigators of the study at a press conference.
How does diabetes play a role in the development of heart disease?
High blood sugar in a diabetic individual can lead to stiffening of blood vessels as a result of damage induced by glucose. Fat and cholesterol deposits then begin to build up in the vessel wall and result in a compromised integrity of the vessel structure. This can also lead to a condition called atherosclerosis where the blood vessel becomes completely blocked by the fat deposits.
If this specifically occurs in the coronary vessels, it will cut off the blood supply to the heart and cause a heart attack.
Individuals with hypertension are also at a higher risk of developing a silent heart attack.
What you should know about prevention
“The less you eat, the more you walk, laugh, and sleep, the longer you’ll live,” says Dr Sai with regards to prevention and self care.
In addition, he recommends that individuals who have been identified to be at risk should also have their blood sugar levels and blood pressure monitored routinely and kept under control. Reducing the amount of alcohol intake and cutting down on cigarettes has also been cited as helping reduce an individual’s risk of developing a silent heart attack.