According to the American Heart Association, a diagnosis of diabetes increases a person’s risk of heart disease more than double the general population. This means a person with diabetes has the same risk of a heart attack as someone without diabetes who has already had a heart attack. In the US, heart disease is the number one cause of death and disability for persons living with diabetes. However, it’s important to remember the person living with diabetes can lower their cardiovascular disease risk.
What is the diabetes and heart disease connection?
Persons with diabetes are encouraged to keep blood glucose levels in a healthy target range. Maximizing “time in range”, or desired glucose target range, is associated with lower diabetes complications. High glucose levels eventually damage blood vessels and the nerves associated with those blood vessels. The more time glucose levels are above the time in range, the greater the risk for complications. Additionally, the risk of heart disease is increased in the presence of other factors:
1. Hypertension / High Blood Pressure
Approximately 50% of persons living with diabetes have high blood pressure. High blood pressure is defined as >140/90 mmHg. Elevated blood pressure causes increased pressure exerted on blood vessels and the heart. High blood pressure increases the risk of heart attack, stroke, and/or kidney problems.
2. High Blood Lipids
The American Diabetes Association estimates approximately 70% of persons with diabetes have elevated blood lipids (a type of fat) levels. Blood lipids include total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. Each of these blood lipids has a unique target range. Lipid target ranges depend on age, diabetes type, pharmacologic treatment, glucose levels, non-diabetes medical conditions, and cardiovascular risk score. The ranges are determined by a healthcare provider.
Many people with diabetes are overweight. While many obese individuals feel the burden of excess weight on their joints, being overweight carries significant risk for heart disease. “Every pound of weight we put on is 5 miles of blood vessels. If your heart beats 100,000 times a day, that’s 500,000 miles a day for one pound of fat,” says Dr. Kopecky with the Mayo Clinic. Being overweight is associated with higher blood pressure, blood glucose, blood lipid levels, and other health complications.
4. Sedentary Lifestyle
The Centers for Disease Control and Prevention recommends every individual have at least 150 minutes of moderate intensity exercise every week. This translates into 30 minutes of activity at least five days a week; or 10 minutes of activity, three times a day, at least five days a week.
Cigarette smoking increases blood pressure and atherosclerosis (plaque build-up) in blood vessels. Smoking while living with diabetes increases plaque buildup in the blood arteries and vessels. The plaque buildup narrows the inside of blood vessels. Narrowing the blood vessels increases blood pressure and impacts blood circulation. Plaque can also break off from vessel walls and travel with the blood to the heart and brain triggering a heart attack or stroke.
Important actions to lower cardiovascular risk:
1.Blood Glucose Control
Keeping blood glucose in a healthy target range is an excellent start toward reducing cardiovascular risk. A certified diabetes care and education specialist can support glucose time in range by explaining the relationship between glucose and the following seven self-care behaviors from the Association of Diabetes Care and Education Specialists:
- Healthy coping
- Eating healthy
- Being active
- Taking medication(s)
- Monitoring (glucose, blood pressure, and blood lipids)
- Reducing risks
Diabetes care and education specialists recommend a meal plan that is heart healthy and carbohydrate controlled. A Mediterranean style diet or the DASH diet (Dietary Approaches to Stop Hypertension diet) are recommended by the American Diabetes Association in the 2022 Standards of Care. A diet that reduces the intake of foods high in trans fats, saturated fats, cholesterol, and sodium while increasing high fiber foods is recommended. Schedule time with a certified diabetes care and education specialist or registered dietitian to make diet modifications specific to individual needs.
2. Lose weight
While an ideal weight may be desired, a weight loss of 5% or more will make a difference in cardiovascular risk. This means a 200 pound person may only need to lose ten pounds to see cardiovascular risk benefit. More weight may be lost if desired or necessary. Additionally, weight loss supports better glucose management.
3. Get up and Move
A goal of 150 minutes a week is easily initiated by reducing time spent “sitting”. The goal is simple: move. Muscles don’t really care “what” the physical activity is, as much as the muscles move. This can be a few minutes of yard work or house-keeping or running the stairs repeatedly throughout the day. A bout of activity can be energizing and will definitely get muscles moving. Bonus: muscles use glucose long after the activity has stopped thus improving blood glucose levels for hours post activity.
4. Stop Smoking
Stopping smoking is absolutely one of the best things a person can do for their health. Additionally, smoking cessation also helps those exposed to secondhand smoke. Quitting smoking is not easy. Talk to a healthcare provider for support when you realize smoking cessation is the right thing to do.
This month we celebrate Valentine’s Day. Remember: the greatest gift you can give your Valentine is you and a healthy heart.