The adverse effect of Diabetes on the cardiopulmonary system
One of the most common causes for mortality in diabetes is cardiovascular disorders. When a person is suffering from diabetes, he/she is more likely to be affected with a cardiovascular disorder. Studies have shown that cardiovascular disorders are 2 to 3 times more common in diabetic men and 4 to 5 times more common in diabetic women (Ministry of Health New Zealand, 2001). Diabetes is a metabolic condition that would affect the cardiovascular system.
The manner in which diabetes affects the cardiovascular system is complex. Diabetes has a serious impact over the blood pressure resulting in a rise in blood pressure. Blood pressure sustained for long periods over 140 mm systolic and 90 mm diastolic can have serious impacts on the body (especially due to atheroscleorsis). This can result in several risks including stroke, atherosclerosis, etc. Studies have shown that when the blood pressure is reduced by 10 mm Hg, there would be at least a 15 % reduction in mortality and a 12 % reduction in other diabetic complications. The presence of other risk factors along with diabetes such as microabluminurea, dyslipidaemia and smoking can increase the risk further for the development of serious cardiovascular complications (Ministry of Health New Zealand, 2001).
In diabetes, the ability for lipid lowering agents to bring down the cholesterol levels in the blood may be poor. People who are diabetic and tend to smoke are at the risk of developing serious complications such as cardiovascular events, renal failure, retinopathy and nephropathy. Diabetics are generally at an increased risk to develop critical cardiovascular events such as angina and myocardial infarction. The frequency of such events in diabetes would be increased and also the chances of the individual not surviving such events are greater in diabetics than other populations (Filho, 2008). However, several other factors such as age, lower HDL level in the blood, HDL: LDL ratio, genetic factors, family history, sex, obesity, duration of the disease, etc, also play an important role in the development of such events. As the age advances, individuals become more and more prone to suffer from serious cardiovascular events (Redmond, 2000 & Siddiqui, 2004). When women suffer from diabetes, the protection they have from female sex hormones against critical cardiovascular events would be reduced (Redmond, 2000).
The exact pathological changes that occur following the development of diabetes may be difficult to understand. However, in diabetics, there are endothelial changes occurring due to hyperglycemia, which can contribute towards atherosclerosis and cardiovascular disorders. The blood vessels usually dilate depending on changes from the endothelium. In diabetics, this process is seriously affected leading to vasoconstriction, ischemia and thrombogenesis. In diabetics a condition known as ‘atherogenic dyslipidemia’ is also common. This condition is characterized by atherogenic dyslipidemia, procoagulation and hypertension (Siddiqui, 2004).
A study conducted by Albert and Ennker (2006), have shown that diabetic patients are at the risk of facing several complications and death during the post-operative period following cardiopulmonary bypass. This may be due to several factors including systemic effects of diabetes, surgical stress, anesthesia, anemia, hypertension, and poor compensatory mechanisms of the heart to overcome the problems that may occur following the surgery. The kidneys are also at a risk of facing complications due to physiological alterations brought about by hemodilution and abnormal tissue perfusion. Diabetes leads to micorvascular angioptahty of the vessels present in the lungs, which could seriously affect the lung function (Albert 2006).
The American Diabetic Association has strongly suggested that the risk factors need to be appropriately addressed in order to prevent development of serious life-threatening cardiovascular conditions in diabetes. Diet needs to be modified so that cholesterol and fat intake is lowered. Weight reduction should be considered essential. Cessation of smoking almost helps to reduce the risk of cardiovascular disease by half. The blood pressure needs to be controlled appropriately using medications. Antioxidants have been shown to lower the risk of coronary heart disease. One of the drugs that have known to be effective in the prevention of critical myocardial infarction and stroke is aspirin (Siddiqui, 2004).
Albert A. (2006). Should we avoid cardiopulmonary bypass with diabetic patients? Clin Res Cardiol , 95 Suppl 1:140-7. http://www.ncbi.nlm.nih.gov/pubmed/16598547?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Filho, M. P. (2008). Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil. Braz J Med Biol Res , 41(6) 526-532. http://www.scielo.br/scielo.php?pid=S0100-879X2008000600015&script=sci_arttext
Ministry of Health New Zealand. (2001). The impact of diabetes on the cardiovascular system. Retrieved March 10, 2009, from Ministry of Health New Zealand: http://www.moh.govt.nz/moh.nsf/pagesmh/5505/$File/ImpactOnCVS.doc
Redmond, S. J. (2000). Diabetes care needs evidence based interventions to reduce risk of vascular disease . BMJ , 321: 768. http://www.bmj.com/cgi/content/extract/320/7249/1554
Siddiqui, M. (2004). The Impact Of Diabetes On The Cardiovascular System And Management Strategies. JK–Practitioner , 11(4). http://medind.nic.in/jab/t04/i4/jabt04i4p233.pdf