When problems overlap: How to manage multiple illnesses
Heart disease shares common risk factors with certain other diseases. Patients with heart failure often suffer from other diseases as well, such as high blood pressure, diabetes, or kidney disease. In addition to potentially experiencing more severe symptoms, the coexistence of multiple diseases also complicates treatment. Individual medications can interact with each other, and simultaneous use can exacerbate side effects and complicate the treatment regimen. On the other hand, there are also medications that have a beneficial effect on several diseases at once.
Interaction between diseases
- Heart failure and kidneys: Heart failure often leads to poor blood flow to the kidneys, which can impair their function and cause the development of what is known as cardiorenal syndrome. When the kidneys are not functioning properly, fluid can accumulate in the body, increasing the strain on the heart and creating a vicious cycle.
- Diabetes and kidneys: Diabetes is the leading cause of chronic kidney disease. High blood sugar levels damage the small blood vessels in the kidneys, causing them to gradually stop working. What is particularly dangerous is that neither diabetes nor kidney damage causes pain, and symptoms may only appear after a long period of time, when the damage may be irreversible. Both can be detected early with a basic biochemical blood test. If you have had a blood test, ask your doctor about your kidney function and blood sugar levels.
- Diabetes and the heart: Diabetes increases the risk of cardiovascular disease. High blood sugar levels damage blood vessels and lead to atherosclerosis (hardening of the arteries), the main cause of chronic ischemic heart disease and heart attack. The heart then has only a limited supply of oxygen and undergoes pathological changes. Heart failure can then gradually develop or worsen.
The concurrence of multiple diseases places increased demands on both patients and physicians.
Comprehensive treatment: Treatment must be comprehensive and focus on all existing diseases. Doctors must carefully select medication, as some heart failure drugs can impair kidney function and vice versa. For some patients, it may be appropriate to choose a drug that has a positive effect on the kidneys, heart, and blood sugar at the same time.
Dietary restrictions: Patients with this combination of diseases often have strict dietary restrictions. They must monitor their intake of sodium (salt), potassium, fluids, protein, and sugar. Ideally, the diet should be designed by a nutritionist to prevent complications while still ensuring an adequate supply of nutrients.
Monitoring: Patients must regularly monitor their body weight, blood pressure, blood sugar levels, and their doctor must also monitor their kidney function. Based on this data, treatment and prevention of acute complications are then adjusted.
What needs to be arranged
Joint effort: Cooperation between a cardiologist, nephrologist (kidney specialist), and diabetologist is important. A team approach ensures that all aspects of the patient’s health are properly monitored and treated. The general practitioner often acts as the care coordinator.
Medication adjustment: Patients often need a combination of medications, such as ACE inhibitors or sartans (for the heart and kidneys and for high blood pressure), diuretics (to remove excess fluid), and insulin or other diabetes medications. A relatively new group of drugs are gliflozins (used for diabetes, heart failure, and chronic kidney disease), which cause increased sugar excretion in the urine. These drugs lower blood sugar and have a complex positive effect on the heart and kidneys. However, the suitability of individual drugs for a specific patient must be assessed by a doctor on a case-by-case basis.
Lifestyle:
Patients can take an active approach to changing their lifestyle. Regular physical activity tailored to personal capabilities, a healthy diet, and quality sleep can help. Smokers should quit. Stress also has a significant negative impact on all of the diseases mentioned above.
