Reducing Your Risk of Heart Disease When You Have Diabetes
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Diabetes and Heart Disease Risk

Controlling blood glucose along with controlling cardiovascular disease (CVD) risk factors are important steps in treating diabetes, since diabetes can cause damage to the heart and blood vessels.

Diabetes
Millions of Americans are affected by diabetes , a serious, chronic condition associated with numerous health complications. Diabetes is easy to diagnose by testing blood sugar levels. Although there is no cure, early detection, appropriate treatment, education, and a healthy lifestyle can help you avoid or delay diabetes-related complications.

Cardiovascular Disease (CVD)
CVD is one of the leading causes of death in the United States and the primary reason for heart attacks. It is also a common complication associated with diabetes. According to the American Diabetes Association (ADA), people with diabetes are 2-4 times more likely to have CVD than the general population. Diabetes significantly increases the risk of heart attack compared to the general population.

Controlling Risk Factors: Getting Appropriate Treatment
Coronary artery disease occurs when there is a gradual build-up of plaques in blood vessels that supply blood to your heart. Over time the plaques narrow or block the arteries, limiting blood supply to the heart. Controlling risk factors that lead to CVD, can decrease your risk of having a heart attack.

Blood Glucose
High blood glucose levels can damage your heart and blood vessels and lead to CVD. Therefore, it is important to regularly monitor and control your blood glucose levels.

Cholesterol
Cholesterol is a substance that is an important component of cell membranes as well as a building block necessary in the production of many hormones. However, abnormally high levels of cholesterol contribute to formation of fatty deposits (plaques) within the walls of blood vessels, which in turn lead to development of coronary artery disease. Cholesterol is transported through the bloodstream by high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL). LDL is frequently called “bad cholesterol” as it promotes accumulation of cholesterol in the walls of your arteries. Diabetes may make the LDL particles more likely to stick to and damage artery walls. HDL cholesterol is sometimes referred to as "good" cholesterol. It helps clear excess cholesterol from your body. Its level is raised mostly by regular exercise.

Besides making appropriate lifestyle changes, the ADA also recommends using statins to lower cholesterol levels if a patient with diabetes has cardiovascular disease or is at risk of cardiovascular disease (even if cholesterol levels are not high). Adults who have diabetes and high cholesterol levels may also need to take a statin medicine.

Blood Pressure
Narrow blood vessels are one reason for high blood pressure (eg, hypertension ). Because high blood pressure can make some of the complications of diabetes worse, the American Diabetes Association recommends aggressive treatment of hypertension for people with diabetes. The ADA recommends a target blood pressure below 130/80 mm Hg for people with diabetes.

The primary groups of medications recommended to treat high blood pressure in diabetics are angiotensin converting enzyme inhibitors (ACE-inhibitors) or angiotensin receptor blockers (ARBs) which may provide additional protection for the cardiovascular system and the kidneys beyond simply reducing the blood pressure.

Controlling Risk Factors: Lifestyle Modifications
In addition to using medication to control cholesterol, blood pressure, and blood glucose levels, modifying certain lifestyle factors is essential for reducing the complications associated with diabetes and improving your length and quality of life.

Healthy Diet
Work with your doctor to devise an eating plan that you can follow. Include foods that are low in saturated fat, trans fat, and cholesterol, and high in fiber and whole grains; consume salt and alcohol in moderation; choose fats that help lower cholesterol (omega-3 fatty acids); and eat plenty of fruits and vegetables every day. A healthy diet can help manage your CVD risk by lowering your blood pressure, cholesterol, and blood glucose levels.

Physical Activity
Adults should aim to complete at least 150 minutes a week of moderate-intensity or 75 minutes a week of vigorous-intensity aerobic physical activity. Being physically active will have broad health benefits; however, those with diabetes need to pay special attention to blood sugar control and footwear during physical activities.

Begin by finding ways to incorporate extra movement into your day—walk briskly, take the stairs instead of the elevator, or park a little farther away from your destination than usual. Start slowly and build up your strength and endurance. Being physically active can be very enjoyable, and it’s good for your health!

Weight Loss
Eating a healthy diet, reducing your calorie intake, and increasing your physical activity will all help you lose weight if needed. Weight loss and increased activity can also increase your healthy HDLs.

No Smoking
If you are thinking about quitting , there are many smoking cessation programs and support groups which can help you. The benefits of quitting are both immediate and long-lasting.

Conclusion
Educate yourself about diabetes and how you can control it. There are many sources of information and organizations dedicated to managing and preventing this disease. Work closely with your healthcare team to monitor your health and help you address your individual health issues.




RESOURCES:
American Diabetes Association

American Heart Association

National Diabetes Education Program

CANADIAN RESOURCES:
Canadian Cardiovascular Society

Canadian Diabetes Association

References:
Cardiovascular disease & diabetes. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp. Accessed June 15, 2012.

Complications . American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/?loc=DropDownLWD-complications . Accessed June 15, 2012.

Diabetes, heart disease, and stroke. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/stroke/. Updated December 6, 2011. Accessed June 15, 2012.

Lipd-lowering in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 17, 2012. Accessed June 22, 2012.

Snow V, Aronson MD, et al. Lipid control in the management of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2004;140(8):644-9.

Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation . 2011;123:1-20.

Prevent diabetes problems: Keep your heart and blood vessels healthy. National Diabetes Information Clearinghouse website. http://diabetes.niddk.nih.gov/dm/pubs/complications_heart/Updated April 2009. Accessed June 15, 2012.

National diabetes statistics, 2011. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/DM/PUBS/statistics/ . Updated December 6, 2011. Accessed June 15, 2012.

2008 Physical activity guidelines for Americans. US Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/pdf/paguide.pdf. Published October 2008. Accessed June 15, 2012.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med. 2009;26:142-148.

Last Reviewed June 2012



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