You Can Prevent a Heart Attack or Stroke
Prevent Heart Attack and Stroke
According to the U.S. Centers for Disease Control and Prevention (CDC), people with diabetes are at a greater risk for high blood pressure, high cholesterol, and for having a heart attack or stroke. Here are a few eye-opening CDC statistics:
• In 2009-2012, of adults age 18 or older with diagnosed diabetes, 65 percent had LDL (bad) cholesterol levels greater than or equal to 100 mg/dl or used cholesterol-lowering medications.
• In 2009-2012, of adults age 18 or older with diagnosed diabetes, 71 percent had blood pressure levels greater than or equal to 140/90 mmHg or used prescription medications to lower high blood pressure.
• In 2003-2006, after adjusting for population age differences, cardiovascular disease death rates were about 1.7 times higher among adults age 18 or older with diagnosed diabetes than among adults without diagnosed diabetes.
Although this information can be a wake-up call, there is hope: You can take steps to keep your heart healthy and lower the risk of a heart attack or stroke.
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, says Francine Kaufman, M.D., author of Diabesity (Bantam, 2006). Chemicals secreted by excess fat cells promote blood vessel inflammation, which is why overweight people may develop other risk factors for cardiovascular disease well before they develop prediabetes or type 2 diabetes. This includes high blood pressure and abnormal blood lipid levels (cholesterol), typically low HDL (good) cholesterol and high triglycerides.
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.
• Chest discomfort
• Pain in the arms, back, neck, jaw, or stomach
• Shortness of breath
• Nausea or cold sweat
• Lightheadedness or fainting
• Pressure or pain in the lower chest or upper abdomen
• Extreme fatigue
Note: Men and women can experience symptoms differently. Get more information on heart attack signs for men and women.
• Numbness or weakness of the face, arm, or leg, especially on one side
• Sudden confusion
• Trouble speaking or understanding
• Trouble seeing from one or both eyes
• Trouble walking
• Sudden dizziness and loss of balance or coordination
F.A.S.T. is an easy way to remember the signs of stroke.
F: Face drooping
A: Arm weakness
S: Speech difficulty
T: Time to call 911
Control Your Diabetes
The good news is that if you're working to control your blood glucose (blood sugar), blood pressure, and cholesterol levels, 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.
"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, improving your blood glucose control can help you improve both your cholesterol and your blood pressure, which can reduce your risk of heart attack and stroke.
The following eight strategies can help reduce your risk.
Quitting smoking is first on the list and something everyone should do, no matter your health condition. 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!
Do you know the dangers of smoking? Find out how much you know by taking the American Heart Association’s Smoking Quiz.
"Losing a few pounds can be a homerun to improve your A1C, blood pressure, and cholesterol numbers," says Linda Delahanty, RD, director of nutrition and behavioral research at the Diabetes Unit at Massachusetts General Hospital in Boston 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.
Five Tips to Start Losing:
• Cut calories! Finding ways to cut just 100 calories a day can deliver long-term results.
• Clean out your pantry and pitch tempting foods that will derail your eating plan.
• Control portions so you can eat what you love while keeping your goals on track.
• Eat more fruits and vegetables with every meal and snack.
• Drink more water!
"The benefits of physical activity are nearly endless," says Sheri Colberg-Ochs, Ph.D., associate professor of exercise science at Old Dominion University in Norfolk, Virginia, 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.
• Lowers blood sugar.
• Lowers LDL (bad) cholesterol.
• Increases HDL (good) cholesterol.
The American Diabetes Association 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."
Take a Statin
Lowering your LDL (bad) cholesterol is a priority to prevent cardiovascular disease. The ADA recommends taking a statin medication if you have heart disease or are older than 40 with one or more risk factors for heart disease, such as diabetes. If you are younger than 40 without heart disease, consider statin medication if LDL levels remain above 100 mg/dl or if you have multiple risk factors for heart disease. You may also need to take medication to lower blood pressure and blood sugar.
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, made 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 sugar, 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 sugar 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 healthy eating plan, physical activity goals, and medication schedule for optimal blood sugar control.
Keep track of your ABCs:
A = A1C or Blood Glucose
Experts rely on target levels set by the American Diabetes Association (ADA) or the American Association of Clinical Endocrinologists (AACE).
A1C: < 7.0 percent (ADA)
A1C: < 6.5 percent (AACE)
Blood glucose: fasting and before meals 70-130 mg/dl (ADA)
Blood glucose: fasting and before meals ≤110 (AACE)
Blood glucose: 1-2 hours after the start of a meal ≤180 mg/dl (ADA)
Blood glucose: 1-2 hours after the start of a meal ≤140 mg/dl (AACE)
B = Blood Pressure*
Goal for people with diabetes: < 140/80 mmHg
C = Cholesterol*
LDL: < 100 mg/dl
HDL : men > 40 mg/dl
women > 50 mg/dl
Triglycerides: < 150 mg/dl
*Standards of Care, American Diabetes Association, 2015
Make Healthier Food Choices
Reduce the total amount of fat grams you eat to cut down on calories. This means less salad dressing, butter, fried foods, cream sauces, and oils. Next, reduce saturated fat and avoid trans fats, and replace them with heart-healthy fats such as monounsaturated and polyunsaturated fats. 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 or avoid foods that include partially hydrogenated oil in the ingredients.
Pick Foods High in Fiber
Soluble fiber helps lower LDL cholesterol by reducing the absorption of cholesterol in the intestines. Your fiber goal should be at least 25 grams a day, the amount that all healthy Americans should eat, according to the ADA.
"Fiber can reduce LDL cholesterol by 5-10 percent," says Stephen Devries, M.D., a preventive cardiologist and associate professor at Northwestern University in Chicago and author of What Your Doctor May Not Tell You About Cholesterol (Time Warner, 2007).
Examples of high-fiber fruits and vegetables:
• Brussels sprouts
Soluble fiber can be found in these foods:
• Lima beans
• Kidney beans
• Black beans
• Pinto beans
Psyllium fiber supplements, such as Metamucil, Citrucel, and FiberCon, are other ways to increase your fiber intake.
Reduce Your Salt and Sodium Intake
Too much sodium increases blood pressure and can lead to water retention and kidney problems. Find ways to cut your sodium intake, such as including more whole foods and less packaged/processed foods in your diet.
Other tips to reduce sodium intake:
• 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, such as canned vegetables and soups.
• Make restaurant-style foods at home, such as your favorite Chinese take-out or pasta dishes. It’s alarming how high in sodium certain restaurant foods are.
• Replace salty junk foods that offer the crunch you crave, like potato chips, with healthier options, such as unsalted nuts, plain popcorn, or carrots.
• Read nutrition labels to find out which foods are hiding high amounts of sodium per serving. Some top offenders include: frozen dinners, pizza, deli meats, bread, soups, poultry, and cheese.