Giant strides have been made in the prevention and treatment of heart disease over the past 50 years. Although it is still America’s leading cause of death, the mortality rate from cardiovascular disease has declined by 60 percent from its peak in the mid-1960s. But progress has plateaued, and deaths from stroke are creeping up.
Ongoing improvements in smoking rates, blood pressure and cholesterol control, and treatments for acute strokes and heart attacks are credited with this positive trend, so why has it stalled? All signs point to our meteoric rise in diabetes.
How Diabetes Causes Heart Disease
The links between coronary heart disease and diabetes are indisputable. Individuals who have diabetes are two to four times more likely to develop heart disease than non-diabetics. Their life expectancy at age 50 is six years shorter, and most of these premature deaths are from cardiovascular causes. Seventy percent of older people with diabetes will succumb to some sort of heart disease, and one in six will die of a stroke.
Given the significance of coronary heart disease and diabetes as a risk factor, it’s easy to see why progress has hit a wall. Nearly one in 10 Americans of all ages and one in four seniors have diabetes, and another 86 million have prediabetes (higher than optimal A1C/blood sugar levels that often leads to diabetes).
The only way to really get a handle on both coronary heart disease and diabetes is to tackle common risk factors, and the most significant of these is obesity.
Excess fat, especially visceral fat in the abdominal area, releases free fatty acids, hormones, and inflammatory chemicals that interfere with the body’s ability to properly utilize insulin. In this condition, called insulin resistance, the pancreas produces plenty of insulin, but the cells are deaf to its signals to let glucose into the cells. So the pancreas churns out more and more insulin in an effort to clear glucose out of the blood. If this overworked organ fails to keep up, blood glucose levels remain high and you have diabetes. But that’s not the worst of it.
Elevated glucose concentrations and compounds secreted by visceral fat cells also damage the endothelium, the protective inner lining of the blood vessels. This sets the stage for diabetic complications of the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy), as well as the most deadly complication of all: cardiovascular disease.
Endothelial dysfunction opens the doors for atherosclerosis (the buildup of plaque in the arteries) and the rupture of those plaques, which can lodge in an artery and cause a heart attack or stroke. It makes the arteries stiffer and less responsive, causing blood pressure to rise and the heart to work harder, thus increasing the risk of heart failure.
It’s a vicious cycle that leads to higher blood pressure, cholesterol and triglyceride abnormalities, additional fat storage and weight gain, and worsening insulin resistance. This cluster of risk factors, known as metabolic syndrome, goes hand-in-hand with both coronary heart disease and diabetes. And it usually begins with obesity.
Seventy percent of Americans are overweight. Even more shocking, 40 percent of adults and nearly 19 percent of children are obese (BMI 30 or higher). It’s an unprecedented increase that parallels the rise in type 2 diabetes, stymies progress in cardiovascular disease, and is considered by many experts to be our greatest public health threat.
Solution: Back to Basics
The Centers for Disease Control and Prevention (CDC) predicts that by 2050, diabetes will affect as many as one in three adults—and this will inevitably translate into a steep increase in heart disease. Dire as this forecast is, it is not inevitable.
In a 2018 briefing on the CDC’s Million Hearts campaign to improve the nation’s cardiovascular health, Anne Schuchat, MD, blamed the plateau in death rates on obesity, inactivity, and diabetes. She stated, “The solution to this national challenge does not depend on a major new discovery or a breakthrough in science.” She also noted, “About 80 percent of deaths from premature heart disease and stroke could be prevented by changes in physical activity, diet, smoking, and management of common medical conditions.”
The medical literature is teeming with studies on exercise, a healthy diet, and weight loss, and they all come to the same conclusion: Lifestyle changes are the most effective therapies for preventing and treating obesity, coronary heart disease, and diabetes.
One can argue the relative merits of aerobic exercise versus weight training, Mediterranean versus vegetarian diets, high-carb versus low-carb, intermittent fasting versus frequent meals, organized weight loss programs versus going it on your own. No single approach works for everybody. The best strategy is the one you can stick with—which leads to the million-dollar question.
Why Don’t We Eat Right and Exercise?
Everyone knows overeating an unhealthy diet causes weight gain and inactivity results in poor physical conditioning. You’re well aware of the downside of letting yourself get fat and out of shape, and you understand the serious ramifications of obesity, diabetes, and cardiovascular disease.
Personal trainers, cooking classes, health care professionals, support groups, etc., can help you make lifestyle changes, but that doesn’t mean you’ll be compliant over the long term. Fear isn’t a particularly effective motivator either. Financial incentives—rewards for hitting health-related goals or payments for missing them—sometimes help, but good luck finding someone to foot the bill.
I wish I had some brilliant new suggestions for putting the brakes on this looming health crisis. Supplements like berberine help, but it really boils down to developing healthier daily habits. Don’t sit around waiting for a therapy that will cure diabetes, reverse cardiovascular disease, and end obesity. There is already a solution for these health challenges. Commit to it today.
