THE RELATIONSHIP BETWEEN DIABETES AND CARDIOVASCULAR DISEASE

1. What is Diabetes?

Diabetes mellitus is a chronic metabolic disorder characterized by persistently elevated blood glucose levels resulting from either insufficient insulin production or ineffective insulin utilization by the body’s cells.

In Vietnam, the Ministry of Health reports approximately 7 million people living with diabetes (over 7% of adults), with more than 50% remaining undiagnosed or improperly treated. Diabetes is one of the leading causes of serious cardiovascular complications, including myocardial infarction, stroke, and heart failure.

Figure 1: Diabetes occurs when blood sugar levels remain elevated over a prolonged period.

2. Why Does Diabetes Cause Cardiovascular Disease?

People with diabetes face a 2–4 times higher risk of developing cardiovascular disease compared to healthy individuals, according to the World Health Organization (WHO). This relationship is explained by several biological mechanisms:

• Endothelial damage: Chronic high blood glucose damages the endothelium, reducing vessel elasticity and promoting fat accumulation, leading to atherosclerotic plaque formation.
• Chronic inflammation and oxidative stress: Advanced glycation end products (AGEs) enhance inflammatory responses, making plaques more prone to rupture, causing heart attacks or strokes.
• Dyslipidemia: Increased triglycerides, reduced HDL-C, and elevated LDL-C accelerate atherosclerosis.
• Increased coagulation and platelet aggregation: These factors heighten the risk of thrombosis in coronary or cerebral arteries.

Figure 2: Diabetes-related metabolic disorders accelerate atherosclerosis and arterial thrombosis.

3. Common Cardiovascular Complications in Diabetic Patients

• Coronary artery disease: Causes angina and is a major contributor to acute myocardial infarction.
• Heart failure: Often congestive in nature, resulting from prolonged myocardial damage due to diabetes.
• Cerebrovascular disease: Leads to stroke (ischemic or hemorrhagic).
• Peripheral artery disease: Causes arterial obstruction in the lower limbs, increasing the risk of tissue necrosis.

4. The Role of Cardiovascular Intervention in Treating Diabetic Patients

When diabetes severely damages blood vessels, particularly the coronary arteries, Percutaneous Coronary Intervention (PCI) may be required to restore blood flow to the heart. However, diabetic patients have a higher risk of restenosis after stent placement due to chronic inflammation and lipid metabolism disorders.

To minimize restenosis, Drug-Eluting Stents (DES) have become the preferred choice for coronary interventions. One notable example is VSTENT – a Sirolimus-Eluting Stent manufactured by USM Healthcare Medical Equipment Factory JSC, which offers several advantages:

• The Sirolimus coating inhibits cell proliferation, significantly reducing restenosis risk post-procedure.
• Its advanced design and unique stent frame structure enhance durability, flexibility, and arterial coverage.
• Developed to international standards, VSTENT is widely used in major interventional cardiology centers across Vietnam.

Figure 3: VSTENT – Sirolimus-Eluting Stent produced by USM Healthcare Medical Equipment Factory JSC.

5. Preventing Cardiovascular Disease in Diabetic Patients

Prevention is the cornerstone of managing both blood glucose and cardiovascular complications.

• Control blood glucose: Maintaining HbA1c below 7% helps prevent vascular damage and reduces the risk of heart attack and stroke (per ADA 2024 recommendations).
• Control blood pressure and lipids: Patients should keep blood pressure below 130/80 mmHg and use statins or ACE inhibitors/ARBs as prescribed.
• Maintain a healthy lifestyle: Eat plenty of vegetables, fish, and whole grains; limit sugar, fats, and processed foods. Exercise at least 30 minutes daily. Avoid smoking, alcohol, and stimulants.
• Regular medical check-ups: Schedule health checks every 3–6 months to monitor blood glucose, lipid levels, and heart and kidney function. Contact your physician immediately if symptoms such as chest pain, shortness of breath, leg swelling, or unusual fatigue occur.

Figure 4: Healthy diet to control blood sugar and prevent cardiovascular complications.

Conclusion

Diabetes and cardiovascular disease are two sides of the same health issue. Maintaining optimal blood glucose control combined with proactive cardiovascular prevention is the key to extending lifespan and improving quality of life for diabetic patients.

References

1. American Diabetes Association. Standards of Care in Diabetes – 2024.
2. European Society of Cardiology. Guidelines on Cardiovascular Disease in Diabetes, 2023.
3. International Diabetes Federation. IDF Diabetes Atlas, 2023.
4. World Health Organization. Diabetes Country Profiles – Vietnam, 2023.
5. Bộ Y tế Việt Nam. Báo cáo Ngày Thế giới Phòng chống Đái tháo đường 2023.
6. Zinman B et al. EMPA-REG OUTCOME. NEJM, 2015.
7. Marso SP et al. LEADER. NEJM, 2016.