Diabetes and Its Relation to Heart Disease

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Beating Heart Disease Together

Information for South Asians

diabetes -and how it

affects your heart


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About this bookletPeople with diabetes have a greater risk o developing coronary heartdisease than those who do not have diabetes. Both diabetes and coronaryheart disease are more common among South Asians living in the UK Indians, Bangladeshis, Pakistanis and Sri-Lankans than in the generalUK population.

This booklet explains:

what coronary heart disease is

what diabetes is and how it afects your heart

what routine checks you should have, and

what you can do to help control your diabetes

and reduce your risk o coronary heart disease.

The inormation in this booklet is not a substitute or the advice your doctormay give you based on his or her knowledge o your condition.

This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu.This English version has been produced to help relatives, carers and healthproessionals who do not read these languages.


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Introduction 5What is coronary heart disease? 6

What causes coronary heart disease? 8

What are the symptoms o coronary heart disease? 9

What to do i you get chest pain or think you may behaving a heart attack 10

What is diabetes? 14What are the symptoms o diabetes? 16

How is diabetes diagnosed? 17

What treatment do you receive or diabetes? 18

Why does diabetes afect the heart? 20

What can I do to reduce my risk o coronary heart disease? 21

Be more physically active 22

I you smoke, stop smoking 25

Control your blood cholesterol and triglyceride levels 28

Eat healthily 29

Keep to a healthy weight and body shape 32

Control high blood pressure 33

Stress 35

Treatments or the heart or people who have bothdiabetes and coronary heart disease 36

The annual review 37

For more inormation 38

Reerences 40

Technical terms 41

Index 42

Contents


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Diabetes and how it aects your heart | 5

Coronary heart disease is the UKs single biggest killer.Almost one in every ve men and one in every six women

die rom this disease.

People with diabetes are at greater risk o developing coronary heartdisease than people who do not have diabetes. This is particularlyimportant or people rom South Asia living in the UK, as they are atleast ve times more likely to have diabetes than the general

population.

Among those who have diabetes, women have a greater risk odeveloping coronary heart disease than men. Women who havediabetes are three to ve times more likely to develop coronary heartdisease than women without diabetes. Men who have diabetes aretwo to our times more likely to develop coronary heart disease thanmen without diabetes.

However, i you do have diabetes there is much you can do in partnership with your diabetes care team to avoid developingcoronary heart disease, or to reduce its efects. This booklet explainswhat you can do.

Introduction


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What is coronary heart disease?

How the heart worksYour heart is a muscle about the size o your st. It beats about 70 timesa minute, pumping blood around your body.

When the blood leaves the heart, it goes to your lungs where it picks upoxygen. The oxygen-rich blood returns to your heart and is then pumpedthrough a system o arteries to provide oxygen to all the organs o yourbody. The blood then returns to the heart through the veins and is then

pumped back to the lungs again. This is called the circulation.

6 | Diabetes and how it aects your heart

the heart

arteries

arteries


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The heart

Your heart muscle gets its own supply o blood rom the coronary arteries.These are blood vessels on the surace o your heart.

Coronary heart disease

Over time, the walls o your arteries can slowly become urred up witha atty material called atheroma. Coronary heart disease is when thecoronary arteries become so narrow that the blood supply to your heart

muscle is restricted. This can cause angina (chest discomort). Or, i acoronary artery becomes completely blocked, it can cause a heart attack.We describe the symptoms o angina and heart attack on page 9.

What happens when atty material builds up in the arteries

When atty material builds up in the arteries, the arteries become narrowand it is more difcult or the blood to ow through them.

right coronaryartery

let coronaryartery

atheroma(atty depositsbuilding up)

atty depositsrestricting blood ow

through the artery

bloodwithin the

artery

artery wall


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These things can all increase the risk o getting coronaryheart disease:

For more on what you can do about these risk actors, see page 21.(A risk actor is something that increases your risk o getting the disease.)

What causes coronary heart disease?

not being physically active enough

smoking

abnormal blood cholesterol levels and triglyceride levels

high blood pressure

obesity (being very overweight)

having a amily history o coronary heart disease, and

having diabetes.


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What are the symptoms of coronaryheart disease?

Angina

Below we describe the symptoms that people oten get with a typicalangina attack. However, the symptoms can vary rom person to person.

Angina is an uncomortable eeling or pain in the chest. It usually eelslike a heaviness or tightness in the centre o the chest, which may spreadto the arms, neck, jaw, back or stomach. In some people, the pain or

tightness may afect only the arm, neck, stomach or jaw. Some peopledescribe angina as a dull, persistent ache. Symptoms usually ade withina ew minutes. For some people the tightness is severe. For others it is notmuch more than mild discomort.

Heart attack

The symptoms o a heart attack are sometimes quite similar to thesymptoms o angina. Sometimes it can be dicult to tell i you are having

an angina attack or a heart attack.

I you get a pain as described above (underAngina), and i you haventhad that sort o pain beore, you may be having a heart attack. Youshould call 999 immediately and ask or an ambulance.

I you already have angina, you may be having a heart attack i:

the pain is diferent to the pain you normally have, or the pain gets worse or does not go away.

On the next page we explain what to do i you think you are havinga heart attack.


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What to do if you get chest pain or thinkyou may be having a heart attack

THIS IS WHAT TO DO:

1 Stop what you are doing.

2 Sit down and rest.

3 Use your GTN spray or tablets. Take the GTN as yourdoctor or nurse has told you. The pain should ease within

a ew minutes. I it doesnt, take your GTN again.

4 I the pain does not ease within a ew minutes o takingthe GTN the second time, call 999 immediately.

5 I you are not allergic to aspirin, chew an adult aspirintablet (300mg) i there is one easily available. I you donthave an aspirin next to you, or i you dont know i youare allergic to aspirin, just stay resting until the

ambulance arrives.

The inormation below is or people who already have coronary heartdisease and are being treated or it with GTN (glyceryl trinitrate) sprayor tablets.

I you already have coronary heart disease, you may get chest painor discomort now and then. Sometimes this will be angina, which youwill be able to manage at home with your GTN. However, it could also be

the symptom o a heart attack. Below we explain what to do i you get:

a crushing pain, or heaviness or tightness in your chest, or

a pain in your arm, throat, neck, jaw, back or stomach.

You may also sweat, eel light-headed, sick or short o breath.


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I you have symptoms that do not match the ones we have

described on page 10 but you think that you are having a heart

attack, call 999 immediately.

Having diabetes can make it more dicult to diagnose a heart attack.

For example, having no pain but a general eeling o being unwell orsweating can be a symptom o a heart attack, but in people withdiabetes these symptoms can be conused with the symptoms oa hypoglycaemic episode (sometimes called a hypo), making thediagnosis more dicult. (A hypo happens when the level o glucosein the blood alls too low. When this happens, the person may getsymptoms such as sweating, eeling shaky, eeling his or her heartpounding, and conusion.)

I you have diabetes and you are not sure whether certain symptomsare due to hypoglycaemia or a heart attack, it is useul to do a bloodglucose test.

I the test shows that the level o glucose in the blood is less than4 mmol/l, it means that you are having a hypoglycaemic attack.You should treat this in the normal way by taking quick-acting

carbohydrate either as a drink or ood, ollowed by a longer-actingcarbohydrate such as a sandwich or a bowl o cereal.

I the test gives a reading higher than 4 mmol/l, it means that youare not hypoglycaemic and so you may be having a heart attack.So you should call 999 or an ambulance, or someone should callor an ambulance or you.


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Diabetes happens when the level o glucose (sugar) in the blood istoo high.

The body produces glucose when it digests starchy oods such as bread,rice, potatoes, and sugar and other sweet oods. The liver also makesglucose. The blood carries glucose to all the cells o the body. A hormonecalled insulin helps the glucose to enter the cells, and the glucose is usedas a uel by the body. Insulin is made in the pancreas a large gland that

lies behind the stomach. As the insulin lets the cells take glucose out othe blood, the amount o glucose let in the blood goes down.

In people with diabetes, the cells become starved o glucose because theycannot obtain it rom the blood. At the same time, because the glucosecannot get into the cells, the level o glucose in the blood goes up.

There are two types o diabetes:

People with Type 1 diabetes do not produce any insulin.

People with Type 2 diabetes do not produce enough insulin,or their cells lose the ability to use the insulin.

Who is at risk o developing diabetes?

Almost 1.9 million people in the UK have diabetes, and there are over hal

a million more adults who have developed diabetes but dont know it,because it hasnt been diagnosed.

What is diabetes?


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People o South Asian origin living in the UK are ve to six times morelikely to have diabetes than the overall UK population. People are morelikely to develop Type 2 diabetes i they have some or all o the ollowingrisk actors:

The risk o developing Type 2 diabetes can be signicantly

reduced by two liestyle changes increasing physical activity

and reducing body weight.

Type 1 diabetes

This type o diabetes is less common than Type 2 diabetes. It usually

develops in children and young adults. Type 1 diabetes probably happensbecause the bodys own immune system (the cells that ght inection)attacks the pancreas and destroys its ability to make insulin. The cause othis is probably viruses or other inections, but no-one is really sure.

Type 2 diabetes

Most people with diabetes about nine out o every ten have Type 2diabetes. This condition tends to develop gradually ater the age o 40.

It is a worrying trend that, in recent years, Type 2 diabetes is beingdiagnosed more and more in younger people, and even in children.It seems that this is largely due to the act that children these days leadless active liestyles.

not being physically active enough

being overweight

having a amily history o Type 2 diabetes

previous diabetes in pregnancy.


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In Type 1 diabetes, the symptoms develop quickly over a ew weeks.However, in Type 2 diabetes the symptoms oten develop gradually overmany years and so you might not think they are abnormal. Diferentpeople develop diferent combinations o symptoms.

The range o symptoms or both types o diabetes are:

These symptoms are the direct result o having too much glucose in theblood and not enough in the cells. However, over many years, the highlevels o glucose can also damage many diferent parts o the body.

This damage can be:

in the heart and blood vessels, causing coronary heart disease,strokes and peripheral arterial disease (disease o the arteries thatcarry blood to the diferent parts o the body such as the legs)

in the eyes, causing reduced vision and sometimes leadingto blindness

itching in the genital area (or regular episodes o thrush).

thirst

passing more urine than usual, particularly at night

tiredness

unexplained weight loss

blurred vision

What are the symptoms of diabetes?


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in the kidneys, which gradually work less well

in the eet, causing ulcers

in the nerves, causing many symptoms such as loss o sensationespecially in the eet and legs, pins and needles, and sexual

impotence.

The good news is that you can prevent or delay or reduce theseproblems by liestyle changes and good management o diabetes.Good management includes keeping good control o your bloodglucose levels and your blood pressure, and going or an annual review.We explain more about the annual review on page 37.

How is diabetes diagnosed?

I you have some o the risk actors or diabetes (see page 15), you should

ask your doctor or a simple screening test to see whether you havediabetes. Remember, even i you dont have any symptoms, you maystill have diabetes.

Your doctor may take a blood sample straight away. Or he or she mayask you to come back on another day, having not eaten anything sincethe night beore. Your doctor will be able to measure the amount oglucose in your blood and, depending on the level, will be able to telli you have diabetes.


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You are likely to have diabetes i you have symptoms o diabetes (excessiveurine and excessive thirst) and unexplained weight loss and your bloodglucose level is:

I you dont have any symptoms o diabetes, your doctor should notdiagnose diabetes on the basis o just one blood glucose measurement, sohe or she will ask you to go back or another glucose test on another day.

11.1 mmol/l, or over, ater eating

11.1 mmol/l or over, two hours ater an oralglucose tolerance test.

7 mmol/l, or over, ater asting, or

What treatment do you receive for diabetes?

I you have Type 1 diabetes, your doctor will need to start treating youwith insulin straight away. He or she may also reer you to a hospital doctor.

I you have Type 2 diabetes, the rst line o treatment is normally to tryand lose weight, become more physically active and eat a more healthydiet. Your doctor or nurse will help you with this.

Some people may need to take medicines or their diabetes. There arediferent kinds o medicines which work in diferent ways. Your doctorwill decide which are best or you. Many people with Type 2 diabetes willeventually need to have insulin injections to control their diabetes, butthis is unlikely to happen when you are rst diagnosed.


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Why does diabetes affect the heart?

Diabetes seems to act in several ways to damage the heart.

High glucose levels in the blood afect the walls o the arteries,making them more likely to develop atheroma (see page 7).

Diabetes increases the damage done by the major risk actors osmoking, high blood pressure and high blood cholesterol.

People with Type 2 diabetes oten have higher triglyceride levels andlower levels o HDL cholesterol (the protective type o cholesterol).We explain why this is important on page 28.

People with diabetes are more likely to have high blood pressure(see page 33).

Diabetes can afect the heart muscle itsel, making it a less ecientpump.

Diabetes can afect the nerves to the heart, so that the symptoms

o heart disease are not elt in the usual way. This leads to delay anddiculties in diagnosis.



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What can I do to reduce my risk ofcoronary heart disease?

Your doctor will prescribe medicines to treat some o the risk actorsthat you may have. Diabetes alone is considered a signicant risk actoror coronary heart disease so, i you have diabetes, you will probablybe given medicines to reduce your risk o coronary heart disease.

Good control o blood glucose and blood pressure is essential orpreventing the long-term problems o diabetes, such as damage tothe eyes, kidneys and eet. However, this is not enough to preventcoronary heart disease. The major risk actors or coronary heart diseaseneed to be controlled by a combination o efective treatment and theollowing liestyle changes.

There are several things you can do:

We explain more about all these things on the next pages.

Be more physically active.

I you smoke, stop smoking.

Control your blood cholesterol and triglyceride levels.

Eat healthily.

Keep to a healthy weight and body shape.

Control high blood pressure.


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Physical inactivity is not only a major risk actor or coronaryheart disease. It is also a risk actor or developing diabetes.

I you already have diabetes, physical activity may help to

reduce the amount o tablets or insulin that you need to take.

The aim is to gradually increase your activity until you are doing30 minutes moderate physical activity a day on at least ve days a week.Moderate physical activity means activity that makes you eel warm and

breathe slightly more heavily than usual.

Walking is one o the best orms o physical activity. Its easy to do,you dont need to wear any special clothes, and its easy to t into youreveryday lie. Other good orms o physical activity include swimming,cycling, heavy housework, dancing and sports.

I your diabetes is treated with insulin or tablets, you may nd that yourblood glucose level alls quickly during or ater exercise. It is important tomonitor your blood glucose careully as you start to build up your level ophysical activity, as you may need to change the dose o your medication.Your doctor can advise you about this.

You should always have some orm o ast-acting carbohydrate with youwhen you take exercise, such as glucose tablets or a sugary drink, in caseyour glucose level alls.

be more physically active


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Sensible advice about physical activity

I you have heart disease or high blood pressure, check with your GPbeore you increase your physical activity.

When you are doing any physical activity or sport, begin slowly or

the rst ew minutes and build up gradually. At the end, spend acouple o minutes slowing down gradually.

Stop i you get any pain, or eel dizzy, sick or unwell, or very tired.

Build up your activity level gradually.

Dress warmly when doing any physical activity outdoors in very coldor windy weather.


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If you smoke, stop smoking

You probably already know that smoking can increase therisk o getting lung cancer. Smoking also increases your risk

o getting heart disease.

Stopping smoking is the single most important thing a smoker can do tolive longer. I you have already tried to stop smoking but have gone backto smoking again, ask your doctor or pharmacist about NHS Stop Smokingservices and about products to help you stop smoking. These includenicotine-based products, such as nicotine chewing gum, microtabs,lozenges and skin patches or non-nicotine-based products, such asbupropion and varenicline (currently sold as Zyban and Champix).You can get these on prescription rom your doctor.

How does smoking afect my heart?

The carbon monoxide in cigarette smoke reduces the amount o oxygenin your blood. So your heart has to work harder but is getting less oxygen.

Smoking also speeds up the build-up o atheroma (atty material) in thecoronary arteries (see page 7).

Ask your doctor or pharmacist about products to help you stop smoking.


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Is shisha smoking harmul?

Yes, it is harmul. Recent research has shown that shisha smoke containslarge quantities o the chemicals that can lead to heart disease, cancer,and addiction in cigarette smokers.1

Shisha smoking has three extra health risks over smoking.

Shisha smokers inhale up to 200 times more smoke in a one-hourshisha session than they would rom smoking a cigarette.

Flavoured tobacco is smoked over coals. The umes rom thesecoals add new toxins to the already dangerous smoke. (Some peopleuse electrical shishas, which dont use coals. But smoking using an

electrical shisha is still harmul to health.) People who are at a shisha smoking session and who breathe in the

shisha smoke inhale high levels o highly dangerous second-handsmoke, even i they dont smoke shisha themselves.

So shisha smokers and those around them are put at greater risk.2

I you are used to meeting riends at a shisha session, why not go out or

a walk with them instead?



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I you need extra help with stopping smoking

I you need extra help, you can call Quitline or the NHS Smoking Helpline.

Quitline

English: 0800 00 22 00

Bengali: 0800 00 22 44. Mondays 1pm to 9pmGujarati: 0800 00 22 55. Tuesdays 1pm to 9pmHindi: 0800 00 22 66. Wednesdays 1pm to 9pmPunjabi: 0800 00 22 77. Thursdays 1pm to 9pmUrdu: 0800 00 22 88. Sundays 1pm to 9pm

Quitline is a telephone helpline or people who want to stop smoking.Calls are ree. You can talk to a trained counsellor who can help you:

NHS Smoking Helpline

English: 0800 169 0 169The ollowing helplines are open on Tuesdays rom 1pm to 9pm:Bengali: 0800 169 0885Gujarati: 0800 169 0884Hindi: 0800 169 0883

Punjabi: 0800 169 0882Urdu: 0800 169 0881

This telephone helpline can ofer inormation on stopping smoking,and support or people who are nding it hard to stop.

i you want help with preparing to stop smoking

i you have a question about a particular product to helpyou stop smoking, or about any aspect o stopping, and

i you want support and encouragement, especiallyduring the dicult times.


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Cholesterol and triglycerides are atty substances that are mainlymade in the body. The liver makes them rom the saturated ats in theood we eat.

Control your blood cholesterol andtriglyceride levels

Cholesterol and triglycerides are atty substances that are mainly made inthe body. The liver makes them rom the saturated ats in the ood we eat.

Cholesterol plays a vital role in how every cell in the body works.However, too much cholesterol in the blood can be harmul. There aretwo main orms o cholesterol:

low density lipoproteins (LDL) the bad cholesterol

which carry cholesterol rom the liver to the rest o the body, and

high density lipoproteins (HDL) the good cholesterol which return excess cholesterol to the liver.

Triglycerides in the body come rom ats in ood.

I you have high levels o both triglycerides and blood cholesterol,

you run a greater risk o coronary heart disease. The risk is particularlyhigh i you also have a low level o HDL cholesterol. Unortunately, thispattern is oten seen in people with Type 2 diabetes.

I you have diabetes, your goal should be to have:

a total cholesterol level under 4 mmol/l

an LDL cholesterol level under 2 mmol/l

an HDL cholesterol level above 1 mmol/l, and

a triglyceride level under 1.7 mmol/l. 3


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I you have diabetes you will probably need to take a statin drug toreduce your cholesterol levels, and perhaps a brate drug to controlyour triglyceride levels.

Some people are born with a high cholesterol level. This condition

is called amilial hyperlipidaemia, or FH. This is a genetic condition(one you are born with). It means that your body cannot get rid o theharmul cholesterol in the normal way. Having FH increases your risko developing coronary heart disease.

I you are diagnosed with FH, you should make sure that other memberso your amily have tests to nd out i they also have this condition.

Eat Healthily

Eating healthily can greatly reduce your risk o getting heart

disease. It will help you to control your weight, your blood

sugar and your cholesterol.

What you can do

You can still eat your avourite dishes. You just need to make smalland gradual changes in what you eat.

Eat at least ve portions o ruit and vegetables a day. Eating adiet that is rich in a range o vegetables and ruits lowers the risk o

heart disease. Eat at least ve portions o ruit and vegetables a day.Try to eat a wide variety o ruit and vegetables. They can be resh,rozen or tinned. Dried and juiced also count, but only once a day.


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Eat less at, particularly saturated at.There are two main typeso ats in oods: saturated ats and unsaturated ats. A diet that islow in saturated ats can lower your blood cholesterol level, helpprevent you putting on weight, and can reduce the risk o coronaryheart disease.

Saturated ats are ound mostly in oods rom animal sources such as atty meat, and dairy products such as butter, ghee, cheese,cream and ull-at milk. Palm oil, coconut oil, coconut cream andcoconut milk are also high in saturated at.

Unsaturated ats are mainly ound in vegetable oils and plant oilssuch as corn oil, sunower oil, olive oil and rapeseed oil.

Eat a portion o oily sh a week. Eating oily sh regularly can help

to reduce the risk o coronary heart disease. The particular oil in shthat has these good efects is called omega-3. It is ound mainlyin oily sh such as trout, sardines, herrings, mackerel or resh tuna.I you eat sh, try to eat oily sh once a week.

E l l H i h l i li k d i h hi h bl d


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WomenNo more than 2 to 3

units o alcohol a day

1 unit o alcohol =

a small glass (100ml) o wine(10% ABV [alcohol by volume])

or

hal a pint (300ml) o normalstrength lager, cider or beer(3% to 5% ABV)

or

a pub measure (25ml)o spirits

MenNo more than 3 to 4

units o alcohol a day

Eat less salt. Having too much salt is linked with high bloodpressure, heart disease and strokes. Most o the salt we eat is hiddenin processed oods and in pre-cooked or pre-prepared meals, whichare sometimes very salty. When choosing these oods, choose onesthat are labelled low salt or reduced salt. Also, avoid adding salt

when cooking or at the table. Use spices, herbs or lemon juice oravour instead.

Alcohol. Heavy alcohol drinking can contribute to heart disease.It also increases the risk o high blood pressure and stroke, as well asliver disease. Men should drink no more than 3 to 4 units o alcohola day, and a total o no more than 21 units a week. Women shoulddrink no more than 2 to 3 units o alcohol a day, and a total o nomore than 14 units a week.

For more inormation about healthy eating, see our bookletLooking ater your heart. And or some healthy recipes, see ourcookbookHealthy meals, healthy heart. (See page 38.)


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Keep to a healthy weight and body shape

South Asian men Your health is at high riski you havea waist size o over 90 centimetres(35 inches).

South Asian women Your health is at high riski you havea waist size o over 80 centimetres(31 inches).

4. Make a note o this measurement.This is your waist measurement.

1. Find the top o your hip boneand the bottom o your ribs.

2. Breathe out naturally.

3. Place the tape measure mid-waybetween these points and wrapit around your body.

People who carry too much weight around their middle have

a greater risk o developing coronary heart disease, high blood

pressure and diabetes.

The easiest way to nd out i you need to lose weight is to measure yourwaist with a tape measure.

How to measure your waist:

Check your measurement in the box below.4, 5

What you can do


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What you can do

I your body shape and waist measurement suggest that you areoverweight, you need to lose some weight.

The best way to lose weight is to:

I you need to lose weight, dont try to lose weight too quickly. Losingweight slowly and steadily about one or two pounds (0.5 to 1 kilo) a week is more healthy, and youre more likely to keep the weight of or good.

cut down on the amount o at in your diet (see page 30)

cut down on sugar, sweet oods and sugary drinks, and

be more physically active (see page 22).


control high blood pressure

Blood pressure is the pressure o blood in the arteries. High

blood pressure increases the risk o having a heart attack or a

stroke. And, over time, it can cause your heart muscle to

become less ecient.

High blood pressure is very common in people with diabetes, and it isessential to control it. I you have diabetes, your target is to have a bloodpressure below 130/80mmHg (or lower than this i your k idneys arealready damaged).3

Some people can control their blood pressure by losing weight, doingmore physical activity, and cutting down on alcohol and salt. However,many people need to take medicines too. For more inormation on

medicines or blood pressure, see our booklet Taking medicines or yourheart(see page 38).


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The way we deal with stress or dicult times in our lives can sometimeslead to an increase in the risk o getting heart disease. For example, whenpeople are under stress, some may smoke or drink more, while others mayeat more. Being aware o what you do to help relieve stress can help youto make changes that can reduce your risk.

It is also useul to learn how to relax. Some people nd that yoga or otherrelaxation techniques really help. You also need to become aware osituations that make you eel extra strain at home or at work and try to

avoid them i you can. Or, nd ways o dealing with this or example, bygoing or a walk, meeting up with riends, or making sure that you havesome time or yoursel each day.

Stress


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Treatments for the heart for people who haveboth diabetes and coronary heart disease

The treatment o coronary heart disease or people with diabetes is moreor less the same as or those who do not have diabetes, with the ollowingimportant exceptions.

Medicines

I you are over the age o 30, and i you have been diagnosed withdiabetes and also have other risk actors or coronary heart disease, yourdoctor may prescribe daily aspirin or you (75mg a day). Check with yourGP beore you start taking aspirin regularly.

Your blood pressure target o 130/80 is lower than the target or peoplewithout diabetes. You may need to take medicines to help reduce yourblood pressure.

I your angina gets worse

I your angina gets worse, your doctor may advise you to have eithercoronary angioplasty or coronary artery bypass surgery.

Coronary angioplasty is a treatment to make your blood vessels wider.In coronary artery bypass surgery, the narrowed sections o the arteries arebypassed using grats. Your doctor will be able to discuss with you whichtreatment is more suitable or you.

I you have a heart attack

Good blood glucose control is very important immediately ater a heartattack, to limit the damage done and promote healing. This may meanchanging your usual diabetes treatment, and perhaps using insulin.

Good blood glucose control is also very important in the months ater aheart attack. Further changes to your usual medicines may be needed,including the use o insulin.


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I you have diabetes, you should have an annual review

to make sure that you are not developing any o the

complications o diabetes, including coronary heart disease.

During the annual review, as well as the normal checks or diabetes, yourdoctor should check your blood pressure, weight and general circulation.He or she will check your long-term blood glucose control and may alsocheck your cholesterol and triglyceride levels. These tests will help yourdoctor decide how well your medication, liestyle and diet are working,and whether you need to make urther changes to any o these.

As well as the annual review you may also need to have more requentcheck-ups to make sure that your diabetes control is satisactory.

The annual review

F nf t n


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For more information

British Heart Foundation website

bh.org.uk

For up-to-date inormation on coronary heart disease, theBritish Heart Foundation (BHF) and its services.

Heart HeLPLine

0300 330 3311

A local rate number.For inormation and support on anything relating to heart health.

This service is available in English only.

Booklets

The ollowing booklets are available in Bengali, Gujarati, Hindi,Punjabi and Urdu:

Blood pressure and how to control it Cholesterol and what you can do about it

Diabetes and how it afects your heart

Heart ailure

Living with angina and heart disease

Looking ater your heart

Taking medicines or your heart

The ollowing booklets are available in English only:

Eating or your heart

Healthy meals, healthy heart

Physical activity and your heart

Smoking and your heart

So you want to lose weight or good


DVDS


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How to OrderThe British Heart Foundation also produces other educationalmaterials that may be o interest. To nd out about these, to ordera Heart health catalogue, or to order publications, please call the BHFOrderline on 0870 600 6566, go to bh.org.uk/publications oremail [email protected]. You can download many o ourpublications rom bh.org.uk/publications

Our publications are ree o charge, but we would welcome a donation.

The ollowing DVDs are available in Urdu, Hindi, Gujarati, Punjabi andBengali. They are ree, but a donation o 5 per DVD would be welcome.

Living to prevent heart disease

Get t, keep t prevent heart disease Cardiac surgery

Cardiac rehabilitation

Afairs o the heart

Magazines and services

Heart & soul is a glossy liestyle magazine aimed at the South Asian

community. This ree magazine is packed ull o inormation on leadinga healthy liestyle and eatures celebrities talking about their ownhealth, delicious recipes and real-lie stories. To receive your ree copycall 0870 600 6566.

Heart Matters is a ree service designed or anyone who has, or is at risko developing, a heart condition, and or anyone who cares or someonewith a heart problem. Members receive personalised inormation, and

can get specialist support rom cardiac nurses or heart health advisers,either by phone or email. They also get regular issues oHeart healthmagazine, which includes updates on treatment and research and looksat issues related to heart health. To join Heart Matters, either registerat our website bh.org.uk/heartmatters or call 0300 330 3300 (a localrate number). This service is available in English only.


For more information on diabetes


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REFERENCES

1 WHO Study Group on Tobacco Product Regulation. 2005.Waterpipe Tobacco Smoking: Health Eects, Research Needs

and Recommended Actions by Regulators. Geneva: WHO.

2 American Lung Association. 2007.An Emerging Deadly Trend:Waterpipe Tobacco Use. American Lung Association.http://slati.lungusa.org/alerts/Trend%20Alert_Waterpipes.pd

3 British Cardiac Society, British Hypertension Society et al. 2005.Joint British Societies guidelines on prevention o cardiovasculardisease in clinical practice. Heart; 91; suppl 5: 1-52.

4 National Institute or Health and Clinical Excellence (NICE). 2006.Obesity: The Prevention, Identication, Assessment and Management

o Overweight and Obesity in Adults and Children. London: NICE.

5 International Diabetes Federation. 2005. The IDF Consensus WorldwideDenition o the Metabolic Syndrome. Brussels, Belgium: International

Diabetes Federation.

Diabetes UK

10 ParkwayLondon NW1 7AADiabetes UK Careline: 0845 120 2960 (a local rate number)

Textphone: 020 7424 1031Website: www.diabetes.org.ukEmail: [email protected]

Diabetes UK provides inormation on diabetes in Bengali, Gujarati, Hindi,Punjabi and Urdu. Call the Diabetes UK Careline to speak to a counselloror to listen to recorded inormation on diabetes in Bengali, Gujarati,Hindi, Punjabi or Urdu. For a publications catalogue, contact Diabetes UKDistribution Department, PO Box 1057, Beaord MK42 7XQ. Freephone:0800 585088.

technical terms


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angina Heaviness or tightness in the centre o the chest, which may spread

to the arms, neck, jaw, back or stomach.

arteries Vessels which carry blood rom the heart to other parts o the body.

atheroma Fatty material that can build up within the walls o the arteries.

blood pressure The pressure o blood in the arteries.

cholesterol A atty substance mainly made in the body by the liver.

coronary arteries The arteries that supply the blood to the heart muscle.

coronary heart disease When the walls o the arteries become narrowedby a gradual build-up o atty material called atheroma.

diabetes A disease caused by a lack o insulin (a chemical in the body),or an increased resistance o the body to insulin.

brate A drug used to reduce triglyceride levels and also cholesterol levels.

heart attack When one o the coronary arteries becomes blocked bya blood clot and part o the heart is starved o oxygen.

high blood pressure When the pressure o the blood in the arteries istoo high. See blood pressure.

hypertension High blood pressure.

saturated at A type o at ound mainly in ood rom animal sources,especially dairy and meat products.

statin A drug to reduce cholesterol levels.

stroke When the blood supply to the brain is interrupted either byatheroma in one o the arteries to the brain, or by bleeding rom one othese arteries into the brain.

triglycerides A type o atty substance ound in the blood.

technical terms

INDEX


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INDEX

activity 22

alcohol 31

angina 7, 9, 36

angioplasty 36

annual review 37

arteries 6, 7

atheroma 7

blood pressure 33

bypass surgery 36

check-up 37

chest pain 9, 10

cholesterol 28

coronary angioplasty 36

coronary heart disease 6

diabetes and the heart 20

diagnosis o diabetes 17

eating 29

exercise 22

amilial hyperlipidaemia 29

ats 30

FH 29

sh 30

ruit 29

glucose level 14, 22

healthy eating 29

heart attack 7, 9, 10, 36

high blood pressure 33

hypertension 33

insulin 14, 18

medicines 21, 29, 33, 36

obesity 32

oil 31

omega-3 30

overweight 32

relaxation 35

risk o coronary heart disease 5

risk o diabetes 5, 14

salt 31

shisha smoking 26

smoking 25

statins 29

stress 35

symptoms o angina 9

symptoms o diabetes 16

symptoms o heart attack 9

treatment or coronary heartdisease 36

treatment or diabetes 18

triglyceride levels 28

vegetables 29

waist 32

weight 32

Acknowledgements


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The British Heart Foundation would like to thank the ollowing people

or their work on this booklet:

the patients who commented on the text and design

Diabetes UK

Dr Ameet Bakhai, and

Dr Deven Patel.

We would also like to thank the staf at Barnet General Hospital ortheir support.

Acknowledgements

Have your sayWe would welcome your comments to help us produce the bestinormation or you. Why not let us know what you think? Contactus through our website at bh.org.uk/contact. Or, write to us atthe address on the back cover.


The British Heart Foundation is the nations heart charity, saving lives through

pioneering research, patient care and information. We rely on donations to


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G3200209

British Heart FoundationGreater London House180 Hampstead RoadLondon NW1 7AWPhone: 020 7554 0000

Fax: 020 7554 0100Website: bh.org.uk

British Heart Foundation 2009, a registered charity in England and Wales (225971) and Scotland (SC039426)

p o ee g esea c , pat e t ca e a d o at o . e e y o do at o s to

continue our vital work. If you would like to make a donation to the British Heart

Foundation, please ring our donation hotline on 0300 330 3322 or contact us

through our website at bh.org.uk/donate or send it to us at the address below.

This booklet is available in Bengali, Gujarati, Hindi, Punjabi and Urdu.

This English version has been produced to help relatives, carers and health

professionals who do not read these languages.

To order further copies, please call the BHF Orderline on 0870 600 6566.

This service is available in English only.

Documents

Diabetes and Its Relation to Heart Disease