Heart disease is the second leading cause of death in Canada. Having diabetes increases your risk of heart disease, but there are steps everyone can take to lower their risk.
People living with diabetes are more likely to develop coronary artery disease, the most common type of heart disease. This happens when the blood vessels that carry blood to the heart become narrow or blocked, reducing blood flow. If blood vessels leading to the brain become blocked, it can cause a stroke.
High blood sugar is one risk factor for heart attack and stroke. Other factors include high blood pressure, high cholesterol, unhealthy eating habits, and not getting enough physical activity. Smoking, high stress, and a family history of heart disease can also increase risk.
High blood pressure (hypertension)
Blood pressure is a measure of how hard your blood pushes against the walls of your blood vessels. When blood pressure is high, your heart has to work harder to move blood through your body.
High blood pressure can damage the heart, brain, kidneys, and eyes over time. People with diabetes are more likely to have high blood pressure especially when blood sugar is high over time. They are also at higher risk of heart disease and stroke, and these conditions may happen at a younger age than in people without diabetes.
For most people with diabetes, the blood pressure target is 130/80 mm Hg or lower. The top number (systolic) measures the pressure when the heart pumps blood. The bottom number (diastolic) measures the pressure when the heart relaxes between beats.
High blood pressure often has no symptoms. You may have it and not know it. If you have diabetes, ask your healthcare team to check your blood pressure at every visit.
High cholesterol
Adults with diabetes should have their cholesterol checked every year, unless their healthcare provider recommends a different schedule. People who take cholesterol-lowering medication may need checking more often. Talk with your healthcare team about your results and what they mean for you.
Cholesterol is a type of fat found in your blood. There are two main types:
- LDL (low-density lipoprotein) is often called “bad” cholesterol because high levels can increase the risk of heart disease. For many people with diabetes, the LDL target is 2.0 mmol/L or lower, or as recommended by their healthcare provider.
- HDL (high-density lipoprotein) is often called “good” cholesterol because higher levels can help protect against heart disease.
A blood lipid panel also measures triglycerides, another type of fat in the blood. Triglycerides can be high when the body converts extra calories from foods, sugary drinks, or alcohol into fat.
Many people with diabetes take a medication called a statin to help lower LDL (bad) cholesterol. Other medications may be used to lower triglycerides or improve cholesterol levels.
Some people with diabetes may benefit from taking a low-dose Aspirin. Talk with your healthcare provider before you start to find out if Aspirin is right for you and what dose is safe. If Aspirin is not suitable for you, other options may be available.
Reducing risk
The good news is that people with diabetes can lower their risk of heart disease and stroke by focusing on lifestyle factors that can make a big difference. Sometimes lifestyle changes might not be enough, and your healthcare provider may prescribe medication to help reduce your risk.
The ABCDEs of diabetes management
Ask your doctor about the ABCDEs to reduce your risk of heart attack and stroke:
A – A1C—Most people should aim for an A1C of 7% (seven per cent) * or less by managing blood sugars well. A1C is a blood test that measures your average blood sugar level over the past 3 months. Your A1C should be measured every three to six months.
B – Blood pressure—Your blood pressure should be less than 130/80* mmHg. Your healthcare provider should take your blood pressure at every diabetes-related visit.
C – Cholesterol—TThe LDL (bad) cholesterol target is less than 2.0* mmol/L. Your blood cholesterol levels (lipids) should be measured every year (more often if you are on cholesterol-lowering medications).
D – Drugs to protect your heart—Speak with your health-care team about medication to protect against heart attack and stroke, such as blood pressure pills (ACE inhibitors or ARBs), cholesterol-lowering pills (statins), Aspirin, Clopidogrel and others.
E – Exercise & Eating—Regular physical activity and a healthy eating pattern. Move your body in ways that make you feel good and try to reduce salt and saturated fat in your regular meals and snacks.
S – Screening for complications—Ask your health-care team about tests for your heart, feet, kidneys, and eyes.
S – Smoking cessation—Stop smoking or seek help to quit.
S – Self management, stress, and other barriers—Set goals for yourself to reach your targets and live well with diabetes, such as managing stress effectively.
*Discuss your target values with your healthcare team. Note that individual targets may vary. Speak with your healthcare provider to find out your targets.
Keep tabs on your health
Working with your health-care team to meet personal goals is the key to good diabetes management. Know your test results and ask questions about what medication, healthy eating pattern and physical activity might be best for you.