People with diabetes are at very high risk of heart disease and stroke, also known as cardiovascular disease (CVD) and cerebrovascular disease.
People with diabetes may develop heart disease 10 to 15 years earlier than individuals without diabetes.
Coronary artery disease is the most common form of heart disease in diabetes. It develops when the arteries that supply the heart with blood become narrowed or blocked by fatty deposits. This process is often called “hardening of the arteries.” If the arteries that supply the brain are hardened , this may lead to a stroke.
High blood glucose (sugar) is one risk factor for heart attack or stroke, but people with diabetes often have a number of other risk factors. These include being overweight (especially if they have excess fat around the waist), inactive lifestyles, high blood pressure and high cholesterol. People who smoke or have a family history of heart disease or stroke are at even higher risk.
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The good news is that people with diabetes can lower their risk of heart disease and stroke considerably by paying careful attention to all of their risk factors. Working with your health-care team to achieve the following targets is the key to good diabetes management. Achieving and maintaining a healthy weight through regular physical activity and healthy eating are important, but most people with diabetes will also require a number of medications to reach these goals.
Do you know your ABCDEs?
Ask your doctor about the ABCDEs to REDUCE your risk of heart attack and stroke:
A – A1C – Glucose control target is usually seven per cent* or less (A1C is a blood test that is an index of your average blood glucose level over the preceding 120 days)
B – Blood pressure (BP) – Control your blood pressure (less than 130/80* mmHg)
C – Cholesterol – LDL (bad) cholesterol target is 2.0* mmol/L or less
D – Drugs to protect your heart: Blood pressure pills (ACE inhibitors or ARBs), cholesterol-lowering pills (statins), or Aspirin or Clopidogrel. Speak with your health-care team about medication to protect against heart attack and stroke.
E – Exercise – Regular physical activity, which includes healthy diet, achievement and maintenance of a healthy body weight*
S – Smoking and stress – Stop smoking and manage stress effectively
* Discuss your target values with your health-care team. Note that A1C targets for pregnant women, older adults and children 12 years of age and under are different.
Controlling high blood pressure
Most people with type 2 diabetes will require at least one or two medications (pills and or/insulin) to meet their blood glucose targets. Diabetes is a progressive life-long disease, so increased doses and additional medications will likely be needed over time.
In addition to following a healthy lifestyle, it may also help to limit intake of salt and alcohol. Many people will be prescribed medications (i.e. an ACE inhibitor or an ARB) which not only lower blood pressure, but also offer protection against heart attack and stroke. Sometimes, two or three drugs are needed to lower blood pressure.
Lowering high cholesterol
Many people with diabetes will be prescribed a drug called a statin to lower LDL (“bad”) cholesterol. Other drugs may sometimes also be used to increase HDL (“good”) cholesterol and to lower other blood fats such as triglycerides.
Low-dose aspirin therapy may be recommended for some people with diabetes. Aspirin helps prevent blood clots from forming. Aspirin is available without a prescription, but is not safe for everyone. Talk to your doctor about whether aspirin is safe for you and the dose you should take. For people who can’t take aspirin or who find it upsets their stomach, or in other specific situations, a prescription blood thinner called clopidogrel will sometimes be used.
Smoking is a deadly habit. One of the best things you can do for your heart, diabetes and overall health is to quit now. Anyone who has tried to quit knows that it can be very challenging, so ask for help. You will increase your chances of success if you have support from your health-care team and family. If at first you don’t succeed, try and try again.
Keeping tabs on your health
At every diabetes-related visit, your doctor should take your blood pressure.
You should have your A1C measured every three months to monitor your blood glucose control.
Your blood lipid (fat) levels should be measured every year and more often if you are on cholesterol-lowering medications
Ask your doctor for all of your test results and work closely with him or her to achieve your targets. Don’t be afraid to ask questions about your medications or your lifestyle changes.
The more you know about your disease and its treatments, the more you can participate in your own care.