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DIABETES & CARDIOVASCULAR HEALTH: WHY DOES THE ENDOCRINE SYSTEM AFFECT BLOOD VESSELS?

DIABETES & CARDIOVASCULAR HEALTH: WHY DOES THE ENDOCRINE SYSTEM AFFECT BLOOD VESSELS?

02/10/2025

Diabetes is not merely a “blood sugar disorder” – it is also a leading risk factor for cardiovascular disease. Vascular injury caused by endocrine and metabolic dysfunction places people with diabetes at a significantly higher risk of myocardial infarction, stroke, and heart failure compared to the general population. Why do endocrine disorders directly affect the cardiovascular system?

Why do endocrine disorders affect cardiovascular health?

Endocrine abnormalities in diabetes directly impact blood vessels through multiple mechanisms:

  • Prolonged high blood glucose damages the vascular endothelium, promotes the formation of atherosclerotic plaques, and increases the risk of arterial stiffness.

  • Insulin resistance reduces insulin’s vasodilatory effect, leading to vasoconstriction and decreased vascular elasticity.

  • Chronic inflammation and oxidative stress resulting from metabolic dysregulation damage vascular structure and accelerate atherosclerosis.

  • Dyslipidemia and hypertension, which often accompany diabetes, further multiply the risk of cardiovascular injury.

  • Other hormones such as cortisol (from the adrenal glands), thyroid hormones, and adipokines (leptin, adiponectin) also contribute to altered metabolism and vascular dysfunction.

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Diagnosis

Diagnosing diabetes is not based solely on blood glucose levels – a comprehensive assessment of cardiovascular risk is also required:

  • Blood glucose tests: fasting glucose ≥ 126 mg/dL; HbA1c ≥ 6.5%.

  • Cardiovascular risk assessment: blood pressure measurement, blood lipids (LDL, HDL, triglycerides), BMI, waist circumference.

  • Complication screening: echocardiography, electrocardiogram, peripheral vascular assessment, renal function tests.

  • Related endocrine evaluation: thyroid function, cortisol, and sex hormones when disorders are suspected.

A combined diabetes–cardiovascular screening package is often used, including blood pressure measurement, blood tests, ECG, and echocardiography to detect early vascular injury.

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Treatment – Individualized and Multidisciplinary

There is no single universal treatment regimen for all patients with diabetes — therapy must be individualized.

  • Lifestyle modification:

    • Balanced diet (reduced refined sugars, increased fiber, fish, and plant oils).

    • At least 150 minutes of exercise per week.

    • Maintain a healthy weight and reduce visceral fat.

  • Antihyperglycemic medications:

    • Metformin: first-line choice.

    • GLP-1 receptor agonists: prioritised for overweight patients with cardiovascular risk (lower HbA1c + weight loss + cardioprotection).

    • SGLT2 inhibitors: for patients with cardiovascular disease, heart failure, or chronic kidney disease.

    • Insulin: used when HbA1c is very high or when oral medications fail.

  • Management of accompanying cardiovascular factors:

    • Stations to control blood lipids.

    • Antihypertensives (ACE inhibitors, ARBs) for heart–kidney protection.

    • Low-dose aspirin (in certain high-risk cases).

Multidisciplinary care: endocrinology works in coordination with cardiology, nephrology, ophthalmology, nutrition, and psychology for comprehensive management.

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Long-Term Management

  • Modern glucose monitoring: Continuous Glucose Monitoring (CGM) helps promptly detect hypo- and hyperglycemia.

  • Telemedicine: physicians monitor patients remotely; patients report data through apps.

  • Personalized health education: patients receive tailored guidance on diet, exercise, and medication based on occupation, lifestyle, and culture.

  • Regular follow-up: HbA1c every 3–6 months; heart–kidney–eye evaluations at least once a year.

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Prevention – Protect Cardiovascular Health Early

  • Maintain healthy body weight and waist circumference.

  • Eat a healthy diet: reduce sugary foods; increase vegetables and whole grains.

  • Exercise regularly.

  • Manage stress and get sufficient sleep.

  • Schedule regular endocrine–cardiovascular check-ups if risk factors are present (family history, obesity, sedentary lifestyle).

Diabetes is a complex endocrine disorder in which the cardiovascular system is one of the most severely affected organs. Early diagnosis, individualized treatment, complication prevention, and multidisciplinary management are key to prolonging life expectancy and improving quality of life for patients.

Reference:

Johns Hopkins Medicine

Johns Hopkins Medicine

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