Diabetes & Your Heart: An Indian Story of Risk and Hope

Why Do Indian Diabetics Develop Heart Disease So Early?

• Genes and body type: Indians store fat around the stomach and organs (visceral fat) even at normal weight. This hidden fat makes the arteries and heart vulnerable.
• Reluctance to control risk factors: Many of us ignore “borderline” sugar, blood pressure or cholesterol. Lifestyle changes feel difficult, and medicines are often delayed.
• Late diagnosis: Almost half of Indians with diabetes don’t know they have it until complications have begun.
• Other conditions: High blood pressure, high triglycerides, fatty liver and obesity commonly occur alongside diabetes, multiplying risk.

The Risk Factors You Must Watch Closely

1. High blood sugar (HbA1c above target >6.5% as per the international endocrine societies)
2. High blood pressure (above 130/80 mmHg)
3. High cholesterol & triglycerides (especially high triglycerides >128 mg/dl validated in Indians & low HDL less than 40 mg/dl in men & <50 mg/dl in women)
4. Central/visceral obesity (big waist, even if body weight is “normal”)
5. Smoking or tobacco use (even 1 cigarette per day kills)
6. Physical inactivity
7. Family history of early heart disease

How Can You Manage These Risks Best?

• Sugar: Keep HbA1c in target range with diet, exercise (at least 150 minutes of cardio/week, and at least 45 minutes strength training/week) and medicines. Evidence has suggested that lifestyle without the right medication for risk factor control could actually be harmful.
• Blood pressure: Aim for less than 130/80 mmHg. Medicines like ACE inhibitors and ARBs (Telmisartan) protect both heart and kidney.
• Cholesterol: Statins in the correct dose and other drugs cut risk of heart attack. Even with “normal” cholesterol, statins are often advised in diabetes.
• Weight & waistline: Even a 5–10% weight loss improves sugar, BP and cholesterol.
• Lifestyle: Quit tobacco, eat less salt and processed food, manage stress.

Slowing Down Heart Disease in Diabetes

• Start treatment before symptoms appear — waiting for chest pain or breathlessness is too late.
• Use modern diabetes medicines (like SGLT2 inhibitors and GLP-1 receptor agonists) — they protect the heart and kidneys beyond just lowering sugar.
• Get regular checks: ECG, echocardiography, cholesterol profile, kidney function, and urine protein.

Preventing Heart Disease — Your Best Safeguard

1. Know your numbers: sugar, BP, cholesterol, weight.
2. Act early: don’t wait for symptoms or “perfect timing.”
3. Adopt lifelong habits: healthy food, daily activity, restful sleep.
4. Take prescribed medicines regularly — skipping doses silently undoes protection.
5. See your doctor regularly — prevention is stronger than cure.

A Compassionate but Firm Reminder

Heart disease in diabetes is not inevitable. It comes earlier in Indians because of our genes and lifestyles, but you can change the outcome. Every effort — lowering BP, walking 30 minutes, quitting tobacco, taking your medicines — pushes back the risk.

Our research in this area

Peer-reviewed publications and conference presentations by Dr. Vishal Gupta and colleagues.

1. Gupta V, et al. Elevated NT-proBNP is associated with significant CT-left anterior descending coronary artery calcification score in T2DM. Diabetes 2023;72(Suppl_1):470-P. doi:10.2337/db23-470-P
2. Gupta V, et al. Comparison of efficacy of canagliflozin 100 mg vs. canagliflozin 300 mg on hs-CRP in patients with type 2 diabetes mellitus. Diabetes 2020;69(Suppl_1):2219–PUB. doi:10.2337/db20-2219-PUB
3. Gupta V, et al. Effect of sacubitril/valsartan combination therapy in type 2 diabetes mellitus patients with elevated NT-proBNP and preserved ejection fraction. Diabetes 2020;69(Suppl_1):1069–P. doi:10.2337/db20-1069-P
4. Gupta V, et al. To evaluate the relationship between hs-CRP and NT-proBNP in 200 type 2 diabetes patients optimised for conventional cardiovascular and renal risk factors at the end of 2 years. Submission number A-19-346-EASD; Barcelona Sept 2019. (EASD resource).
5. Gupta V, et al. Despite optimal use of angiotensin receptor blockers there exists substantial cardiovascular risk as suggested by elevated NT-proBNP in 259 T2DM patients. Diabetes 2019;68(Suppl_1):2210–PUB.
6. Gupta V, et al. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of cardiovascular risk in patients with type 2 diabetes optimised for conventional cardiovascular and renal risk factors, and its relationship with highly sensitive C-reactive protein (hs-CRP) at the end of 2 years. Indian J Cardiol (Photon) 2019;112:130–144.
7. Gupta V, et al. To evaluate patient characteristics in those with elevated NT-proBNP in type 2 DM patients optimized for conventional CV risk factors on standard care for two years. Diabetes 2018;67(Suppl_1):1516–P. doi:10.2337/db18-1516-P
8. Gupta V, et al. The role of NT-proBNP as a biomarker in evaluating residual cardiovascular risk in 200 type 2 DM patients optimized for conventional CV risk markers over two years. Diabetes 2018;67(Suppl_1):1513–P. doi:10.2337/db18-1513-P