|
9 Ways to Protect Your Heart When Diabetes Threatens It: diabetes and heart disease often go hand in hand. Here's how you can uncouple them.
Harvard Heart Letter
April 2007
Diabetes and heart disease were once thought to be entirely unrelated
disorders. New thinking suggests that they may actually spring from the same
underlying cause — chronic, systemwide inflammation — or at least be influenced
by it. This intertwining is a bad thing, since developing diabetes usually means
developing heart disease as well. It also has a silver lining: Protecting
yourself against one of these chronic conditions works against the other,
too.
More than one million Americans are diagnosed with type 2 diabetes each year.
Traditionally, up to 80% of people with diabetes develop some form of
cardiovascular disease, from heart attack and stroke to peripheral artery
disease and heart failure.
The connection between the two diseases isn’t ironclad. The American Heart
Association and the American Diabetes Association have joined forces to fight
both heart disease and diabetes. Their latest effort focuses on helping people
with diabetes whose hearts seem healthy keep them that way.
As you scan the table below, notice that almost every recommendation is good
for diabetes as well as heart disease. The complete guidelines are available at
health.harvard.edu/112.
|
Strategy
|
Goal
|
Getting there
|
|
Know your risk
|
Knowledge is power. Calculate your risk of heart disease, or ask your doctor
to do it.
|
The Framingham calculator is a general heart disease–risk estimator. Specific
ones for people with diabetes have been developed by two diabetes groups. All
are available online at health.harvard.edu/113.
|
|
Exercise
|
Aim for at least 150 minutes a week of moderate exercise (like walking) or 90
minutes of vigorous exercise.
|
If you do just one thing on this list, choose exercise. It is a key to
controlling blood sugar, strengthens the heart and lungs, improves blood
pressure, corrects out-of-whack cholesterol, and has other beneficial
effects.
|
|
Weight
|
If your weight is in the healthy range, work to keep it there. If you are
overweight, try to lose 5%–7% of your weight over the next 12 months. (That’s
about a pound a month for someone weighing 200 pounds.)
|
Cutting out just one 12-ounce can of sugared soda a day (150 calories) is
enough to help you lose a pound a month. You can easily double that by burning
more calories with exercise.
|
|
Diet
|
-
Cut back on unhealthy fats: Lower saturated fat to under 7% of calories
(about 17 grams), and keep trans fat intake as close to zero as possible.
-
Add more unsaturated fats from fish, grains, and vegetable oils.
-
Include at least 30 grams of fiber a day.
-
Watch the salt — reduce your intake to under 2,500 milligrams a day.
-
Choose whole grains and other slowly digested
carbohydrates.
|
The foods you eat can help you control blood sugar and protect your arteries.
The main strategy is to get more fruits, vegetables, beans, whole grains, fish,
and vegetable oils (especially olive oil), and less fast food, salty or fried
food, and rapidly digested carbohydrates. There is no one-size-fits-all
“diabetes diet.” The American Diabetes Association released a comprehensive set
of nutrition recommendations in January 2007 (get them at health.harvard.edu/113). But rather
than trying to wade through these, ask your doctor to refer you to a
nutritionist.
|
|
Blood pressure
|
A healthy blood pressure is 120/80 or below. If you have high blood pressure,
aim for a systolic pressure of 130 or lower and a diastolic pressure of 80 or
lower.
|
Measure your blood pressure often; home monitors are a good investment. If it
is above the goal, try exercise, the DASH diet, and, if needed, weight loss,
smoking cessation, or medications.
|
|
Cholesterol
|
Aim for these levels:
|
A healthful diet and exercise can do a lot to reverse risky lipid levels. A
cholesterol-lowering statin can help protect against heart attack and stroke
even when LDL levels are near the recommended goal. Niacin or a fibrate can
improve HDL and triglyceride levels.
|
|
Smoking
|
If you smoke, try to stop. Avoid secondhand smoke whenever possible.
|
The most effective quitting strategy includes talk therapy plus nicotine
replacement therapy along with drugs such as bupropion (generic, Wellbutrin,
Zyban) or varenicline (Chantix).
|
|
Blood sugar control
|
Aim for hemoglobin A1c to be at least under 7% and, ideally, as close to 6%
as possible without causing bouts of low blood sugar.
|
Managing carbohydrate intake and switching to whole grains can help ease the
blood sugar roller coaster. Exercise is vitally important. Use medications such
as metformin, thiazolidinediones, and insulin as needed.
|
|
Antiplatelet agents
|
Take a low-dose aspirin (75–162 milligrams) every day unless your doctor
tells you not to.
|
Aspirin prevents platelets from latching onto each other, an early step in
clot formation. Preventing clots helps prevent heart attack and stroke.
|
|
