Over 101 million Indians live with diabetes, and another 136 million are pre-diabetic, according to recent data. Dr DM Saini, a CTVS surgeon, warns that diabetes not only affects blood sugar but also silently damages the heart, making coronary artery disease (CAD) harder to detect and treat.
What is Coronary Artery Disease?
Coronary Artery Disease (CAD) occurs when fatty deposits, or plaque, narrow or block the arteries supplying blood and oxygen to the heart. This reduced blood flow can lead to chest pain, heart attacks, heart failure, or sudden cardiac death. CAD is a leading cause of illness and death among people with diabetes, but its progression is often slow and subtle.
Why CAD is More Challenging in Diabetics
High blood sugar damages blood vessels and nerves that carry pain signals from the heart to the brain. As a result, diabetic patients may not experience typical intense chest pain during a cardiac event. Instead, they report subtler signs like shortness of breath, sweating, fatigue, light-headedness, or reduced exercise tolerance. The disease also accelerates plaque buildup, often affecting multiple arteries—including smaller ones—making diagnosis and treatment more complex. Due to this silent progression, CAD in diabetics frequently goes undetected until an advanced stage, increasing the risk of serious cardiac events.
Risk Factors for CAD
Common factors that contribute to CAD include high cholesterol, high blood pressure, obesity, low physical activity, unhealthy diet, family history of heart disease, stress, aging, and diabetes. Managing these risk factors is crucial for diabetic patients.
Treatment Options: CABG vs. Angioplasty
For diabetics with severe or widespread blockages, coronary artery bypass grafting (CABG) is often the most suitable option. In CABG, surgeons use healthy blood vessels from the chest, arm, or leg to create new routes around blocked arteries. This approach can clear multiple blockages in a single operation, leading to better long-term outcomes: longer survival, fewer heart attacks, and fewer repeat procedures.
Angioplasty, a minimally invasive procedure where a stent is inserted to keep an artery open, offers faster recovery. However, for diabetics with complex multi-vessel disease, the chances of needing further interventions are higher. Angioplasty is typically more suitable for single-artery blockages.
Importance of Early Diagnosis
“CAD progresses slowly in diabetics. By the time symptoms show up, significant damage may have already happened,” Dr Saini explained. Early screening can detect the disease before it causes serious problems, allowing a range of treatment options to manage or prevent complications. Identifying the condition early can be the difference between preventing a cardiac event and treating one after it has occurred.
Regular check-ups, heart screenings, a healthy diet, physical activity, medication adherence, and controlling blood sugar, blood pressure, and cholesterol are essential to slow disease progression. When arteries are badly or widely blocked, medicines alone may not be enough, and surgical intervention like CABG becomes necessary.
