How diabetes affects heart disease risk

 

How diabetes affects heart disease risk

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Diabetes raises the risk of heart disease by four to five times compared with people without the disease. For this reason, in addition to controlling blood sugar, people with diabetes need to pay close attention to controlling their blood pressure and cholesterol levels.

The treatment goals for people with diabetes are more stringent than those for people without diabetes. The good news is that lifestyle changes — and weight loss in particular—to improve your blood sugar usually will have a beneficial effect on the other values as well.

Blood pressure targets for people with diabetes

Your blood pressure reading has two parts, the systolic blood pressure (the first number) and the diastolic blood pressure (the second number). The systolic number represents the pressure while the heart is contracting and pushing blood into your vessels, and the diastolic number represents the pressure while the heart is refilling with blood between beats.

People with high blood pressure (known medically as hypertension) are more than twice as likely to suffer a heart attack or stroke as those with normal blood pressure. For that reason, people with diabetes are advised to keep their blood pressure as close to the ideal as possible, and always less than 130/80 millimeters of mercury (mm Hg).

Much of the dietary advice commonly recommended for people with diabetes—such as restricting salt intake, increasing physical activity, and losing weight—should help to lower your blood pressure. To make sure, your health care provider will test your blood pressure regularly. If diet and exercise alone do not bring your blood pressure into a healthy range, medications may be necessary to lower it.

The ABC's of diabetes control

Having diabetes increases your risk for cardiovascular disease, including heart attack and stroke. If you have diabetes, you should pay close attention to factors that can put you at greater risk for heart trouble. These are often referred to as the "ABC's:"

• hemoglobin A1c (HbA1c) blood sugar test
• Blood pressure
• Cholesterol.

"ABC" Goals

HbA1c	Less than 7%
Blood pressure	Less than 130/80 mm Hg
LDL (bad) cholesterol	Less than 100 mg/dL
Triglycerides	Less than 150 mg/dL
HDL (good) cholesterol	More than 40 mg/dL in men and 50 mg/dL in women

Cholesterol levels

Your blood cholesterol level reflects the amount of one of the circulating lipids (fats) in your blood. This material travels in the bloodstream within spherical particles called lipoproteins. About two-thirds of blood cholesterol is in the form of low-density lipoprotein (LDL). This is sometimes referred to as "bad" cholesterol, because the higher the level of LDL cholesterol, the greater the risk for heart disease and stroke. High-density lipoprotein (HDL), on the other hand, counteracts the harmful effects of LDL. For that reason, HDL is sometimes referred to as "good" cholesterol. Another aspect of your lipid profile is the triglyceride level. Triglycerides are the main form of stored fat in the body and are carried by another type of lipoprotein. High triglyceride levels also increase the risk for heart disease, although not as much as LDL cholesterol.

Blood tests for cholesterol, which are measured after a fast of eight hours or more, provide information on total cholesterol as well as LDL, HDL, and triglyceride levels. These measurements provide another indicator of whether the changes you have made in your diet and activity levels and any medications you take have reduced your risk for heart disease, and whether you need to make any further adjustments.

The goals for LDL cholesterol in people with diabetes are quite stringent, as diabetes, in and of itself, places people at high risk for heart disease. The National Heart, Lung, and Blood Institute (NHLBI) recommends that everyone with diabetes keep LDL levels below 100 mg/dL. For people with diabetes whose cardiovascular risk is particularly high because they have a history of previous heart disease or other poorly managed risk factors (such as smoking cigarettes), the NHLBI suggests lowering LDL levels even further, to less than 70 mg/dL. Although dietary approaches are an important first step, medications are often required to reduce LDL cholesterol to ideal levels.