Diabetic patients who have had a heart attack are more prone to develop recurrent cardiovascular diseases than heart attack patients without diabetes, despite both groups receiving similar treatments.
A more intensive treatment, with an emphasis on improved nutrition and lifestyle, can improve health. Epidemiologists from the Wageningen university demonstrated this by analysing existing data. Their study was published on the 31st October in the British Medical Journal Open.
In terms of risk factors, heart attack patients with diabetes are worse off than survivors of a heart attack without diabetes. For example, they are one and a half to two times more likely to suffer from obesity. Moreover, their blood pressure is higher and the amount of 'good' HDL cholesterol is significantly lower. This is not related to the prescribed medicines since there was no difference between the two groups. 'Treating patients with multiple chronic diseases becomes more complex,' says Sabita Soedamah-Muthu, an assistant professor in Epidemiology. 'We are dealing with elderly people, who have had a heart attack and who have diabetes.'
As such, the researchers believe that more can be done when treating this group of patients. For example, the attention given to nutrition and lifestyle advice is relatively little. Moreover, diabetes increases the risks of cardiovascular diseases with a factor of two to four. The guidelines recommend giving these patients more medicines than regular patients.
Soedamah-Muthu analysed the data which included 4837 heart attack survivors; of these, 1014 suffer from diabetes. These patients had taken part in the large Alpha Omega Trial conducted by Daan Kromhout, professor of Public Health Research. This research has previously shown that consuming omega-3 fats does not help to prevent cardiovascular diseases. However, benefits were seen in the sub-group of diabetic patients. 'We now think that we were unable to find an effect in the general group because heart attack patients receive very good treatment,' says Soedamah-Muthu. 'Diabetic patients probably benefit more from omega-3 fats because their treatment is not sufficient.'
Following the increase in obesity, the number of people with type 2 diabetes is increasing rapidly all over the world. In practice, these numbers can be cut down. 'Countless trials have been conducted which show that the number of diabetic cases can be reduced by 50 percent with increased physical activity and better nutrition,' says Soedamah-Muthu. 'We keep stressing the importance of prevention. Nutrition and lifestyle are often overlooked.'
The Alpha Omega Trial is financed by the Dutch Heart Foundation, the American National Institute of Health and Unilever.