Diabetes and Heart Disease

By Alan Peterson, M.D.

Cardiovascular disease is responsible for 65% of deaths in persons with Type 2 diabetes.  However, awareness of cardiovascular disease risk factors among patients with diabetes remains low, resulting in missed opportunities to lower risks for coronary events (heart attacks) and strokes.  The National Diabetes Education Program has begun a campaign to increase patient participation in risk-reduction practices by promoting a “ABC’s” of diabetes care: 

• A.     A1c level
• B.      Blood pressure
• C.     Cholesterol level      

By increasing patient awareness of the link between diabetes and heart disease, family physicians can encourage patients to take medications (including aspirin where appropriate), stop smoking, lower blood pressure, and lower cholesterol and blood glucose (sugar) levels.

Seventeen million Americans have diabetes.  Eighty percent of patients are treated by primary care physicians.  Unfortunately diabetes is becoming even more common.  Between 1990 and 1998, the age-adjusted prevalence rose by 33%.  Currently 20% of person’s age 65 and older have Type 2 diabetes.

If you have diabetes, you have a high risk for having a heart attack or a stroke.  You are more likely to get heart disease and at a younger age than someone without diabetes.  There are things that you can do to reduce your risk for heart disease.  Learning about the ABC’s of diabetes can help you control your condition and stay healthy.

“A” stands for the hemoglobin A1c test.  This test measures your blood sugar over the past two to three months in one blood test.  It is the best way to know if your blood sugar is under control.  Ask your doctor to get a hemoglobin A1c test at least two times per year.  Get the test more often if your blood sugar stays too high or if your doctor changes your treatment plan.  The A1c goal for people with diabetes is below 7 and many that are doing research in diabetes today feel that it should be in the mid 6’s. 

“B” stands for blood pressure.  High blood pressure makes your heart and blood vessels work too hard and create damage in their walls.  Your blood pressure should be taken at every visit to the doctor’s office.  The blood pressure goal for people with diabetes is below 130 for the top number, which is the systolic pressure.  The bottom, or diastolic number, should not be over 80 or average.   The combined value then should not be higher than 130/80.  Obviously, this is not easy to do in all patients.  Indeed, in some patients it is very difficult to do without causing symptoms or side effects in the person from medications.  However, this is the goal that shows the least complications from heart disease, stroke and kidney failure.  Lower than this is even better as long as one is not having significant symptoms, such as significant light-headedness.

“C” stands for cholesterol.  Bad cholesterol or low-density lipoprotein (LDL, for short) cholesterol builds up and clogs your arteries.  Ask your doctor to check your cholesterol level at least once a year.  This may need to be more often if not controlled.  The LDL cholesterol goal for people with diabetes is below 100 milligrams. 

• Eat less fat and salt.  Americans, in general, today are eating too much of each.
• Eat more fiber: whole grains, fruits, vegetables, nuts and beans.
• Stay at a healthy weight.  Again, discuss this with your doctor.
• If you smoke, ask your doctor to help you stop.  There are multiple medications and therapies that can be offered today.
• Take the medicines and does that your doctor prescribes for you.  Unfortunately, many of these are expensive.  Some patients need to be placed at high doses and multiple medications to reach the goals previously described.
• Ask your doctor if you should take an aspirin every day.  Some patients should not take this because of past or present medical problems or because of other medications they are taking.

If one follows the suggestions in this article and has diabetes, you can truly reduce your risk of cardiovascular complications and enjoy a longer, happier life with less long-term discomfort (and fewer hospital visits) from your diabetes.

Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.