In addition to having an endocrinologist to help you control your blood glucose levels, many patients with diabetes could use a cardiologist looking over their shoulder. That’s because diabetes is as much a macrovascular disease as it is a microvascular one. And preventing heart disease in people with diabetes isn’t simply a matter of getting the blood glucose under control
People who have diabetes get heart disease sooner, have more extensive blockages and are more likely to have a fatal cardiac event than those without diabetes. Although controlling blood glucose is important and will lower risk, the two large population studies, The Diabetes Control and Complication Trial (DCCT) and especially the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that for people with diabetes even excellent blood glucose control alone wasn’t able to reduce the risk of cardiac events sufficiently. That is why it is so important for people with diabetes to also focus on controlling their blood pressure and lipids.
According to Dr. Martin Abrahamson chief medical officer of the Joslin Diabetes Center, “of the 26 million people in the United States with diabetes, seventy-five to eighty percent of them will ultimately die of a cardiovascular event,” but, he continues “aggressive control of glucose, lipid, and blood pressure can reduce the risk of having a major cardiac event by as much as 50 percent.”
For people with diabetes that means keeping blood pressure under 130/80 mm/Hg and lipid levels less than 100mg/dL for low density lipoprotein (LDL), less than 150mg/dL for triglycerides and above 40mg/dL for HDL. The lower the LDL and higher the HDL the better. The American Heart Association states that an HDL level of greater than 60mg/dL is protective against heart disease.
There are a slew of drugs out there to help lower blood pressure and lipid levels, but all of them work far better with the add of lifestyle factors. Physical activity and healthy eating, along with weight loss if needed, go a long way to bringing A1C, blood pressure and lipids to target. Aerobic exercise of 30 minutes at least four times a week will lower your blood pressure and cholesterol.
Exercise helps lower cholesterol indirectly by aiding with weight loss and directly by stimulating transport of LDL away from the artery walls back to the liver and increasing the size of LDL particles. Smaller LDL particles are more atherogenic. In addition, it stimulates the production of lipo-protein lipase an enzyme that digests very low density lipoprotein (VLDL) making triglyceride available for energy use by the muscle. Excess triglyceride in the bloodstream contributes to insulin resistance.
Diet is also important. Heart healthy choices such as reducing saturated fat, trans fat and excess calories along with increasing soluble fiber content can reduce LDL cholesterol by 15 to 25 points.
Taking care of your heart is as important as taking care of your diabetes and you can use many of the same tools to keep both in good shape.