Ask the Expert: Diabetes and Heart Attacks

Dr. David Ostrander, a cardiologist affiliated with Sharp, answers frequently asked questions about diabetes and heart attacks.

Why are people with diabetes at risk for heart attack?
People who have diabetes are at very high risk to have a heart attack, no matter how they’re treated. It is fair to say that excellent control of blood sugar is important for all diabetics, however it’s achieved.

How can a diabetic best avoid heart attacks?
The safest approach is always good diet and exercise and weight loss. And then we also have to remember that people who have diabetes very often have other risk factors that put them at risk for heart attack. Like high blood pressure, high cholesterol, low levels of good cholesterol and treating those other risk factors in addition to the blood sugar pay huge dividends in reducing the risk of heart attack.

What else can I do to stay healthy?
Eat healthfully, exercise for an hour a day, keep your weight down. If you have diabetes, you should also be on a statin, one of the drugs that lowers the bad cholesterol. If your level of good cholesterol is low, you may need to be on a medicine to raise that. If your blood pressure is above 120 over 80, you should be on medicine, particularly something called an ACE inhibitor to lower your blood pressure. And, of course, it goes without saying that you shouldn’t smoke cigarettes.

Will diabetics know when they are having a heart attack?
Diabetics commonly do not experience chest pain when the heart muscle is not getting enough blood. So they may be having significant episodes of what we call ischemia, or lack of blood supply to the heart muscle, but not recognizing it with chest pain. So when a diabetic presents with unusual fatigue or breathlessness, their doctor should really get them over to a cardiologist to have an evaluation.

Certainly diabetics can have the usual symptoms of chest pain, just like anyone else but, in addition, you have to be aware that they may just have shortness of breath, they may have unusual sweating, they may have unexplained fatigue, poor sleep patterns or absolutely no symptoms at all.

What should I do if I think I'm having a heart attack?
If your symptoms are acute, meaning occurring suddenly; you suddenly break out into a sweat, feel extreme exhaustion, certainly chest pain, my advice would be to get to the hospital right away. Particularly for somebody with ongoing chest pain, there’s only one way to do that, and that’s to call 911.

For More Information
For more information about heart and vascular care at Sharp or to find a Sharp-affiliated doctor, search for a San Diego cardiologist or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about heart and vascular care, visit Cardiovascular Diseases in Adult Health or read the Heart and Cardiovascular News archive.