Diabetes and heart health
Diabetes raises the chances of developing heart problems... eating well and getting or
staying active. Even if you have had a heart attack already, you can do a
lot more than just take medicines your doctor prescribes.
What causes heart disease?
Atherosclerosis is when, over time, fat deposits from cholesterol
build up on the walls of your arteries. As the fat builds up, less blood
is flows through. If the blood to your heart is blocked enough, you
have a heart attack. If these fat deposits break loose, the result is a
stroke. This is why doctors focus on reducing cholesterol.
Diabetes is also more likely to cause heart problems due to damage from high glucose levels and high blood pressure.
Managing A1c levels
A1c
is a measure of your blood sugar control over a period of time....daily testing for glucose levels will help manage how well you feel.
Regular A1c tests help you know what steps you have to take to keep
your blood sugar under control to protect your heart.
Managing blood pressure
High
blood pressure can cause heart and kidney disease. Some people can
reduce it with changes in diet or physical activity. Others require
medicines. Your doctor or doctors will help you make the best decision
for your specific situation.
Managing cholesterol
This chart shows
you what most doctors agree are good measures of the scores you get.
| Normal |
less than 150 mg/dL |
| Borderline High |
150-199 mg/dL |
| High |
200-499 mg/dL |
| Very High |
500 mg/dL |
What are the risk factors for heart disease and stroke in people with diabetes?
Diabetes itself is a risk factor for heart disease and stroke.
Also, many people with diabetes have other conditions that increase
their chance of developing heart disease and stroke. These conditions
are called risk factors. One risk factor for heart disease and stroke
is
having 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), you may be at increased risk.
You can't change whether heart disease runs in your family, but you
can take steps to control the other risk factors for heart disease
listed here:
- Having central obesity. Central obesity means
carrying extra weight around the waist, as opposed to the hips. A waist
measurement of more than 40 inches for men and more than 35 inches for
women means you have central obesity. Your risk of heart disease is
higher because abdominal fat can increase the production of LDL (bad)
cholesterol, the type of blood fat that can be deposited on the inside
of blood vessel walls.
- Having abnormal blood fat (cholesterol) levels.
- LDL cholesterol can build up inside your blood vessels, leading
to narrowing and hardening of your arteries-the blood vessels that carry
blood from the heart to the rest of the body. Arteries can then become
blocked. Therefore, high levels of LDL cholesterol raise your risk of
getting heart disease.
- Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
- HDL (good) cholesterol 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.
- Having high blood pressure. If you have high
blood pressure, also called hypertension, your heart must work harder to
pump blood. High blood pressure can strain the heart, damage blood
vessels, and increase your risk of heart attack, stroke, eye problems,
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 is metabolic syndrome and how is it linked to heart disease?
Metabolic syndrome is a grouping of traits and medical conditions
that puts people at risk for both heart disease and type 2 diabetes. It
is defined by the National Cholesterol Education Program as having any
three of the following five traits and medical conditions:
| Traits and Medical Conditions |
Definition |
| Elevated waist circumference |
Waist measurement of
- 40 inches or more in men
- 35 inches or more in women
|
| Elevated levels of triglycerides |
- 150 mg/dL or higher
or
- Taking medication for elevated triglyceride levels
|
| Low levels of HDL (good) cholesterol |
- Below 40 mg/dL in men
- Below 50 mg/dL in women
or
Taking medication for low HDL cholesterol levels
|
| Elevated blood pressure levels |
- 130 mm Hg or higher for systolic blood pressure or
- 85 mm Hg or higher for diastolic blood pressure
or
Taking medication for elevated blood pressure levels
|
| Elevated fasting blood glucose levels |
- 100 mg/dL or higher
or
- Taking medication for elevated blood glucose levels
|
Source: Grundy SM, et al. Diagnosis and
Management of the Metabolic Syndrome: An American Heart
Association/National Heart, Lung, and Blood Institute Scientific
Statement.
Circulation. 2005;112:2735-2752.
Note: Other definitions of similar conditions have been
developed by the American Association of Clinical Endocrinologists, the
International Diabetes Federation, and the World Health Organization.
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What can I do to prevent or delay heart disease and stroke?
Even if you are at high risk for heart disease and stroke, you can
help keep your heart and blood vessels healthy. You can do so by taking
the following steps:
- Make sure that your diet is "heart-healthy." Meet with a registered dietitian to plan a diet that meets these goals:
- Include at least 14 grams of fiber daily for every 1,000
calories consumed. Foods high in fiber may help lower blood
cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried
beans and peas (such as kidney beans, pinto beans, and black-eyed peas),
fruits, and vegetables are all good sources of fiber. Increase the
amount of fiber in your diet gradually to avoid digestive problems.
- 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, lard, and tropical oils such as palm and
coconut oil. Your dietitian can figure out how many grams of saturated
fat should be your daily maximum amount.
- Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
- Keep the amount of trans fat in your diet to a minimum.
It's a type of fat in foods that raises blood cholesterol. Limit your
intake of crackers, cookies, snack foods, commercially prepared baked
goods, cake mixes, microwave popcorn, fried foods, salad dressings, and
other foods made with partially hydrogenated oil. In addition, some
kinds of vegetable shortening and margarines have trans fat. Check for
trans fat in the Nutrition Facts section on the food package.
- Make physical activity part of your routine.
Aim for at least 30 minutes of exercise most days of the week. Think of
ways to increase physical activity, such as taking the stairs instead
of the elevator. 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. If
you are overweight, try to be physically active for at least 30 minutes a
day, most days of the week. Consult a registered dietitian for help in
planning meals and lowering the fat and calorie content of your diet to
reach and maintain a healthy weight. 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.
- Get prompt treatment for transient ischemic attacks (TIAs).
Early treatment for TIAs, sometimes called mini-strokes, may help
prevent or delay a future stroke. Signs of a TIA are sudden weakness,
loss of balance, numbness, confusion, blindness in one or both eyes,
double vision, difficulty speaking, or a severe headache.
How will I know whether my diabetes treatment is working?
You can keep track of the ABCs of diabetes to make sure your
treatment is working. Talk with your health care provider about the
best targets for you.
A stands for A1C (a test that measures blood
glucose control). Have an A1C test at least twice a year. It shows
your average blood glucose level over the past 3 months. Talk with your
doctor about whether you should check your blood glucose at home and
how to do it.
| A1C target |
| Below 7 percent |
| Blood glucose targets |
| Before meals |
90 to 130 mg/dL |
| 1 to 2 hours after the start of a meal |
Less than 180 mg/dL |
B is for blood pressure. Have it checked at every office visit.
| Blood pressure target |
| Below 130/80 mm Hg |
C is for cholesterol. Have it checked at least once a year.
| Blood fat (cholesterol) targets |
| LDL (bad) cholesterol |
Under 100 mg/dL |
| Triglycerides |
Under 150 mg/dL |
| HDL (good) cholesterol |
For men: above 40 mg/dL
For women: above 50 mg/dL |
Control of the ABCs of diabetes can reduce your risk for heart
disease and stroke. changes in
diet, activity, and medications can help reach goals.
What types of heart and blood vessel disease occur in people with diabetes?
Two major types of heart and blood vessel disease, also called
cardiovascular disease, are common in people with diabetes: coronary
artery disease (CAD) and cerebral vascular disease. People with
diabetes are also at risk for heart failure. Narrowing or blockage of
the blood vessels in the legs, a condition called peripheral arterial
disease, can also occur in people with diabetes.
Coronary Artery Disease
Coronary artery disease, also called ischemic heart disease, is
caused by a hardening or thickening of the walls of the blood vessels
that go to your heart. Your blood supplies oxygen and other materials
your heart needs for normal functioning. 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
Cerebral vascular disease affects blood flow to the brain, leading
to strokes and TIAs. It is caused by narrowing, blocking, or hardening
of the blood vessels that go to the brain or by high blood pressure.
Stroke
A stroke results when the blood supply to the brain is suddenly cut
off, which can occur when a blood vessel in the brain or neck is
blocked or bursts. Brain cells are then deprived of oxygen and die. A
stroke can result in problems with speech or vision or can cause
weakness or paralysis. Most strokes are caused by fatty deposits or
blood clots-jelly-like clumps of blood cells-that narrow or block one of
the blood vessels in the brain or neck. A blood clot may stay where it
formed or can travel within the body. People with diabetes are at
increased risk for strokes caused by blood clots.
A stroke may also be caused by a bleeding blood vessel in the
brain. Called an aneurysm, a break in a blood vessel can occur as a
result of high blood pressure or a weak spot in a blood vessel wall.
TIAs
TIAs are caused by a temporary blockage of a blood vessel to the
brain. This blockage leads to a brief, sudden change in brain function,
such as temporary numbness or weakness on one side of the body. Sudden
changes in brain function also can lead to loss of balance, confusion,
blindness in one or both eyes, double vision, difficulty speaking, or a
severe headache. However, most symptoms disappear quickly and permanent
damage is unlikely. If symptoms do not resolve in a few minutes,
rather than a TIA, the event could be a stroke. The occurrence of a TIA
means that a person is at risk for a stroke sometime in the future.
Heart Failure
Heart failure is a chronic condition in which the heart cannot pump
blood properly-it does not mean that the heart suddenly stops working.
Heart failure develops over a period of years, and symptoms can get
worse over time. People with diabetes have at least twice the risk of
heart failure as other people. One type of heart failure is congestive
heart failure, in which fluid builds up inside body tissues. If the
buildup is in the lungs, breathing becomes difficult.
Blockage of the blood vessels and high blood glucose levels also
can damage heart muscle and cause irregular heart beats. People with
damage to heart muscle, a condition called cardiomyopathy, may have no
symptoms in the early stages, but later they may experience weakness,
shortness of breath, a severe cough, fatigue, and swelling of the legs
and feet. Diabetes can also interfere with pain signals normally
carried by the nerves, explaining why a person with diabetes may not
experience the typical warning signs of a heart attack.
Peripheral Arterial Disease
Another condition related to heart disease and common in people
with diabetes is peripheral arterial disease (PAD). With this
condition, the blood vessels in the legs are narrowed or blocked by
fatty deposits, decreasing blood flow to the legs and feet. PAD
increases the chances of a heart attack or stroke occurring. Poor
circulation in the legs and feet also raises the risk of amputation.
Sometimes people with PAD develop pain in the calf or other parts of the
leg when walking, which is relieved by resting for a few minutes.
How will I know whether I have heart disease?
One sign of heart disease is angina, the pain that occurs when a
blood vessel to the heart is narrowed and the blood supply is reduced.
You may feel pain or discomfort in your chest, shoulders, arms, jaw, or
back, especially when you exercise. The pain may go away when you rest
or take angina medicine. Angina does not cause permanent damage to the
heart muscle, but if you have angina, your chance of having a heart
attack increases.
A heart attack occurs when a blood vessel to the heart becomes
blocked. With blockage, not enough blood can reach that part of the
heart muscle and permanent damage results. During a heart attack, you
may have
- chest pain or discomfort
- pain or discomfort in your arms, back, jaw, neck, or stomach
- shortness of breath
- sweating
- nausea
- light-headedness
Symptoms may come and go. However, in some people, particularly
those with diabetes, symptoms may be mild or absent due to a condition
in which the heart rate stays at the same level during exercise,
inactivity, stress, or sleep. Also, nerve damage caused by diabetes may
result in lack of pain during a heart attack.
Women may not have chest pain but may be more likely to have
shortness of breath, nausea, or back and jaw pain. If you have symptoms
of a heart attack, call 911 right away. Treatment is most effective if
given within an hour of a heart attack. Early treatment can prevent
permanent damage to the heart.
Your doctor should check your risk for heart disease and stroke at
least once a year by checking your cholesterol and blood pressure levels
and asking whether you smoke or have a family history of premature
heart disease. The doctor can also check your urine for protein,
another risk factor for heart disease. If you are at high risk or have
symptoms of heart disease, you may need to undergo further testing.
What are the treatment options for heart disease?
Treatment for heart disease includes meal planning to ensure a
heart-healthy diet and physical activity. In addition, you may need
medications to treat heart damage or to lower your blood glucose, blood
pressure, and cholesterol. If you are not already taking a low dose of
aspirin every day, your doctor may suggest it. You also may need
surgery or some other medical procedure.
For additional information about heart and blood vessel disease, high
blood pressure, and high cholesterol, call the National Heart, Lung,
and Blood Institute Health Information Center at 301-592-8573 or see
www.nhlbi.nih.gov on the Internet.
How will I know whether I have had a stroke?
The following signs may mean that you have had a stroke:
- sudden weakness or numbness of your face, arm, or leg on one side of your body
- sudden confusion, trouble talking, or trouble understanding
- sudden dizziness, loss of balance, or trouble walking
- sudden trouble seeing out of one or both eyes or sudden double vision
- sudden severe headache
If you have any of these symptoms, call 911 right away. You can
help prevent permanent damage by getting to a hospital within an hour of
a stroke. If your doctor thinks you have had a stroke, you may have
tests such as a neurological examination to check your nervous system,
special scans, blood tests, ultrasound examinations, or x rays. You
also may be given medication that dissolves blood clots.
What are the treatment options for stroke?
At the first sign of a stroke, you should get medical care right
away. If blood vessels to your brain are blocked by blood clots, the
doctor can give you a "clot-busting" drug. The drug must be given soon
after a stroke to be effective. Subsequent treatment for stroke
includes medications and physical therapy, as well as surgery to repair
the damage. Meal planning and physical activity may be part of your
ongoing care. In addition, you may need medications to lower your blood
glucose, blood pressure, and cholesterol and to prevent blood clots.
For additional information about strokes, call the National Institute
of Neurological Disorders and Stroke at 1-800-352-9424 or see
www.ninds.nih.gov on the Internet.
- If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke.
- Controlling the ABCs of diabetes-A1C (blood glucose), blood
pressure, and cholesterol-can cut your risk of heart disease and stroke.
- Choosing foods wisely, being physically active, losing
weight, quitting smoking, and taking medications (if needed) can all
help lower your risk of heart disease and stroke.
- If you have any warning signs of a heart attack or a stroke,
get medical care immediately-don't delay. Early treatment of heart
attack and stroke in a hospital emergency room can reduce damage to the
heart and the brain.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK) is one of the National Institutes of Health (NIH) under
the U.S. Department of Health and Human Services. The NIDDK conducts
and supports research in diabetes, glucose metabolism, and related
conditions. Several studies related to diabetes, heart disease, and
stroke are under way.
- The Look AHEAD (Action for Health in Diabetes) trial is studying
whether strategies for weight loss in obese people with type 2 diabetes
can improve health. This trial is also sponsored by other NIH
Institutes and by the Centers for Disease Control and Prevention. For
more information on the Look AHEAD trial, visit the website at www.niddk.nih.gov/patient/SHOW/lookahead.htm.
- The EDIC (Epidemiology of Diabetes Interventions and
Complications) study is examining the long-term effects of prior
intensive versus conventional blood glucose control. It is a follow-up
study of patients who took part more than a decade ago in the Diabetes
Control and Complications Trial (DCCT), a major clinical study funded by
the National Institutes of Health.
- The BARI 2D (Bypass Angioplasty Revascularization Investigation 2
Diabetes) trial, sponsored by the National Heart, Lung, and Blood
Institute, in partnership with NIDDK, is studying approaches to the
medical care of people with type 2 diabetes who also have coronary
artery disease. For more information on the BARI 2D trial, visit the
website at www.bari2d.org
or call the nearest research center (listed on the website).
- The ACCORD (Action to Control Cardiovascular Risk in Diabetes)
trial is studying three approaches to preventing major cardiovascular
events in individuals with type 2 diabetes. For more information on the
ACCORD trial, visit the website at www.accordtrial.org or call 1-888-342-2380.
- The NIDDK and other components of the NIH will continue to fund
research on the best ways to enhance health promotion, self-management,
and risk reduction in people with diabetes.
Steps:
