You Can Prevent a Heart Attack or Stroke
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.
- Chest discomfort
- Pain in the arms, back, neck, jaw, or stomach
- Shortness of breath
- 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.
"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.
"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."
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
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.
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.
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.
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!