Online Health Chat with Dr. Leslie Cho and Dr. Vinni Makin

Date: May 12, 2011


Cleveland_Clinic_Host: People with diabetes have an increased risk of developing heart disease at some point in their lives. It is important to control risk factors early on. Join cardiologist Leslie Cho, MD, and endocrinologist, Vinni Makin, MD,online for answers to your questions concerning the link between diabetes and heart disease.

Leslie Cho, MD,is Director of Cleveland Clinic’s Women’s Cardiovascular Center. She is also Section Head,Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Dr. Cho is board-certified in interventional cardiology, cardiovascular medicine, and internal medicine. Her specialty interests focus on general cardiology, heart disease, and peripheral arterial and vascular disease and their attendant therapies and treatments. Dr. Cho specializes in heart disease in women.

A graduate of the University Of Chicago Pritzker School Of Medicine, Dr. Cho completed her residency in internal medicine at University of Washington Medical Center. She completed cardiovascular medicine and interventional cardiology fellowships at Cleveland Clinic.

Vinni Makin, MD, is an endocrinologist in Cleveland Clinic’s Endocrinology & Metabolism Institute. She is board certified in endocrinology and internal medicine, and her specialty interests include general endocrinology, diabetes, hirsutism, acne, and thyroid disorders.

A graduate of Delhi University’s Lady Hardinge Medical College, Dr. Makin completed her residency in internal medicine at John H. Stroger Jr. Hospital of Cook County in Chicago. She completed her endocrinology fellowship at Cleveland Clinic.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Drs. Cho and Makin. We are thrilled to have them here today for this chat. Let’s begin with some of your questions.

keep_going: How does diabetes hurt your heart? If your diabetes is well-managed, can the heart still be damaged?

Dr__Makin: If you have diabetes, you have a two to four times greater risk of developing heart disease, especially blockage of the coronary arteries. Good control of your diabetes can decrease your chances of having a heart attack, but it does not eliminate it completely.

nutzy: Is the opposite also possible. Can valvular heart disease induce diabetes over time? Anette.

Dr__Makin: Valvular heart disease does not cause diabetes.

efpat: I am somewhat aware of the link between diabetes and cardiovascular disease that can lead to heart attacks. Is diabetes linked to other types of heart disease, such as atrial fibrillation, other electrophysiological disorders, or cardiomyopathy?

Dr__Cho: You are correct. Diabetes leads to cardiovascular disease. While diabetes does not cause atrial fibrillation or other arrhythmias, having diabetes and atrial fibrillation can lead to poor outcome. Also, diabetic patients can have greater rates of ischemic cardiomyopathy; however, this is due to atherosclerosis.

breaking_it: Is heart disease treated the same for diabetics as non-diabetics?

Dr__Cho: Once patients have heart disease, both diabetic and non-diabetic patients are treated aggressively for their risk factors. Prior to developing heart disease, diabetic patients' cholesterol and blood pressure are treated more aggressively than their non-diabetic counterparts.

Heart Function

rocket_man: I was told my diabetes damaged 75 percent of my heart. What exercises and drugs can improve a damaged heart? Can it be repaired?

Dr__Cho: Normal heart pumping function (otherwise known has left ventricular ejection fraction) is around 55 percent to 65 percent. Heart damage that is caused by diabetes is usually due to heart attacks. Did you have heart attacks? Once a heart muscle is damaged, it is usually irreparable. However, with medication, exercise, and lifestyle modification, patients can still have good quality of life.

bunnycalif: I have diabetes and had quintuple bypass surgery in March 2010. What is the life expectancy of the "new" heart if I follow a heart healthy diet?

Dr__Cho: It depends on what your heart pumping function is and what your functional capacity is. It is difficult to answer life expectancy questions without knowing your full history.

crash_and_burn: Are diabetics checked regularly for heart conditions as part of their diabetes treatment, or do they, as patients, need to have themselves monitored?

Dr__Cho: Diabetic patients should have their blood pressure, cholesterol, and BMI monitored carefully.

There was a study looking at routine stress testing in diabetic patients versus no routine stress testing. This study showed that routine stress testing was not beneficial. Therefore, we recommend that diabetic patients get seen by their physician regularly and have symptom-guided testing.


Supra: I am seeing a preventive cardiologist at Cleveland Clinic. My last report talked about pre-diabetes, and they mentioned estimated average glucose. Is this a better indicator than my hgA1c of risk for this? What numbers should I be looking at?

Dr__Makin: The estimated average sugar on a lab report is derived from the HbA1c. The HbA1c is like a movie; it gives us an idea of your blood sugars for the last three months. HbA1c between 5.8 and 6.5 is considered pre-diabetic. HbA1c greater than or equal to 6.5 is considered diabetic.

Harry: What exactly is pre-diabetes and its impact on heart disease? My doctor said I have it, and I am wondering what to do with it. My hgA1c is 5.9. What can I do to bring it down?

Dr__Makin: Pre-diabetes is a precursor of diabetes and can increase your risk of heart disease. The best way to prevent the progression of pre-diabetes to diabetes is by diet and exercise, decreasing the carbohydrates, simple sugars, and fat in your diet. Research shows that decreasing your weight by 5 percent to 10 percent can decrease your chances of progressing to diabetes by 64 percent. It would be beneficial to consult with a dietitian or a diabetes educator for help regarding changes in diet needed.

Cholesterol/Blood Pressure

promo9: Under what conditions do you recommend that a person with diabetes take statins?

Dr__Makin: Every person with diabetes should have their cholesterol checked every three to six months. If the bad cholesterol, also called the LDL cholesterol, is high (>100), you should be started on a statin drug. If you have heart disease and have had interventions -- such as stents or bypass surgery -- done in the past, then you also should be on a statin to decrease your chances of having another heart attack.

megn: I am 54. I have high cholesterol and high blood pressure, both controlled with medication. My father had heart disease and diabetes, and eventually died of a stroke at age 67. I am taking care of my heart issues, but should I do anything else to prevent diabetes since it is familial? My exercise regime and diet are good.

Dr__Makin: With the family history of diabetes, you should be periodically checked for diabetes by your health care provider. Continue the good work with the diet and exercise.

davies: My dad has diabetes and high blood pressure. It does not seem like either is getting in better control. He is seeing a family doctor at this time and I think he should see a specialist. His dad died of a heart attack in his 60s. Do you know what type of doctor he should see, or should he see more than one? I am worried.

Dr__Cho: Because of his previous history of heart attack, he should be seen annually by a cardiologist. It is important to control his blood pressure, especially in light of his previous heart disease.

zfernandez: My body keeps producing plaques that clog my arteries. However lipid profiles are within normal limits. After two stents five years ago, I just found out one of my arteries is clogged again. Why does my body behave this way? I am 51 years old, normal BMI, and a healthy eater

Dr__Cho: Diabetic patients with heart disease should have aggressive control of their cholesterol and blood pressure. Also, they should keep their HgA1c less than 7.0. Their bad cholesterol (LDL) should be less than 70. In some patients, their LDL appears to be low; however, their other atherogenic cholesterol is quite high. We recommend that those patients see a cardiologist who specializes in cholesterol problems.


juju3: Is there a greater risk of heart disease for men or women with diabetes?

Dr__Cho: Large epidemiological studies indicate that women with diabetes were at a greater risk of having heart attacks and heart failures then diabetic men. Women have heart disease in their 60s and men in their 50s. However, diabetic women start having heart disease in their 50s. Thus, it is crucial for diabetic women to take good care of their blood pressure, cholesterol, diabetes, etc.

grandview: Is someone with Type 1 or Type 2 diabetes more at risk for heart disease, or is there no difference?

Dr__Cho: Patients with Type 1 diabetes have had diabetes for a longer time and thus they present with heart disease at an earlier age. Type 2 diabetes is more likely to be found later in life. Thus, those patients present with disease later. However, they are both at risk for heart disease.

leslieb: What is the risk to children with diabetes? My daughter's friend (16) has diabetes and relies on insulin to control her blood sugar. Her diet and exercise habits are not good.

Dr__Makin: We are now seeing more adolescents and children with diabetes because of the obesity epidemic. It is difficult to say whether your daughter's friend has Type 1 (insulin deficiency) or Type 2 (insulin resistant) diabetes. It is important to maintain a healthy lifestyle, decrease fast food, and encourage exercise in children and adolescents to decrease their risk of diabetes.


jp3: Does Lasix have any effect on blood sugar?

Dr__Makin: Sometimes, initiating Lasix (furosemide) can lead to a need for a change in diabetes medication. You should check with your health care provider about your blood sugar if you are started on Lasix.

lutherb: What are your thoughts on Avandia®?

Dr__Makin: The research data about Avandia® (rosiglitazone maleate) at this time is controversial and contradictory. If any of our patients have heart disease, we do not initiate them on Avandia®. If any of our patients have been on Avandia® for some time, we explain the concerns to them and give them a choice of either continuing the Avandia® or changing to an alternative medication.

If you are currently under the care of a health care provider due the diabetes, please contact them before stopping the Avandia®. You are also welcome to make an appointment with our endocrinology office if you would like.

mickiem: What are your thoughts on diabetics taking aspirin to help prevent heart diseases?

Dr__Makin: Aspirin is advised for all diabetics over the age of 50 years unless there is a bleeding problem, which is a contraindication to its use.

notimelikepresent: My mom has diabetes and had heart surgery last December. She is not overweight and is on cholesterol medications. Heart disease runs in our family and I am worried that she will clog her arteries again. What steps should she take? She does eat a low fat diet. Are there certain medications she definitely should be on? Are there certain oral diabetes medications that are better for the heart?

Dr__Makin: Metformin is the diabetes medication that has been shown to decrease the risk of heart disease. The health care provider who manages her diabetes can determine if she can be started on metformin. It is important that your blood sugars are under good control to prevent further heart events.

nodoubtnd: My father had a heart attack about a month ago that was caused by his diabetes. Is it true that he has to be on aspirin for a year to keep his stents open or does he have to take aspirin for the rest of his life?

Dr__Cho: In patients with heart attack and stents, we recommend that they be on aspirin for life. The dose of aspirin can vary with individual patients.

William: I was in the hospital for heart surgery and was on oral medications for diabetes, but now they have me on insulin. Is that normal? How long will it be before my sugars are back to normal?

Dr__Cho: Frequently after heart surgery, patients can have stress-induced diabetes that does require treatment. After discharge, those patients are typically seen by an endocrinologist to determine if they need to be on further treatment. It is not unusual for patients to stay on treatment for diabetes.


bababoom: How do you correlate a heart healthy diet with a healthy diabetic diet? My grandmother will be staying with my family for some time and has both issues. Where can I get more information on this?

Dr__Makin: Both a heart healthy diet and a diabetic diet are low in fats, simple sugars, and carbohydrates. Additionally, a heart healthy diet will also be low in sodium to better control blood pressure. A consultation with a dietitian would be beneficial and will give more information about meal planning to integrate the two.

stormyw: What is the role of eating more grains in diabetes management and heart disease prevention?

Dr__Makin: Whole grains are better than processed grains for diabetes management and heart disease prevention. It is important, though, that you remember that whole grains are also carbohydrates and have calories that will increase blood sugars if eaten in large quantities.

sax_player: I recently read an article online about eating almonds in helping with diabetes and heart disease. Is there any real basis to this? If so, how much would one eat?

Dr__Cho: Almonds are good for you; however, they are also high in fat. Thus, do everything in moderation. Probably 10 a day is good. However, the more important things to do are exercise, eat in moderation, eat vegetables, etc. There are no simple or easy answers to a heart healthy diet.

OKD: Can you comment on a vegetarian diet?

Dr__Makin: Vegetarian diets have been shown to be preventive for heart disease since animal fats are harmful. The important thing to remember is not to eat more carbohydrates, such as bread and rice, because of the lack of meat. You also need to ensure that you are getting enough protein in your diet.


CatherineW_: My mom has congestive heart failure. She also has Type 2 diabetes and is on insulin. Her sugars are getting better. I think she should exercise. She is on a special diet and has lost 15 pounds, but exercise I think would help her too. I’m not sure what she should do next to get her going safely with her sugars and heart condition. Do you have any suggestions?

Dr__Cho: She should exercise. However, she might be afraid to start. At Cleveland Clinic, cardiologists along with exercise physiologists design a program that will help patients start an exercise program. Some hospitals have this program so you should talk to your doctor about it.

trimming: What can you suggest for exercise for patients with limited mobility?

Dr__Makin: Water exercises can be very helpful for patients with limited mobility. If there is an issue with joint pains, a stationary bike can be useful for exercise.

General Questions

going4it: Can you discuss resveratrol (in grape skins) and its benefits to diabetes and heart disease? Are there any?

Dr__Cho: I know there was huge enthusiasm for this in the past and patients are excited about it. However, the definitive study has not been done. In my personal opinion, I would recommend that we hold off all the enthusiasm until a phase 3 study is done.

goddard: How do you treat diabetes if you have atrial fibrillation?

Dr__Makin: Diabetes treatment does not change if you have atrial fibrillation or osteoporosis.

April: I am 45 years old and have diabetes. Lately I have been having some numbness in my left hand and then a little pressure in my chest, but I have no other risk factors of heart disease. Could it be my heart?

Dr__Cho: It is hard to tell from your description what it could be. Cardiac pain is usually associated with exertion. Thus, we recommend that you talk to your primary care physician.


Cleveland_Clinic_Host: I'm sorry to say that our time with Drs. Leslie Cho and Vinni Makin is now over. Thank you again Drs. Cho and Makin for taking the time to answer our questions about diabetes and heart disease.

Dr__Cho: Thank you for joining us. We look forward to talking to you again.

Dr__Makin: Thank you for all your questions. It was a pleasure answering them.

More Information

To make an appointment with Dr. Cho, or any of the specialists in the Heart & Vascular Institute at Cleveland Clinic, please call 216.444.6697 or call toll-free at 800.223.2273, ext. 46697. You can also visit us online at

To make an appointment with Dr. Makin or any of the specialists in the Endocrinology & Metabolism Institute at Cleveland Clinic, please call 216.444.6568 or call toll-free at 800.223.2273, ext. 46568. You can also visit us online at

You may request a remote second opinion from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit myConsult

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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