Diabetes increases your risk of heart disease and stroke. People with diabetes may develop heart disease 15 years earlier than those without diabetes.
The most common form of heart disease in diabetes is coronary artery disease. It develops when the arteries that supply the heart with blood become narrowed or blocked by fatty deposits. If the arteries that supply the brain become blocked, this may lead to a stroke.
High blood glucose (sugar) is one risk factor for heart attack or stroke, but people with diabetes often have a number of other risk factors. These include being overweight (especially if the excess fat is around the waist), inactivity, high blood pressure and high cholesterol. People who smoke or have a family history of heart disease or stroke are at even higher risk.
Reducing risk
The good news is that people with diabetes can lower their risk of heart disease and stroke considerably by paying careful attention to all of their risk factors. Working with your health-care team to achieve the following targets is the key to good diabetes management. Achieving and maintaining a healthy weight through regular physical activity and healthy eating is important, but most people with diabetes will also require medications to reach these goals.
The ABCDEs of diabetes management
Ask your doctor about the ABCDEs to reduce your risk of heart attack and stroke:
A – A1C—Most people should aim for an A1C of seven per cent* or less by managing blood sugars well. A1C is a blood test that measures your average blood sugar level over the past 120 days.
B – Blood pressure—Your blood pressure should be less than 130/80* mmHg.
C – Cholesterol—The LDL (bad) cholesterol target is less than 2.0* mmol/L.
D – Drugs to protect your heart—Speak with your health-care team about medication to protect against heart attack and stroke, such as blood pressure pills (ACE inhibitors or ARBs), cholesterol-lowering pills (statins), Aspirin, Clopidogrel and others.
E – Exercise & Eating—Regular physical activity and a healthy diet can help you achieve and maintain a healthy body weight.*
S – Screening for complications—Ask your health-care team about tests for your heart, feet, kidneys, and eyes.
S – Smoking cessation—Stop smoking or seek help to quit.
S – Self management, stress, and other barriers—Set goals for yourself to reach your targets and live well with diabetes, such as managing stress effectively.
*Discuss your target values with your health-care team. Note that A1C targets for pregnant women, older adults and children 12 years of age and under are different.
Controlling high blood pressure
In addition to healthy living habits, it may also help to limit your intake of salt and alcohol. Many people will be prescribed medications (i.e. an ACE inhibitor or an ARB) which not only lower blood pressure, but also offer protection against heart attack and stroke. Sometimes, two or three drugs are needed to lower blood pressure.
Lowering high cholesterol
Many people with diabetes will be prescribed a drug called a statin to lower LDL (“bad”) cholesterol. Other drugs may sometimes also be used to increase HDL (“good”) cholesterol and to lower other blood fats such as triglycerides.
Low-dose Aspirin therapy may be recommended for some people with diabetes. Aspirin helps prevent blood clots from forming. Aspirin is available without a prescription, but is not safe for everyone. Talk to your doctor about whether Aspirin is safe for you and what dose you should take. For people who can’t take Aspirin or who find it upsets their stomach, or in other specific situations, Clopidogrel (a prescription blood thinner) will sometimes be used.
Quit smoking
Smoking is a deadly habit. One of the best things you can do for your heart, diabetes and overall health is to quit now. Anyone who has tried to quit knows that it can be very challenging, so ask for help. You will increase your chances of success if you have support from your health-care team and family.
Keep tabs on your health
- Your doctor should take your blood pressure at every diabetes-related visit
- Your A1C should be measured every three months
- Your blood lipid (fat) levels should be measured every year (more often if you are on cholesterol-lowering medications)
- Know your test results and ask questions about what medication, diet and exercise is best for you
The more you know about your health and the treatments available, the more you can be part of your own care.