CHOLESTEROL AND DIABETIC LINK

WHY EVERY DIABETIC SHOULD RECEIVE A STATIN?

Cardiovascular disease is the main condition associated with Diabetes Mellitus that is a cause for considerable morbidity and mortality, around 2-4 times that of a non diabetic person. An entity called metabolic syndrome has abdominal obesity, prediabetes, high Blood pressure and lipid abnormalities as its components. The lipid parameters we often study are triglycerides, the good cholesterol (HDL) and the bad cholesterol (LDL). When we tackle these individual components, total cholesterol value becomes less important. In Diabetics and in metabolic syndrome raised triglycerides and lowered good cholesterol are the abnormalities seen. The degenerative changes in a vessel wall attributed to cholesterol are seen since adolescence in form of a fatty streak. Its progression to sinister atherosclerosis, blockages and heart attacks is hastened in diabetes. Raised blood sugar causes generation of reactive oxygen species that can oxidize the LDL molecules making them more dangerous. These also damage the vessel wall, endothelium, allowing easier penetration of the bad lipid particles into the vessel wall, initiating the process of lipid plaque that leads on to the dreaded blockages.. Triglycerides, adversely affect by making the bad cholesterol, into still worse, small dense particle form of bad cholesterol. The normal level of triglyceride permitted is up to 150 mg/dl. Exercising muscles utilize triglycerides for producing energy and thus lower its level. Refined carbohydrates like maida (Atta is preferred), soft drinks, fruit juices (whole fruits would be preferable) and alcohol need to be avoided to keep Triglycerides under control. Consuming more of food rich in omega 3 fatty acids also lowers triglycerides e.g. Fish oils, walnuts, almonds, methi (fenugreek) and flaxseeds. Medication for raised triglycerides, generally in form of fibrates, is prescribed, only after the measures to normalize the LDL cholesterol have not lowered triglycerides to permissible level. The good cholesterol or HDL, actually lowers the risk of heart disease. It is genetically determined and there aren't any safe and effective medicines to raise it. Exercise is reported to raise HDL cholesterol. The LDL cholesterol is the main component of the lipid plaque or bleb that forms in the inner lining of a blood vessel. As the plaque enlarges, the vessel lumen of the blood vessel, supplying blood to the heart muscle, gets narrowed. When the narrowing is more than 70%, a patient starts feeling, chest pain or heaviness in chest or even breathlessness on exertion. This is called Angina Pectoris. At times, sudden overexertion, sudden emotional outburst, associated with sudden rise in blood pressure or other heart related alterations can cause the plaque to crack or rupture. The raw wound in the vessel wall, thus formed, initiates a process of clot formation. The clot blocks the tiny vessel very rapidly. The sudden stoppage of blood supply to the heart muscle can be catastrophic and is commonly referred to as 'heart attack'. Higher the level of LDL cholesterol in blood, higher is the chance of development of atherosclerotic plaques. Controlling the levels of blood LDL cholesterol is our prime target to prevent heart disease. Permissible limit of LDL cholesterol in blood depends on presence of other risk factors. In diabetics the permissible limit is 100 mg/dl. Reducing the amount of fatty food in diet, avoiding Hydrogenated fats like vanaspati and margarine for their trans fat content, avoiding repeated heating and reheating of oil during cooking, avoiding excess of omega 6 fats in diet as normally obtained from safflower oil, sunflower oil and corn oil, use of mustard or Rice bran or groundnut oil and ghee in moderation are some of the measures everyone should take, to reduce their LDL levels. The group of drugs that is effective in lowering LDL cholesterol is called statin; Atorvastatin and Rosvastatin are most popularly used. Statins not only reduce cholesterol but also prevent the plaque rupture; that is, they make the plaque less vulnerable to rupture. This is the final, most important defense to prevent a heart attack. Besides, the significant blocks seen in coronary angiography, there can be many more smaller plaques that do not limit the flow in the vessel, but they too can potentially rupture and give rise to a heart attack. As mentioned earlier, diabetics are more prone to suffer from heart ailments and giving them statin irrespective of the cholesterol level, even if below 100 mg/dl can be an important measure to reduce their risk of getting a heart attack. Thus, while controlling blood sugar is important in a diabetic, it is equally important to keep their blood pressure and cholesterol under control.