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Heart Disease and Stroke
People with diabetes are at very high risk of heart disease, also known as cardiovascular disease (CVD) and stroke (cerebrovascular disease). In fact, up to 80% of people with diabetes will die as a result of a heart attack or stroke. In addition, people with diabetes may develop heart disease 10 to 12 years earlier than individuals without diabetes, and die from these events at rates much higher than people without diabetes (3 times higher for men and 5 times higher for women).
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 affected, the result can be a stroke.
High blood glucose is one risk factor for these complications, but people with diabetes often have a number of other risk factors. These include being overweight (especially in the abdomen), 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.
Reducing risk
Protect your heart with our cardiovascular risk self-assessment tool
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 healthcare 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.
Blood glucose target:
A1C of 7.0% or below (A1C is a blood test that is an index of your average blood glucose level over the preceding 120 days)
Blood pressure target:
Below 130/80 mm Hg
LDL (“bad”) cholesterol target:
less than 2.0 mmol/L or lower
Total cholesterol to HDL (“good”) cholesterol ratio: below 4.0
Controlling high blood glucose: Most patients with type 2 diabetes will require at least 1 or 2 medications (pills and or/insulin) to achieve recommended blood glucose targets. Diabetes is a progressive disease, so frequently increased doses and additional medications will likely be needed over time.
Controlling high blood pressure: In addition to the general healthy lifestyle advice above, it may also help to limit intake of salt and alcohol. Many patients will be prescribed medications (i.e. an ACE inhibitor or an ARB) which not only lower blood pressure, but also offer protection against CVD. Again, frequently 2 or 3 blood pressure-lowering drugs are required.
Lowering high cholesterol: Most 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 and stable CVD. 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 clopidrogel will sometimes be used.
Quit smoking. 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 healthcare 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 3 months to monitor your blood glucose control.
- Your blood lipid (fat) levels should be measured at least every 1 to 3 years (and possibly more often if you are on medications).
- Ask your doctor for all of your test results and work closely with him or her to achieve the targets shown above.
- 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.