4 Ways to Save Your Heart
Let's get this out of the way at the start: People with diabetes have a higher-than-average risk of cardiovascular disease, such as heart attack and stroke. Now let's move on to what you can do about it. According to the American Diabetes Association Position Statement "Standards of Medical Care in Diabetes 2008," there are four crucial steps you can take to reduce your risk.
1. Take Aspirin
One of the main jobs of the platelets in your blood is to form clots. This is good when you cut yourself, but not so good if a clot forms in an unhealthy, narrowed blood vessel. That's because it will plug up what space is left, causing a heart attack or stroke. People with diabetes have sticky platelets that form clots too easily. Aspirin makes platelets less sticky. The evidence that aspirin therapy is useful is backed up by more than a hundred studies, and yet less than half of people who could and should be are taking aspirin.
Who Should Take Aspirin
If you have a history of cardiovascular disease (CVD), take 75–162 mg of aspirin a day. A "history of CVD" includes a heart attack, a stroke, a mini-stroke (TIA), angioplasty, angina (chest pain due to coronary artery disease), peripheral vascular disease, peripheral arterial disease, or a history of vascular surgery. Aspirin reduces your risk of another CVD event.
One Thing You Can Do Today: Buy a Bottle
Buy a bottle of low-dose aspirin and take your first tablet.
- One low-dose aspirin per day will cost you about $15 for an entire year.
- Call your doctor's office if you're not sure whether it's okay for you to take aspirin.
- You'll see 81-mg aspirin labeled "low dose," "low strength," "regimen," or "baby aspirin."
If you don't have a personal history of CVD, your doctor may recommend aspirin if you're at higher risk for CVD because of any of these reasons:
- You're over 40
- You have a family history of CVD
- You have high blood pressure
- You smoke
- You have unhealthy cholesterol levels
- You have early signs of kidney disease
Who Shouldn't Take Aspirin
Don't take aspirin if you have an allergy to aspirin or a bleeding tendency; are already on anticoagulant therapy; have had recent gastrointestinal bleeding; or have active liver disease. Your doctor might consider another medication that will prevent clots.
Aspirin therapy in people under 30 is not recommended, because researchers don't know if it will help. People younger than 21 should not take aspirin because of the risk of Reye's syndrome.
2. Quit Smoking
We don't have to convince you that smoking is colossally unhealthy, right? Even the tobacco companies agree.
One Thing You Can Do Today:
Go To Trial
See if there's a clinical trial in your area that includes help with quitting smoking as one of the interventions. Go to www.clinicaltrials.gov. Search for "smoking" or "smoking cessation" plus your state. For example, "smoking cessation rhode island" brings up half a dozen studies.
If you've tried to quit before, don't give up. Many people quit three or four times before being able to stay off tobacco for good.
- Stop thinking of smoking as just a habit; start thinking of it as a medical problem.
- Check out www.smokefree.gov for help in getting off tobacco.
3. Control Blood Pressure
You can get a lot of bang for your buck just by controlling your blood pressure. You lower your risk of heart attack and stroke as well as kidney disease.
Lifestyle Changes That Lower Blood Pressure
Lose some excess weight.
No matter what your starting weight, losing just 10 pounds can make a difference.
Be more active.
If you do very little exercise now, start small. Walk a half block. Walk again tomorrow. Keep it up.
Ease up on the salt.
Take the salt shaker off the table. Eat fewer processed foods.
Find ways to relax.
Even if you think you don't have time, make the time.
Don't drink too much alcohol.
The occasional glass of wine is okay, but that's it.
Do we need to say it again?
Your blood pressure should be taken at every routine office visit. It's expressed as one number "over" another number. Your doctor will look at both numbers. You want each to
meet its goal. Systolic blood pressure is the top number. You want it to be under 130 mmHg. Diastolic pressure is the bottom number. The goal is under 80 mmHg.
When to Take Action
If your blood pressure is higher than 130/80, it should be checked on another day. If either number is above its goal upon repeat testing, you have high blood pressure (hypertension).
If the top number is 130–139 mmHG, or the bottom number is 80–89 mmHg:
- Your doctor may advise you to try lifestyle changes first (see box at right).
- If your blood pressure is still not to goal, your doctor should add medication.
If your blood pressure is higher than 140/90, there's no time to waste.
- You need to be on medication, possibly more than one.
- Start lifestyle changes right away as well.
One Thing You Can Do Today:
Write Your Own Prescription
Put a sticky note marked "Rx: Relax" on your bathroom mirror. During the day, do one thing that you find relaxing.
- Sit in a quiet, comfortable spot and read.
- Go to a movie in the middle of the afternoon.
- Play Scrabble with someone who thinks using the X on a single-letter space is a pretty good move
4. Control Lipids
Your cholesterol (lipid) levels should be checked with a fasting blood test.
- The main target is LDL ("bad") cholesterol.
- The goal for most people with diabetes is an LDL of under 100 mg/dl.
- Your goal might be lower—70 mg/dl—especially if you're at very high risk for a CVD event.
ADA-Recommended Lipid Levels Low-density lipoprotein (LDL) cholesterol less than 100 mg/dl* High-density lipoprotein (HDL) cholesterol men: more than 40 mg/dl
women: more than 50 mg/dl
Triglycerides less than 150 mg/dl *In some cases, doctors recommend aiming for an LDL of less than 70 mg/dl.
One Thing You Can Do Today:Sue Robbins, RD, CDE, of Clarian Diabetes Centers in Lafayette, Ind., says that reducing saturated fat is the most important dietary change you can make. One way to do so is to stop going to fast food restaurants. "Every time you walk into a fast food restaurant, you're walking into a cage with a tiger," Robbins says.
Drive Past, Not Thru
Really, what are the chances that you're going to order a salad when the burgers and fries look so tempting? Even if you do order the salad, you know you're going to "just try" the high-fat meal your tablemate orders. A better choice is to skip the place altogether.
To Improve Your Lipid Levels
- Eat less saturated fat, trans fat, and cholesterol.
- Lose some excess weight.
- Be more active.
- Take medication. A statin drug is best for most people. (But not if you're pregnant.)Buy a bottle of low-dose aspirin and take your first tablet.
• You'll see 81-mg aspirin labeled "low dose," "low strength," "regimen," or "baby aspirin."
• One low-dose aspirin per day will cost you about $15 for an entire year.
• Call your doctor's office if you're not sure whether it's okay for you to take aspirin.
Forget all the numbers for right now. Just take a walk. If it's too cold, rainy, or dangerous outside, walk around your living room. Sitting in front of the TV? Set a goal that you'll walk through one commercial break. One walk can reduce stress.
One walk can distract you if you're craving a cigarette. Regular walking can lower blood pressure and help you maintain weight loss. Walking is something you can start doing today, without an appointment, and without special equipment. The means to keep your heart healthy is truly in your control.
Marie McCarren is the author of American Diabetes Association Guide To Insulin & Type 2 Diabetes and A Field Guide To Type 2 Diabetes.
What About Blood Glucose Control?
People with diabetes have higher-than-normal blood glucose levels, and they also have a higher risk of cardiovascular disease. Ergo, lower blood glucose and you'll lower the risk of CVD?
Maybe, maybe not. A 2007 joint statement from the ADA and the American Heart Association on cardiovascular disease says that the question of whether lowering blood glucose lowers CVD (and how low to go with blood glucose) is "one of the most hotly debated clinical questions in diabetes."
In Type 1 Diabetes
There is very good evidence that lowering average blood glucose as measured by A1C lowers the risk of the microvascular complications of diabetes (diabetic kidney and eye disease) and neuropathy. This was clearly shown in the Diabetes Control and Complications Trial (DCCT), a 10-year study of 1,441 people who had type 1 diabetes. The DCCT, which started in 1983, compared two groups of people: those on two-shot-a-day regimens who had an average A1C of about 9 percent, and people on flexible insulin plans who achieved an average A1C of just over 7 percent. The difference in the risk of microvascular complications was so dramatic that the study was stopped early.
Because the participants in the DCCT were young—13 to 39 years old on entry—there were few cardiovascular events in either group, so researchers couldn't tell by the end of the DCCT whether tight glucose control also lowers the risk of macrovascular disease, including CVD.
Researchers did a follow-up study of the DCCT participants, in a study called Epidemiology of Diabetes Interventions and Complications (EDIC). In 2005, EDIC researchers announced that the lower-A1C group from the DCCT had less than half the number of CVD events as the higher-A1C group. At the time, Saul Genuth, MD, chair of EDIC, said, "The longer we follow patients, the more we're impressed by the lasting benefits of tight glucose control. The earlier intensive therapy begins, and the longer it is maintained, the better the chances of reducing the debilitating complications of diabetes."
In Type 2 Diabetes
Many experts believe that tight glucose control will be shown to lower the risk of CVD in type 2 diabetes as well. A large body of research shows a strong connection between higher A1C levels and risk for CVD, but a cause-and-effect relationship has not yet been proven.
The ongoing Veterans Affairs Diabetes Trial (VADT) is studying the effects of tight glucose control on risk of CVD events in type 2 diabetes. More than 1,700 men and women with long-standing type 2 that has been difficult to control (average A1C: 9.4 percent) are enrolled at 20 VA medical centers across the country. All the participants have been treated to lower blood pressure and improve their lipid levels (cholesterol). All are on daily aspirin. They have been counseled on healthy diets, staying active, and quitting smoking.
The researchers want to tease out the effects of blood glucose on heart health, so they have divided the participants into two groups. Half the participants were randomly assigned to the intensive glucose control group, with A1C expected to drop to the goal of under 6.5 percent. The other half of the participants were randomly assigned to standard treatment, and their average A1C is expected to improve to about 8.5 percent.
The trial started in December 2000 and is scheduled to end in April. Researchers will see whether participants in one or the other group had more heart attacks, strokes, or amputations. Will it turn out that intensive glucose control lowers the risk of CVD enough that it's worth the time, money, and energy that it takes? Or does most of the risk reduction come from controlling blood pressure and cholesterol, taking aspirin, and quitting smoking? The VADT researchers hope to announce results at ADA's Scientific Sessions in June.