While the link between diabetes and heart disease has been known for more than 40 years, until recently there has been little guidance on how to care for people with either condition.
The Miami Cardiac & Vascular Institute is responding to the need for a more comprehensive approach to this patient population with the launch of its cardiometabolic disorders and prevention program in 2021.
Jonathan Fialkow, MD, assistant medical director, chief of cardiology at the Miami Cardiac & Vascular Institute, and chief population health officer of Baptist Health South Florida.
“This will be a coordinated, individual approach for patients at risk for or with cardiovascular disease who will benefit from a more holistic and complete approach to their risk reduction,” said Dr. Jonathan Fialkow, assistant medical director, chief of cardiology at Miami Cardiac & Vascular Institute, and chief population health officer of Baptist Health South Florida.
Dr. Fialkow sat down with the Resource News team to explain the link between diabetes and heart disease. In his words, “It’s more than the sugar.”
Q: How strong is the link between diabetes and cardiovascular disease?
DR. Fialkow: “Diabetes and pre-diabetes, a metabolic disorder that precedes a true diagnosis of diabetes, are both major risk factors for cardiovascular disease and death.”
Q: Can you give us an idea of how big the impact these diseases are on our health system?
DR. Fialkow: “Diabetics are two to four times more likely to suffer from heart disease, stroke and death. Nearly 70% of people over 65 with diabetes die from some form of heart disease, including heart attacks and heart failure, and 16% die from stroke. Billions of dollars are being spent treating the effects of this poorly controlled disease. “
Q: When we think of treating diabetes, we think of controlling blood sugar. Does a person’s blood sugar affect their risk of developing heart disease?
DR. Fialkow: “People with diabetes often have other metabolic disorders such as high blood pressure, dyslipidemia (a condition with abnormal cholesterol particles and high triglycerides), obesity, obstructive sleep apnea, fatty liver disease and many more. The sum of all these metabolic disorders contributes to the high rates of cardiovascular disease and death in diabetics.
“If we just focus on glucose control and ignore all of these other components, we haven’t shown that we could reduce heart disease and death in diabetics. It’s more than the sugar. “
Q: What does the term cardiometabolic disorder mean?
DR. Fialkow: “This is now the term we use for the metabolic conditions that lead to cardiovascular disease and death, including heart attack, heart failure and stroke. The same conditions also lead to kidney disease and an increased risk of needing dialysis. It is not a single condition like high blood pressure. The metabolic disorders are well known, and reviews and treatments are now available that have been shown to reduce cardiovascular disease and death. ”
Q: Can you explain how drugs originally designed for other purposes such as lowering blood sugar also benefit heart health?
DR. Fialkow: “The cardiometabolic disorder has many components. Since a drug is designed to treat one component, it is not uncommon for us to find a benefit in relation to another component. “
Q: What role can these drugs play in preventing cardiovascular disease in diabetics? Is their use limited to people with diabetes?
DR. Fialkow: “Many of the new, relatively safe therapies originally developed for diabetics have been shown to lower blood sugar, reduce cardiovascular death, heart failure and myocardial infarction, and also reduce kidney failure and hospitalization. We are now seeing benefits in patients who are at high risk for heart disease rather than diabetic disease, which in turn shows the multiple ways in which metabolic diseases lead to disability and death.
“It should be noted that it is believed that less than 10% of diabetics are currently receiving treatment for all conditions that lead to cardiovascular disease and death.”
Q: People with high blood pressure or high triglycerides may not have bothersome symptoms. How do you get someone who is feeling good to say, “Oh, I see. And am I going to take this drug that could cost me money or cause side effects? “
DR. Fialkow: “The whole concept of ‘prevention’ evaluates someone when they are comfortable to see if there are signs that something is happening that may lead to something bad in the future that is preventable.
“First we need to identify the patients with markers of high cardiovascular risk, like high blood pressure, high triglycerides, low HDL cholesterol, obstructive sleep apnea, etc. Even things like abdominal obesity, low testosterone, fatty liver disease, mild kidney dysfunction, and more are markers of one higher risk. Then we make a good assessment of what may contribute to that in the person’s medical status and lifestyle. An individualized treatment plan that includes diet, exercise, sleep pattern reviews and recommendations is needed, followed by medications that have been shown to prevent the poor results.
“Ultimately, there is data that diabetes can be avoided and even reversed, and drugs for other conditions can be discontinued with proper diet in mind.”
Q: What is the role of the Miami Cardiac & Vascular Institute’s Cardiometabolic Disorders and Prevention Program?
DR. Fialkow: “There are many community-based education and support programs, all of which are of great value, but do not reach many people who will benefit.
“The Miami Cardiac & Vascular Institute is one of five founding members of a national Cardiometabolic Center Alliance in which we will participate in creating national standards for the treatment of this condition, sharing best practices with other major centers, and consolidating our data as soon as we do learn more about this important condition. We believe we can educate our community and medical providers about the importance of identifying this condition and its components and taking early action to avoid poor cardiac outcomes. “
Q: What are the benefits of this approach for the community?
DR. Fialkow: “Many people with cardiometabolic disease or on their way to developing it are either unaware or too busy to care. Many patients and doctors focus on one element and do not have time for full education, assessment, and treatment. The program provides an organized way for the patient to manage these components by providing in-office visits and telemedicine visits in full support of family doctors and other specialists in the community. Similar programs show the effects of treating people appropriately and avoiding poor medical outcomes. “
