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Obesity, diabetes, and coronary artery disease: How are they related?

Emily M. Deskin

School of Nursing, James Madison University

NSG 461: Pathophysiology and Pharmacology

Dr. Blyer

April 12th, 2023

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Obesity, diabetes, and coronary artery disease: How are they related?

Obesity has quickly become a global epidemic with around 1 billion adults and 10

percent of children worldwide are currently suffering from obesity (Gomes, et., at., 2019).

Unfortunately, individuals who suffer from obesity are subject to other co-morbidities that are

consequences of being overweight. There are numerous co-morbidities that can be associated

with obesity; however, this paper will focus on two of the most prominent, type 2 diabetes and

coronary artery disease. These two diseases are prominent in people who suffer from obesity and

if left untreated, can lead to devastating consequences. Without proper treatment, lifestyle

changes and support obesity can lead to type 2 diabetes and coronary artery disease. This paper

will describe the relationship between obesity, type 2 diabetes (DM2) and coronary artery

disease (CAD).

Disease Information

Text begins as a new paragraph. No writing is needed if using level 2 headings. Look at

examples of this on pages 61 – 65 in the APA text.

Pathophysiology

Type 2 Diabetes

Type 2 diabetes is seen in more than 90 percent of diabetes cases in the United States

(McCance and Heuther, 2019). The risk factors for type 2 diabetes are family history as well as

obesity. Traditionally, type 2 diabetes is seen in people who are over the age of 40 and obese,

however with the uptick of obesity in the United States, it is being diagnosed at even younger

ages. Typically, with people who suffer from type 2 diabetes, the pancreas does still secrete some

insulin, however resistance to this insulin occurs. Unlike in type 1 diabetes where no insulin is
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secreted. Type 2 diabetes, unlike type 1, can be treated with simple lifestyle modifications.

Whereas type 1 diabetics must give themselves insulin.

Diabetes occurs when there is a lack of balance between the demand and the production

of the hormone insulin. Insulin, which is produced by beta cells in the pancreas, regulates the

movement of sugar into the body’s cells, and is an important factor in type 2 diabetes. In people

with type 2 diabetes, there is a large amount of insulin produced, and the pancreas is unable to

keep up with insulin production, and cells do not respond accordingly to this high level of insulin

production. In turn, this results in little to no low blood sugar and causes blood sugar levels to

rise and insulin resistance. The effects of type 2 diabetes have also been examined at the cellular

level. Numerous studies have shown people with type 2 diabetes have a gene mutation that

encodes calpain-10, which is a cystine protease. Studies have shown that there is a relationship

between and an allele of the gene that encodes peroxisome proliferator-activated receptor-y,

which is involved in adipocyte differentiation and glucose metabolism (McCance and Heuther,

2019, p. 170). With all this occurring at the cellular level, it unfortunately produces system

effects on the body.

Type 2 diabetes has numerous different consequences that occur on the systemic level,

and if left untreated can have deadly consequences. According to Daryabor et., al., (2020),

metabolic abnormalities such as dyslipidemia, insulin resistance and obesity can lead to the

progression of type 2 diabetes. Type 2 diabetes can cause issues in the circulatory system, such

as coronary artery disease, the liver, such as NASH, the GI tract, as well as the musculoskeletal

system. People suffering from type 2 diabetes often are diagnosed with CAD, due to the high

level of high-density lipoproteins circulating in the blood system. In turn, leads to clogged

arteries and veins, called atherogenesis. Also, due to insulin resistance in the liver, which is one
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of the most important organs that metabolizes glucose, can create a disease called non-alcoholic

fatty liver disease. Diabetic neuropathy can also result from diabetes because of high blood

glucose levels and high levels of fat in the blood stream. This can cause damage to nerves in

small blood vessels where oxygen and nutrients are needed to survive.

Coronary artery disease

Coronary artery disease is the most common heart disease seen in people diagnosed with

DM2 and obesity. CAD amounts for as many as 3 million cases of heart disease each year in the

United States. Risk factors of CAD include obesity, smoking or tobacco use, lack of physical

activity and unhealthy eating, gender, and family history. The cause of CAD is largely due to the

narrowing of the major blood vessels that supply the heart with oxygen and blood. People

diagnosed with CAD often report symptoms of chest pain or chest discomfort, weakness,

lightheadedness, nausea, pain and discomfort in the arms or shoulders, and shortness of breath. If

left untreated, overtime, CAD can weaken the heart muscle which leads to a more serious

condition called heart failure. Heart failure can ultimately lead to death.

CAD has been studied at the cellular level extensively. It was first thought to be due to a

cholesterol storage issue, however, researchers suggest it is due to atherogenesis, which is the

process of plaque formation in the arteries. When this plaque formation occurs in the smooth

muscle of the arteries, over time it becomes harder for oxygen rich blood to move through the

arteries. This process leads to a weakened heart muscle, which can lead to heart failure.

CAD can lead to many different systemic effects on the body. The narrowed arteries due

to atherogenesis, can block blood flow to the heart muscle and the rest of the body. This lack of

blood flow can weaken the heart muscle and cause further damage over time. People with CAD

also report chest pain or angina as their most common symptom. Shortness of breath can be
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present as well. If CAD is left untreated, it can lead to cardiogenic shock, that develops after

severe injury to the heart muscle, such as a heart attack. Individuals with cardiogenic shock must

receive immediate medical attention as it could ultimately lead to death.

Obesity

Obesity is now considered one of the most critical and important global health epidemics.

It affects more than 1.1 billion adults and 10 percent of children globally. With obesity comes an

increase in co-morbidities as well as mortality. Obesity is caused by taking in more calories that

are burned by exercise and normal daily activities and in turn the body stores the excess calories

as fat. Those with obesity often live a sedentary lifestyle and have a family history as well.

Obesity can lead to other serious conditions such as DM2 and CAD.

Obesity is the excessive amount of accumulation of triglycerides in fatty tissue. As these

fat cells swell, their fat mass increases creating a decrease in blood flow. This decrease in blood

flow leaves less oxygen available to the adipose or fatty tissue. The lack of oxygen in the fatty

tissue leads to cell death which ultimately weakens the fatty tissue. As more fat is added to the

body, more fat cells are made and the existing fat cells increase in size, leading to a person

becoming obese. Obesity can lead to many systemic effects on the body.

Being obese unfortunately comes with many co-morbidities. Some of the most prominent

are type 2 diabetes and heart disease. Type 2 diabetes is caused by the over production of insulin,

leading to resistance as the body cannot keep up with this production. Heart disease is seen in

many obese individuals as their body struggles to transport oxygen and nutrient rich blood to the

heart. This is due to atherogenesis, caused by plaque buildup in the arteries.

Obesity, DM2 and coronary artery disease are interrelated. Obesity is one of the main

causes of the development of DM2 and CAD. One of the most important risk factors of
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developing DM2 is being obese. Together, obesity and type 2 diabetes increase the risk for

developing heart disease.

Obesity is the leading risk factor for the development of type 2 diabetes. Diabetes is very

important to get under control as it can cause damaging, lasting effects on the body. If a person is

obese, they are at a higher risk for developing diabetes and in turn, obesity can cause diabetes to

worsen faster. When obesity and type 2 diabetes occur simultaneously, the cells resist letting

insulin move glucose into them because of the overproduction of insulin. When the insulin has

nowhere to go, it remains in the bloodstream triggering the pancreas to produce even more

insulin. The pancreas then attempts to move the glucose out of the bloodstream. As a result, the

pancreas becomes overworked and weakens, in turn producing less insulin and creating a

resistance in the body.

Type 2 diabetes is seen as one of the main risk factors for cardiovascular disease as it

produces vascular injury due to high levels of high-density lipoproteins circulating in the body.

Vascular injury is a direct result of a higher number of endothelial cells throughout the body

which in turn creates plaque formation in the vascular system. With plaque build-up, red blood

cells cannot circulate through the body properly, thus leading to an in-effective output from the

heart.

Treatment of the Disease

Pharmacologic Treatment

Type 2 Diabetes

There are many pharmacologic and non-pharmacologic treatments that exist for the

treatment of type 2 diabetes. These include biguanides, such as metformin, and sulphonylureas,

such as glipizide. The non-pharmacologic treatments include exercise and diet control.
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Biguanides, commonly known as metformin, brand name Glucophage, can help improve

the body’s resistance to insulin. This medication does not produce insulin and it helps to lower

blood glucose. It decreases hepatic output in the liver and prevents rises in blood glucose. This

medication is taken orally with a large glass of water. The dosing for this medication can differ

from patient to patient. When nurses have patients taking metformin, they should educate them

on the potential side effects. Metformin can cause diarrhea, nausea, and vomiting. Also, if a

patient is scheduled to have any type of scan with contrast, the patient should stop taking

metformin 48 hours before the test is scheduled to be performed as this medication can be very

harsh on the kidneys. In turn, it may be difficult for the kidneys to secrete the oral contrast.

Sulphonylureas, such as glipizide, brand name Glucotrol help lower blood glucose and

stimulate the pancreas to produce insulin. This medication is taken orally and should be taken 30

minutes before a meal to promote maximum effectiveness. Nurses should teach patients taking

this medication to look out for hypoglycemia, which can be life threatening if the blood sugar

becomes too low.

Lastly, type 2 diabetes can be controlled through diet and exercise. If a person with type 2

diabetes follows a healthy diet and exercise regimen, they may be able to come off all their

medications completely. Nurses with patients who want to make a lifestyle change should enlist

the help of a dietician to guide the patient in the right direction with their diet. Nurses should

encourage exercise and healthy eating habits.

Coronary artery disease

There are several different medications that can be used to treat heart disease. While heart

disease is not curable, these medications can help slow the progression of the disease. The most

common medications work in tandem to help reduce the risk of heart disease worsening. These
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include cholesterol lowering medications, such as statins, anticoagulants, such as warfarin or

ACE inhibitors such as lisinopril.

Cholesterol medications help reduce blood cholesterol levels. A common cholesterol

medication is Lipitor. This medication works to reduce cholesterol levels by blocking the

enzyme that is needed by the body to make cholesterol, which results in less cholesterol in the

blood. These pills are taken orally and taken at night as this is when your body makes most of its

cholesterol, making the cholesterol medication more effective. Nurses who are taking care of

patients on these medications should teach the patient that some side effects could consist of

muscle pain or tenderness, heart burn and gas. More serious but less common side effects include

liver problems or failure.

Anticoagulants, such as warfarin, also known as Coumadin, work to inhibit the synthesis

of Vitamin K-dependent clotting factors. This helps reduce the risk of forming a blood clot

which can be caused by the narrowing of arteries due to atherogenesis present in people with

heart disease. Blood clots can lead to a more serious health condition called a pulmonary

embolism. This medication is taken orally and works best if taken at the same time each day. The

most common side effect of warfarin is the high risk of bleeding. Nurses with patients on

warfarin should educate them on the risk of bleeding, especially if they endure any trauma as this

will increase the risk of bleeding exponentially.

Lastly, ACE inhibitors can be used in tandem with the other medications previously

mentioned to treat heart disease. ACE inhibitors, such as lisinopril can be used to decrease blood

pressure and treat heart failure. This medication works by decreasing the amount of angiotensin

II and blocks it from attaching to the cell, in turn, decreasing the cellular effects on the vascular
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and cardiac system (McCance and Heuther, 2019, p. 1065). This helps relax the veins and

arteries, allowing blood to flow more freely through them and in turn lowering blood pressure.

Obesity

Obesity can be treated with pharmacologic, non-pharmacologic, and even surgical

interventions. There are currently six FDA approved weight loss drugs, one of them being

semaglutide. Non-pharmacologic interventions include healthy lifestyle changes. Lastly, surgical

interventions, such as gastric bypass can be used to help treat obesity.

Semaglutide, sold under the brand name Wegovy, can help treat obesity. This medication

works to increase the production of insulin and lowers blood sugar levels as well as signals the

pancreas to produce more beta cells. Also, this medication inhibits the production of glucagon,

needed for glycogenesis, which is the process of releasing stored carbohydrates from the liver.

This in turn reduces food intake and slows down digestion in the stomach, lessening a person’s

feeling of hunger. It comes in pill form and patients on Wegovy can experience side effects such

as nausea, vomiting, diarrhea, and abdominal cramping.

Non-pharmacological interventions include lifestyle changes, such as dieting and

exercising. People with obesity can greatly reduce their risk of developing other co-morbidities

by watching what they eat and adding exercise into their daily routines. It may be helpful for

people struggling with obesity to enlist the help of a dietitian, to guide them in the right direction

of what to eat. Simple lifestyle changes can be very beneficial in the long run to patients

suffering with obesity.

Lastly, surgical interventions can be performed to help those struggling with obesity who

have not been successful with making healthy lifestyle changes. One surgery that can be

performed is gastric bypass. Gastric bypass is used to make the stomach smaller, therefore
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hopefully leading a person to eat much less. Nurses taking care of patients who received this

surgery should teach them about infection control, as there will be small incisions made in the

patient’s abdomen. Also, for the first few months a patient with have to be on a liquid diet, and if

tolerating they can slowly introduce foods gradually.

Role of the Nurse (4 paragraphs max)

Describe the role of the nurse in the treatment and management of a person with these

conditions.

Describe how you would provide inclusive care in terms of age, sex, gender, race,

ethnicity, nationality, and religion.

Conclusion (2 paragraphs max)

Write a conclusion to your paper. Summarize briefly the key points and lessons learned.

Explain what this paper told the reader.

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