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One in eight Maltese adults suffering from diabetes

Diabetes can make a heart attack ‘feel different’. Photo: Shutterstock

Diabetes can make a heart attack ‘feel different’. Photo: Shutterstock

On World Diabetes Day, diabetologist Sandro Vella tells Stephanie Fsadni why people with diabetes may not always feel usual symptoms like acute chest pain when they have a heart attack. This may lead to a higher mortality rate.

Approximately one-third of heart attacks in Malta occur in patients with diabetes, which is one of the most prevalent non-communicable diseases in the country. The recent Saħħtek study established that one in eight of Maltese adults aged 25 to 64 years suffer from diabetes, of whom approximately 10,000 are unaware of the disease.

“Together with other risk factors such as high blood pressure, high cholesterol, smoking and obesity/being overweight, diabetes fuels a diffuse inflammatory process that leads, among others, to narrowing of major and minor arteries throughout the human body,” says Sandro Vella, consultant physician, diabetologist and endocrinologist.

“This unrelenting process compromises blood supply to major organs, leading to potentially fatal or severely debilitating complications such as heart attacks, strokes, amputations, retinopathy (disease affecting the circulation of the retina at the back of the eyes), neuropathy (disease of the nerves) and kidney disease.”

However, Dr Vella points out that ischaemic heart disease is the primary cause of excess mortality among diabetics. Statistics show that patients have a six-fold increased risk of heart attacks and a three-fold increased risk of coronary artery narrowing.

Patients with diabetes may also experience worse outcomes following a heart attack.

This “excess mortality” may be partly explained by the fact that people with diabetes may not always feel classic symptoms like acute chest pain when they have a heart attack.

Dr Vella remarks: “Up to one-third of patients who sustain a heart attack can experience no chest pain. Patients with diabetes comprise a larger proportion of such a group of patients.”

Up to one-third of patients who sustain a heart attack can experience no chest pain. Patients with diabetes comprise a larger proportion of such a group of patients

The disease, which affects the sensory innervation of the heart (autonomic neuropathy), can significantly impair a patient’s perception of ‘cardiac pain’ which is typically compressive, localised behind the breastbone (sternum), radiates to the neck, jaw and/or arms and is frequently associated with sweating, nausea, vomiting, shortness of breath and possibly dizziness.

“A significant proportion of diabetes patients do not describe chest pain as their most striking symptom and erroneously ascribe their ill-being to the effects of hypoglycaemia or low prevalent glucose levels, side effects of medications or other symptoms such as shortness of breath or indigestion,” he says.

A small study, published re­cently in BMJ Open, backs his claims. Researchers examined the data of a number of people in the UK who had been diagnosed with diabetes and had also experienced a heart attack.

Most of the participants reported feeling some chest pain but they often said it did not feel like what they expected or that they did not think it was really a heart attack.

Many felt like their pain was not severe enough to be a heart attack or did not consider the discomfort they felt in their chest as similar to what they would expect with a heart attack.

The researchers noted that this may have contributed to delays in seeking care, which are in turn associated with lower survival odds and a higher risk of complications and disability for people who do live through the event.

So what can be done? Prevention is the only answer but this requires “aggressive strategies”, according to Dr Vella.

He suggests embarking on a healthy lifestyle, maintaining a healthy body weight by following a healthy balanced diet and regular exercise and avoiding/stopping smoking, which can mitigate the onset of diabetes and other established risk factors for coronary heart disease.

“In patients with established diabetes, regular monitoring of blood sugar levels, regular liaison with specialists in the field, compliance to prescribed medications such as glucose, cholesterol and blood pressure lowering agents has been consistently shown to improve outcomes, including lowering the risk of mortality.”

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