MANILA, Philippines ? Doctor Homobono Calleja, one of the veritable icons of Philippine cardiology, emphasizes in the scholarly dissertation he wrote for the Philippine Journal of Internal Medicine that diabetes is a cardiovascular disease by itself. And that is so, he believes, right from the start when the blood sugar may not be that elevated yet.

Dr. Calleja or HB as we fondly call him, is a past president of the Philippine Medical Association, Philippine Heart Association, and Philippine College of Physicians; and the founding director of the St. Luke?s Heart Institute.

He has trained many homegrown cardiologists now practicing in various parts of the country.

At 80, he can still give golfers many years his junior humbling moments at the golf course with his accurate short game and putting finesse.

HB shows the same level of expertise in scientific forums as he exhibits on the golf course ? calculating but accurate. I had the privilege to be in the same panel with him a few months ago to discuss diabetes and hypertension.

Diabetes used to be recognized only as a risk factor just like high blood pressure, smoking or cholesterol problems. But now, many heart experts like HB contend that a diabetic is just like someone who has a heart disease already, and may even be considered a high-risk patient or a prime candidate to develop a heart attack or stroke or kidney failure ? and all these, without the individual, who thinks himself in good shape, realizing it.

Linking DM with CVD, stroke

HB cited a recent survey among physicians conducted by the ?make the link? project of the American College of Cardiology and the American Diabetes Association linking diabetes mellitus (DM) with coronary artery disease and stroke.

The survey showed that DM was the highest or most dominant risk factor for cardiovascular disease (CVD), higher than traditional risk factors of smoking, hypertension, hypercholesterolemia or obesity.

Further, DM is associated with more extensive atherosclerosis affecting blood vessels in the eyes, brain, heart, kidneys and peripheral arteries in the neck, aorta and lower extremities. These blood vessel changes appear several years before overt DM is manifested.

?Indeed, more than just another risk factor for CVD, DM can be conceptualized and correctly called CVD,? HB says. ?The intimately incriminating connection between DM and CVD is compelling,? he adds.

HB explains that the manifestations of DM affect more arteries and blood vessels ? from the big to the small ones or arterioles ? than any other disease. None of the currently known risk factors inflicts more illness, disability, and death than DM, according to HB.

?Indeed, DM is not only a major risk factor for CVD but in reality DM is CVD that destroys the vascular beds of several target organs,? HB stresses.

Still not convinced

HB laments that many internists, diabetologists, nephrologists, neurologists, and cardiologists are still not convinced that DM is a classic model of cardiovascular pathology, with a potential for malignant and risky progression leading to vital organ damage which is already irreversible when recognized.

?DM begins to damage the cardiovascular system even before it is diagnosed,? HB says. He explains that DM ? like a terrorist in the night ? silently destroys all arteries, building atherosclerotic lesions and aneurysms (thinning and ballooning of the arteries). Benign as it may seem at the start, diabetes is a malignant disease, I remember him saying during our panel discussion.

Early on, some might have borderline elevation of the blood sugar, a stage called pre-diabetes or impaired fasting glucose (IFG). Some might have normal fasting blood sugar (FBS) when taken before breakfast after a whole night fasting but once they would eat, the blood sugar would rise excessively. This is called post-prandial hyperglycemia or impaired glucose tolerance (IGT), so one should have a blood sugar test taken after a meal or sugar load (oral glucose tolerance test or OGTT) even if the FBS level is normal.

HB emphasizes that even IFG and IGT already put one at risk to develop damage to the arteries which can eventually lead to serious complications.

Early recognition and treatment is therefore imperative and this should be a concern of physicians of various specialties.

?Treating a patient with impaired glucose tolerance and overt DM must be a ?responsibility? among [medical] specialties,? HB says.