Diabetes and Heart Disease

What is the risk of heart disease and attacks for people with diabetes?

People with diabetes face many challenges staying healthy and heart health is no exception. Having diabetes puts you at much greater risk for heart disease and heart attacks. 2 out of 3 people with diabetes will actually die from stroke or heart disease.

Diabetics tend to develop heart disease or have heart attacks at an earlier age than the average population. Some studies suggest that if you are middle-aged and have Type 2 diabetes, the chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Further, women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of child-bearing hormones.

Those with diabetes who have already had one heart attack are at an even greater risk of having a second one. Finally, heart attacks in people with diabetes are more serious and more likely to result in death.  

What types of heart or vascular disease do people with diabetes have?

Your heart is a big muscle responsible for pumping blood through your body through a system of arteries and veins. Your blood supplies oxygen and other materials your body needs to function normally.

High blood glucose levels or high cholesterol, over time, can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels.

• Coronary artery disease (CAD) is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.
  
• Cerebral vascular disease is a condition which affects the blood vessels in the neck and head, which puts them at much greater risk for a stroke.
  
• Peripheral Artery Disease (PAD) is a condition that occurs when the blood vessels in the legs narrow or are blocked. An estimated 1 out of every 3 people with diabetes over the age of 50 have this condition. Others may have the following symptoms:
  

• People with diabetes are also at risk for heart attack or failure. A heart attack happens when a blood vessel in or near the heart becomes blocked. Not enough blood can get to that part of the heart muscle. That area of the heart muscle stops working and permanent damage, or even death, can occur.

What are the warning signs of a heart attack?

You may have one or more of the following warning signs:

• chest pain or discomfort
• pain or discomfort in your arms, back, jaw, or neck (common sign for women)
• indigestion or stomach pain
• shortness of breath
• sweating
• nausea or vomiting
• light-headedness

It is also possible to have no warning signs at all.

Are there other risk factors of heart disease for people with diabetes?

Unfortunately, diabetes itself is a risk factor for heart disease. There are also many other conditions that increase a person’s chance of developing heart disease.

• A family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), or had heart disease, you may be at increased risk.
• Having an apple shaped middle. Carrying extra weight around the waist instead of the hips is a risk factor. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have a condition called “central obesity”. The risk of heart disease is higher for these people because abdominal fat has shown to increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.
• Abnormal cholesterol levels.

o LDL cholesterol (bad) can build up inside blood vessels, leading to narrowing and hardening, or even a blockage, of the arteries — the blood vessels that carry blood from the heart to the rest of the body. High levels of LDL cholesterol raise your risk of getting heart disease.

o High Triglycerides are another type of blood fat that can raise your risk of heart disease.

o HDL cholesterol (good) removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

• High blood pressure. High blood pressure, or hypertension, causes your heart to work harder (think of what happens when you block off part of the stream of water from a hose). People with diabetes are at greater risk for having high blood pressure, too. This can strain the heart, damage blood vessels and increase the risk of heart attack, stroke, eye and kidney problems.
• Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

What can you do to prevent heart disease?

The most important action you can take, to avoid all of the complications associated with diabetes, is to keep your blood glucose under control. You should monitor your glucose levels multiple times daily and log them so you can track trends.

Diabetes is a balancing act. Factors such as physical activity, diet, stress levels and medications can all impact your glucose levels. If you are having problems maintaining good glucose levels, keeping track of this information can provide you and your medical team with clues to modify your treatment and get better control.

You should also have an A1c test 3 – 4 times yearly. This simple blood test reports your average blood glucose levels for the previous 2 - 3 months. The target for people with diabetes is below 7. Non-diabetics have A1c levels between 4.0 and 6.0.

Even if you are at high risk for heart disease and stroke, you can still help keep your heart and blood vessels healthy.

Maintaining target levels for blood pressure and cholesterol are important to decrease your chances for having a stroke. Equally important are attention to diet, physical activity and other lifestyle factors such as being overweight and smoking.  

Know Your Blood Pressure. Although each individual’s blood pressure varies a bit and what is normal for you might not be for someone else, there is a healthy range. If the top number (systolic) is more than 135, or if the lower one (diastolic) is more than 90, you should go to a doctor to be evaluated for high blood pressure. As a diabetic you should be visiting your doctor at least 4 times a year, but you can always go to your nearest pharmacy and have them take your blood pressure. Today, there are also moderately priced home blood pressure cuffs, so you can keep track if high blood pressure is an ongoing problem. Lifestyle changes and, perhaps, medication may be in order to bring your blood pressure back into the normal range.

Keep your blood pressure under control. Have it checked at every doctor visit. The target for most people is below 130/80 mg/dL.  

Keep your cholesterol under control. Have it checked at least once a year. The targets for most people are:

• Total cholesterol: Less than 200 mg/dL

• LDL (bad) cholesterol: below 100 mg/dL
• HDL (good) cholesterol: above 40 mg/dL in men and above 50 mg/dL in women
• Triglycerides (another type of fat in the blood): below 150 mg/dL

Make sure that your diet is “heart-healthy.” Meet with a nutritionist or registered dietitian to help plan a diet that meets these goals:

Try to consume at least 14 grams of fiber daily for every 1,000 calories consumed. Be sure to increase the amount of fiber in your diet gradually to avoid digestive problems.

Foods high in fiber are plant based and are naturally low in cholesterol, which may also help lower blood cholesterol. In addition, the body metabolizes them more slowly, which can also be of benefit to maintaining target blood glucose levels.

Whole grain foods such as oatmeal, barley and brown rice, as well as legumes (dried beans and peas) such as kidney, pinto and navy beans, lentils and, of course, fruits and vegetables are all good sources of fiber.

Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products and eggs.

Cut down on saturated fat-it raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening and lard. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.

Fortunately, food manufacturers have got on board and eliminated most trans fats from our processed foods (but only because they are really, really bad for you). However, small quantities still lurk in some crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods and salad dressings. In addition, some kinds of vegetable shortening and margarine's have trans fat. Be sure to check for trans fat in the Nutrition Facts section on the food package.  

Aim to eat less than 1,500 mg of sodium per day to prevent high blood pressure, strokes, heart disease and kidney disease. Read labels: Watch for both natural and added sodium content. Ordinary table salt is sodium chloride. Watch for the words "soda" (soda refers to sodium bicarbonate, or baking soda) and "sodium" and the symbol "Na" on labels. These products contain sodium compounds.

Note: When dining out, be specific about what you want and how you want it prepared. Ask for your dish to be prepared without salt.

To illustrate, the following are sodium equivalents in the diet:

· 1/4 teaspoon salt = 600 mg sodium

· 1/2 teaspoon salt = 1200 mg sodium

· 3/4 teaspoon salt = 1800 mg sodium

· 1 teaspoon salt = 2400 mg sodium

· 1 teaspoon baking soda = 1000 mg sodium

Note: The Diabetic Friendly Recipes on the Defeat Diabetes Foundation website include all the nutritional content and are lower in sodium.  

Make physical activity part of your regular routine. Aim for at least 30 minutes of physical activity at least 5 days out of the week.

You can participate in a wide array of physical activities, from archery to yoga, and everything in between. New studies indicate you can even break up your physical activity into 3 or more increments of 10 minutes if you can’t allocate more time at once. You can also add small acts of physical activity each day that really add up: use the stairs instead of the elevator; park at the far end of the lot; be physically active during commercial breaks instead of grabbing a snack; walk for local errands (statistics show the average errand within 6/10 of a mile from home).

If you haven’t been physically active recently, see your doctor for a checkup before you start an exercise program.  

Reach and maintain a healthy body weight. Almost 2/3 of the American population is overweight or obese, so you certainly aren’t alone. But almost everyone can shoot to lose 5 – 10% of their body-weight, which is usually only 10 – 20 pounds. Most folks can do that by cutting sugary drinks from their diet, reducing portion sizes, cutting out unhealthy snacking and adding more fruits and vegetables to their diet. Aim for a loss of no more than 1 to 2 pounds a week.

If you smoke, quit. Your doctor can help you find ways to quit smoking.

Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

Take your medicines as directed.

Sources:

American Heart Association

Mayo Clinic

National Diabetes Education Program

Copyright © 2011, Defeat Diabetes Foundation