Interview with Prof. Diethelm Tschöpe, Clinical Director of the Diabetes Center, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University of Bochum, Bad Oeynhausen, Member of the Advisory Council of the German Heart Foundation and Chairman of the "The Diabetic Patient with Heart Disease" (Der herzkranke Diabetiker) Foundation
Diabetics are not only schooled in getting a handle on their blood glucose levels, but also in looking out for possible complications. One long-term complication of diabetes is nerve damage. It is often responsible for the so-called "diabetic foot", where minor injuries that cannot be felt can lead to large-scale inflammation and infection. Something many people are not aware of is that the heart can also be put at risk by nerve damage.
A heart attack usually involves severe chest pain. Why are diabetics not able to feel this pain?
Diethelm Tschöpe: Especially after they have had diabetes mellitus for a long time, people often also suffer from nerve damage, so-called neuropathy. Due to the degeneration of nerve fiber function, pain perception is reduced or entirely lost. This is why patients don’t feel the typical angina pectoris symptoms of an impending heart attack like shortness of breath, chest tightness or chest pain. Type 2 diabetes symptoms often also show up late. The disease is frequently not detected until coronary artery atherosclerosis is already advanced or there has been an attack. Even early stages of disturbed glucose metabolism already affect the heart and vessels.
Women frequently experience a heart attack differently than men. The typical chest pain or discomfort might be absent. What do women or diabetics generally need to look out for?
Tschöpe: The anatomy of the heart and coronary vessels is different in women. Heart attack symptoms in women are generally more “atypical“, which is why they are often misinterpreted or even dismissed. Signs might be nausea, vomiting, pain between the shoulder blades or in the upper abdomen. In women with diabetes, the pre-menopausal hormone protective effect is often eliminated. That means, their risk of developing coronary heart disease is similar to that of men, especially if there are added risk factors such as high blood pressure, lipid metabolism disorders or obesity, linked to metabolic syndrome for example. Needless to say, the situation continues to worsen after menopause when the production of reproductive hormones declines. Conversely, it means that women with diabetes have to be far more vigilant in terms of risk factor management. In the event of a detected or calculated risk, early preventive medical checkups should be scheduled with an internal specialist.
What preventive measures do you recommend for women with diabetes to avoid a heart attack?
Tschöpe: Generally speaking, it is essential to correctly recognize the symptoms of a heart attack and to see a doctor in time. Some evidence suggests that women are treated later than male heart attack patients. When it comes to preventive medical checkups for female patients with diabetes: if there are no symptoms of heart disease, women should still have an EKG once a year. In case of any abnormalities, they should follow up with a cardiac ultrasound and a stress test (or exercise EKG). In addition to a quarterly HbA1c test to measure blood glucose levels over an extended period of time, all risk factors including blood pressure and lipid levels must be lowered to target values. Patients should pay attention to exercise and a healthy diet. In honor of the heart disease prevention weeks in Germany in November 2016, valuable prevention tips are available for free in four published guidelines at the German Heart Foundation.