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You Can Prevent a Heart Attack or Stroke

Did you know you're far more likely to have a heart attack or stroke than to lose a limb? The good news is there are steps you can take right now to reduce your risk of cardiovascular disease and improve your diabetes management at the same time.

Prevent Heart Attack and Stroke

"Just having diabetes multiplies the risk for heart disease sixfold and stroke fourfold," says Francine Kaufman, M.D., head of the Center for Endocrinology, Diabetes, and Metabolism at Children's Hospital Los Angeles and author of Diabesity (Bantam, 2006). "When you have diabetes, your risk of a heart attack is as high as it is for a person without diabetes who's had a heart attack."

However, there's hope: You can take steps to prevent a heart attack or stroke. Read on for more.

How Diabetes Affects Your Heart

Chronically high blood glucose levels cause glucose to attach to the cells that line blood vessel walls in a process called glycation. Over time, glycation makes the blood vessel inflamed, causing it to swell, which impairs blood flow to vital organs such as the heart and brain. This decreased blood flow increases the chance of heart attack and stroke.

The problem is compounded if you're overweight, Kaufman says. Chemicals secreted by excess fat cells promote blood vessel inflammation, which is why overweight people may develop risk factors for cardiovascular disease well before they develop pre-diabetes or type 2 diabetes.

People with diabetes:

  • tend to get heart disease earlier
  • have twice the risk for heart attack
  • have four times the risk for stroke
  • are more likely to die as a result of heart disease

Signs of a Heart Attack or Stroke

If you experience any of these symptoms, call 911 immediately.

Heart Attack

  • Chest discomfort
  • Pain in the arms, back, neck, jaw, or stomach
  • Shortness of breath
  • Nausea
  • Lightheadedness

Stroke

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side
  • Sudden confusion
  • Sudden trouble speaking or understanding
  • Sudden trouble seeing from one or both eyes
  • Sudden trouble walking
  • Sudden dizziness and loss of balance or coordination

Control Your Diabetes

The good news is that if you're working to control your diabetes, you're already on the right track. A recent study found that people with type 1 diabetes were able to reduce their chances of having cardiovascular disease by 42 percent and their odds of having a heart attack or stroke by 57 percent by keeping tight control over their blood glucose levels.

"Managing diabetes today is no longer just about blood glucose control," Kaufman says. "It's critical to get and keep your A1C, blood pressure, and cholesterol numbers in target ranges." Fortunately, good blood glucose control can help you improve both your cholesterol and your blood pressure, which reduces your risk of heart attack and stroke.

These eight strategies will get you on track.

Check out 8 tips to lower A1C.

Lose Weight

"Losing a few pounds can be a home run to improve your A1C, blood pressure, and cholesterol numbers," says Linda Delahanty, director of nutrition and behavioral research at Massachusetts General Hospital's Diabetes Unit and coauthor of Beating Diabetes (McGraw-Hill, 2006). Plus, excess weight puts extra strain on your cardiovascular system. By losing weight, you will help your heart circulate blood more efficiently and pump more effectively.

Our 12 weight loss tips will keep you motivated.

Get Moving

"The benefits of physical activity are nearly endless," says Sheri Colberg-Ochs, Ph.D., associate professor of exercise science at Old Dominion University and author of The Diabetic Athlete's Handbook (Human Kinetics, 2008). Among its benefits, exercise:

  • improves insulin sensitivity
  • reduces blood vessel inflammation
  • reduces blood pressure
  • reduces blood glucose
  • reduces LDL ("bad" cholesterol)
  • increases HDL ("good" cholesterol)

The ADA suggests at least 30 minutes of moderate-intensity aerobic activity five times a week plus resistance training three times a week. As an exercise expert who has diabetes, Colberg-Ochs knows it's tough to begin. "Just start moving around more," she says. "You'll have more energy and be ready to add more activity. Don't start out with too much gusto. Start slowly so you don't get discouraged or injured."

Follow these simple moves to get fit.

Take a Statin

Lowering your LDL ("bad" cholesterol) is a priority to prevent cardiovascular disease. The ADA recommends that anyone older than 40 who has diabetes should take a statin drug, which reduces LDL. You may also need medicines to lower blood pressure and blood glucose.

However, it is possible to stay off medications for a while. As the number and cost of his prescriptions mounted, Ivan Wright, who lost 40 pounds after his type 2 diabetes diagnosis, was forced to make lifestyle changes including losing weight, eating healthfully, and being active.

"I realized there would be a point at which more drugs would not help," he says. Ivan's blood glucose, blood pressure, and cholesterol are now on target, and he has reduced the number of his medications to just two: one for diabetes and one for blood pressure. "Plus, I'm saving a bundle of cash," he says.

Manage Glucose Levels

Keep your blood glucose level as near to normal as possible. Over time, high levels of blood glucose damage blood vessels, causing complications that affect your circulation, vision, and kidney function. Follow your meal plan and medication schedule for optimal blood glucose control.

Keep track of your ABCs:
A = A1C or Blood Glucose
Experts rely on target levels set by the American Diabetes Association or the American Association of Clinical Endocrinologists.

A1C: under 6.5 (ACE) or 7 (ADA)
Blood glucose: fasting and before meals         70-130 mg/dl (ADA)
Blood glucose: fasting and before meals        ≤110 (ACE)
Blood glucose: one to two hours after the start of a meal        Blood glucose: one to two hours after the start of a meal        ≤140 mg/dl

B = Blood Pressure*
Goal for people with diabetes: under 130/80 mmHg

C = Cholesterol*
LDL: under 100 mg/dl
HDL: above 60 mg/dl
Triglycerides: under 150 mg/dl

*"Standards of Medical Care in Diabetes," American Diabetes Association, 2008

Check out these tips to lower blood sugar.

Make Better Food Choices

Reduce the total amount of fat grams you eat to cut down on calories. This means eat less salad dressing, butter, fried foods, cream sauces, and oils. Next, reduce saturated and trans fat. Start with a few small changes or substitutions:

  • Use a liquid oil, such as canola, olive, or sunflower, rather than butter or shortening.
  • Eat fish twice a week, especially those with omega-3 fatty acids, such as salmon, trout, or bluefish.
  • Eat more fruits and vegetables.
  • Choose whole grains over refined starches and sweets.
  • Choose low-fat or part-skim cheeses.
  • Choose lean cuts of meat and trim visible fat.
  • Remove skin from poultry.
  • Limit foods that include partially hydrogenated oil in the ingredients.

Diabetes menus: What's for dinner?

Pick Foods High in Fiber

Foods that contain soluble fiber, such as oats and barley, may help lower your blood cholesterol level and smooth out your blood glucose level so it doesn't rise too fast or too high after you eat. Other food sources of soluble fiber include beans, whole wheat and bran cereals, and many fruits and vegetables. If the fruit or vegetable peel is edible, leave it on for even more fiber.

Check out these whole grain recipes.

Reduce Your Sodium Intake

Too much sodium increases blood pressure and can lead to water retention and kidney problems. Try filling your saltshaker with a salt-free seasoning mix. Use herbs and spices to flavor foods. Look for reduced-sodium products at the grocery store.

Check out these low sodium recipes.

Quit Smoking

Over time, smoking narrows blood vessels, which increases cholesterol and blood pressure. Plus, diabetes compounds the risks that smoking poses for cardiovascular disease. If you haven't done so already, now is a great time to quit!

Diabetic Living Video

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