The link between the disease and the heartbeat
If you’re among the more than 35 million Americans living with diabetes, you should already know about the disease and its link to heart health. According to the Centers for Disease Control and Prevention (CDC), the unfortunate truth is those with diabetes are twice as likely to develop cardiovascular disease as individuals who are not living with diabetes. What’s more, those with diabetes are likely to develop cardiovascular disease at a younger age, and the longer a person has diabetes, the greater the risk of heart problems become.
A recent article published on July 25, 2023, by Time Magazine takes a look at a specific category of heart-related complications – arrhythmias – noting that many studies point to a connection with diabetes.
What is Heart Arrhythmia?
Every time the heart beats (some 3 billion times during the average lifetime!) blood is drawn into its two upper chambers before being pumped out into the heart’s lower chambers. It’s this continuous pumping action that makes sure oxygenated blood leaves the heart and enters the bloodstream where it feeds the body and its organs. About six liters of oxygenated blood enter the bloodstream through this process every minute. When a person is being physically active and the heart is working harder, this amount could go up to 35 liters of blood every minute.
It's no simple feat for the heart to keep up this rhythm and requires a complex network of valves, muscles, and electronic circuitry. These factors must work in perfect unison, or the steady pumping process starts to develop hiccups. This is what results in arrhythmia. It happens when there’s a breakdown in the system causing the heart to pump either too fast or too slow. The heart might also lose its regular rhythm causing an irregularity in the heartbeat.
Dr. Jonathan Piccini, a cardiologist and arrhythmia specialist at Duke University Medical Center points out in the Time Magazine post, “When we say arrhythmia, we literally mean out of rhythm.”
Heart Arrhythmia impacts up to 5% of the general population with the most common form being atrial fibrillation (Afib), in which the upper regions of the heart begin beating far too rapidly. Between 60 and 100 beats per minute is normal, but in Afib the top of the heart could be beating at up to 600 beats per minute.
Diabetes and Arrhythmia
Though more studies need to be done to find out exactly why people with diabetes are more prone to arrhythmias, the fact that there is a connection is well established.
One of the most famous studies ever conducted, called the Framingham Heart Study, began in 1948 with 5000 participants from the town of Framingham, Massachusetts, and the study is still going on today. This is the hallmark study that showed smoking, high blood pressure, a lack of physical activity and other factors contributed to heart disease.
It's also helped reveal that people with diabetes are at an increased risk of arrhythmia, particularly Afib. According to some estimates, those with Type 2 diabetes are up to 34% more likely to develop Afib than individuals without the disease. Why?
How Does Type 2 Diabetes Cause Arrhythmia?
One theory is that elevated levels of blood sugar, the primary factor in diabetes, can damage the heart. We know that elevated blood sugar contributes to cardiovascular disease, and this might include damage to the heart muscle that can result in arrhythmia.
Another reason diabetes might cause arrhythmia has to do with high blood pressure. Prolonged blood sugar associated with diabetes can, over time, damage blood vessels in ways that cause blood pressure to rise. Once hypertension develops, it nearly doubles the risk of Afib.
One more theory points to the inflammation associated with diabetes as a possible culprit. People with diabetes can experience both localized and systemic inflammation, which can become severe, particularly if blood sugar is not properly controlled. If this inflammation persists long enough and reaches a certain magnitude it could increase the risk of arrhythmia.
It may very well be that a combination of diabetes-related factors are working together to contribute to a higher risk of arrhythmia, rather than just a single factor.
What Can You Do to Avoid Arrhythmia?
This is probably not going to come as a surprise. The best thing you can do to lower your risk of heart disease, arrhythmia and other diabetes-related complications is to maintain proper control over your blood sugar.
“We’ve learned that the higher the glycemic load, the higher the likelihood a person will develop Afib,” says Dr. Piccini. “For anyone with diabetes, the goal is good glycemic control.”
There are also new diabetes medications that show promising signs of both lowering blood sugar and reducing a person’s odds of experiencing arrhythmia. There are also new medications like finerenone that are designed specifically to reduce the risk of cardiovascular disease in people with diabetes and may also contribute to a lower risk of Afib by counteracting inflammation.
Again, while these drugs are reason for optimism, a lot more study needs to be done to determine just how effective they are in terms of reducing the likelihood of Afib and other arrhythmias.
In the meantime, maintaining blood sugar in the target range is the best medicine for those living with diabetes.
– Test your blood sugar regularly using a glucose meter and test strips, or a doctor-prescribed continuous glucose monitoring (CGM) device.
– Follow your prescribed medication schedule, including insulin injections by syringe or pen, or administering doses using an insulin pump.
– Stick to a low-carbohydrate, low-sugar diet that includes lean proteins, leafy veggies, and healthy fibers.
– Get in 150 minutes of physical activity each week as recommended by the American Diabetes Association (ADA)
While there is little doubt of the link between diabetes and heart arrhythmias, more work needs to be done and more data needs to be collected before a complete understanding of the connection can exist. In the meantime, as someone living with diabetes, keeping your blood sugar under control is the best way to reduce the risk of diabetes-related complications and live your best life. If you are experiencing frequent highs or lows in blood sugar, consult your diabetes physician right away. A simple adjustment to your treatment and testing plan will likely get you right back on track.