Heart attacks cause over 28,000 deaths every year in India. Cardiac arrest is one of the most common causes of death in India, and the incidence has increased by 73 percent in just 10 years. Experts say that people with co-morbidities, especially diabetes, are more vulnerable to silent heart attacks. Diabetes is a condition that causes high blood sugar levels due to the body’s inability to either produce insulin or use it well enough to control glucose. People with diabetes show symptoms such as increased appetite and thirst, and urination later; unexpected weight changes; persistent wounds; numbness or tingling in the arms or legs; fatigue; And also blurred vision.
In India, the prevalence of diabetes increased from 7.1 percent in 2009 to 8.9 percent a decade later. Currently, more than 25 million Indians have diabetes, which is projected to increase to 36 million by 2045. Most of these people are at risk for silent heart attacks – those that occur without any symptoms, or with symptoms that are unrecognizable. People may not know they have had a heart attack until a diagnosis is received a few weeks or months later.
Silent heart attacks are a matter of concern globally, not just in India. According to the American Heart Association (AHA), silent heart attacks account for one-fifth of the estimated 805,000 heart attacks in the United States each year.
The link between diabetes and heart attack
It is estimated that 50-60 percent of diabetics develop heart disease – diabetics with high blood sugar are likely to develop a ‘block’. “Block means a slow blockage in the blood flow to the coronary arteries, cerebral arteries and kidneys. Dr Ashok Kumar Jhingan, Senior Director, Delhi’s renowned BLK-Max Super Specialty Hospital, explains that this complete continuation of diabetes creates hindrance in the flow of blood to the vessels of the whole body.
“These usually present together and include diabetes, high blood pressure, heart disease, stroke, kidney diseases, peripheral vascular disease and retinal problems. High blood sugar levels can damage the blood vessels and nerves that control the heart. High blood pressure increases the force of blood through the arteries and can damage the artery wall,” Dr Jhingan said.
Patients with diabetes experience slow death of nerve endings, leading to extreme pain. As a result, diabetics who develop a heart attack may not present the typical symptoms of chest pain. Instead, they may show symptoms of fatigue, breathlessness, lethargy, sweating, dizziness, loss of consciousness, etc. Because such attacks go unnoticed, they often go untreated.
“Since most of the diabetic cases are late, their cases are more complicated. They tend to end up with multiple blocks, multiple vessel disease and low ejection fraction (low pumping of the heart). This complete continuation of diabetic patients developing silent heart attacks with multiple blocks and low ejection fraction leads to poor prognosis and poor long-term outcomes. Most of these patients are subjected to multi-vessel angioplasty or open-heart bypass surgery,” Dr Jhingan said.