Diabetes

Diabetes is one of the most powerful drivers of cardiovascular disease, significantly increasing the risk of heart attack, stroke, peripheral vascular disease, and heart failure. At Makam Medical, Dr. Arjun Makam, DO, FACC, manages the cardiovascular complications of diabetes with the same precision he brings to complex lipid and cardiac cases — ensuring that your heart health is protected as aggressively as your blood sugar. Serving patients in Anaheim and Corona, CA — call us or request an appointment online today.

What is diabetes, and why does it matter for heart health?

Diabetes is a chronic metabolic condition in which blood sugar levels remain persistently elevated — either because the body doesn't produce enough insulin (Type 1), doesn't respond to insulin effectively (Type 2), or both. Over time, chronically elevated blood sugar damages blood vessels and nerves throughout the body, with the heart and cardiovascular system bearing a particularly heavy burden.

Cardiovascular disease is the leading cause of death in people with diabetes. Adults with diabetes are two to four times more likely to develop heart disease than those without it, and they tend to develop it earlier and more aggressively. Managing diabetes without aggressively addressing cardiovascular risk leaves the most dangerous part of the condition unaddressed.

At Makam Medical, Dr. Arjun Makam, DO, FACC, provides specialized cardiovascular care for patients with diabetes — focused not just on blood sugar numbers, but on protecting the heart, arteries, and kidneys from the long-term damage diabetes causes.

How does diabetes damage the heart and blood vessels?

Elevated blood sugar causes direct injury to blood vessel walls over time, accelerating the buildup of atherosclerotic plaque in the coronary arteries and increasing the risk of heart attack and stroke. Several interconnected mechanisms drive this process:

• Accelerated atherosclerosis: High blood sugar promotes plaque formation in the coronary arteries at a faster rate than in non-diabetic patients, often leading to heart disease 10 to 15 years earlier
• Diabetic cardiomyopathy: Diabetes can damage the heart muscle directly, impairing its ability to fill and pump effectively — even in the absence of blocked arteries
• Autonomic neuropathy: Nerve damage from diabetes can blunt the heart's normal warning signals, meaning diabetic patients frequently have "silent" heart attacks with no chest pain
• Clustering of risk factors: Most patients with Type 2 diabetes also have hypertension, elevated triglycerides, low HDL cholesterol, elevated Lipoprotein(a), and obesity — a combination that dramatically multiplies cardiovascular risk

What lipid abnormalities are common in diabetes?

Diabetes produces a characteristic lipid pattern — often called diabetic dyslipidemia — that is particularly dangerous and frequently undertreated. This includes elevated triglycerides, low HDL cholesterol, and small dense LDL particles that are highly atherogenic even when total LDL appears normal on a standard panel.

Dr. Makam's board certification in Clinical Lipidology (ABCL) means he looks beyond the standard lipid panel to identify and treat the full lipid picture in diabetic patients — including advanced testing for ApoB, LDL particle size, and Lipoprotein(a) — and can prescribe the full range of lipid-lowering therapies, including PCSK9 inhibitors and siRNA therapy, when standard medications are insufficient.

What can I expect at a diabetes cardiovascular consultation?

Your evaluation begins with a thorough review of your diabetes history — including how long you've had it, your current glucose control, your A1c trend, current medications, and any prior diabetes-related complications. Dr. Makam also reviews your complete cardiovascular risk profile, family history, blood pressure history, and lipid history.

A physical examination is performed, and diagnostic testing is selected based on your individual risk level. Testing may include:

• Advanced lipid panel including Lp(a), ApoB, and triglycerides
• Electrocardiogram (EKG) to assess heart rhythm and electrical function
• Echocardiogram to evaluate heart structure and pumping function
• Stress testing when symptoms or risk factors suggest possible coronary artery disease
• Coronary Artery Calcium (CAC) scoring for cardiovascular risk stratification

What does cardiovascular treatment for diabetes look like?

Treatment is individualized and focused on reducing your total cardiovascular risk — not managing blood sugar in isolation. Depending on your situation, your care plan may include:

• Precision lipid management to achieve aggressive LDL targets appropriate for high-risk diabetic patients (typically LDL below 70 mg/dL, and below 55 mg/dL if prior ASCVD is present)
• Blood pressure optimization to target levels proven to reduce cardiovascular and kidney risk
• Guidance on selecting diabetes medications with proven cardiovascular benefit — including SGLT2 inhibitors and GLP-1 receptor agonists, which reduce heart attack and heart failure risk beyond their glucose-lowering effects
• Lifestyle modification including a heart-healthy dietary pattern, structured physical activity, and weight management
• Close coordination with your primary care physician and endocrinologist to ensure your cardiovascular and metabolic management are working together

The goal is not to duplicate your primary care — it is to ensure the cardiovascular dimension of your diabetes is being managed at the level of precision it demands.

For cardiovascular diabetes care at our Anaheim or Corona, CA offices, call Makam Medical or request an appointment online today.