Blood Pressure, Cholesterol and Diabetes
If you have diabetes, you know how important it is to maintain healthy blood glucose levels. Tight control can prevent serious complications, including kidney failure, vision loss due to diabetic retinopathy and nerve damage. But you may not realize that cardiovascular disease, heart attack and stroke are actually the greatest diabetes-related threats to your health.
All too often, patients and their doctors focus so intently on blood glucose that they fail to work just as hard to lower blood pressure and cholesterol levels—measures proven to delay or prevent cardiovascular disease.
Though we don't yet know why diabetes is associated with increased cardiovascular risk, we do know that the following steps are crucial to protecting your heart.
Bring down blood pressure High blood pressure can cause damage to the walls of your arteries, leading to a buildup of cholesterol and other substances within plaques that block blood flow to the heart.
Convincing studies have shown that lowering systolic blood pressure (the higher number in a blood pressure reading, representing the pressure of the heart's ventricles contracting) to 140 mm/Hg reduces the risk of heart attack and stroke in people with diabetes.
Some of the same measures you take to bring down blood glucose are also effective for blood pressure, including 30 minutes of exercise five times per week and weight control. In addition, limiting daily sodium to 1,500 mg and, if necessary, taking a blood pressure medication, will help bring systolic blood pressure down to the target 140.
Control cholesterol Clinical trials have proven that lowering LDL (bad) cholesterol slows the development of arterial plaques, reducing the risk of heart attack and stroke (and the need for interventions such as plaque-reducing angioplasty and bypass surgery).
The most important dietary step to reduce high cholesterol is to limit saturated fat, found most abundantly in red meat and dairy products. (Lean meats such as turkey and low- or nonfat dairy products are much lower in saturated fat.) Trans fats, found in processed foods such as margarine and many packaged snacks, should be avoided altogether—they not only raise LDL cholesterol but also lower protective HDL (good) cholesterol.
For people with diabetes, lowering LDL cholesterol is so important that dietary changes may not be sufficient, in which case your doctor may prescribe a medication such as a statin.
Medications Can Help Reduce Heart Disease Risk
Ask your doctor if you're a candidate for one of these common therapies for heart disease:
- Statins can help slash LDL (bad) cholesterol by 25 to 55 percent and have also been shown to ease chronic inflammation in the arteries, a risk factor for heart disease. If your LDL cholesterol is 100 mg/dL or higher, you may be a candidate for a statin. such as Lipitor, Crestor or Zocor. (A recent review paper showed that people with diabetes who took statins reduced their risk of heart attack and stroke by 20 percent for every 39 mg/dL they lowered LDL cholesterol.)
- Fibrates are a class of drug that can help raise levels of HDL (good) cholesterol and are often used in conjunction with a statin. Fibrates, such as Tricor and Lopid, also help lower triglycerides, another blood lipid associated with heart disease.
- Blood pressure medication Because even a small increase in blood pressure is dangerous to people with diabetes, medications that lower blood pressure, such as Aceon, are often prescribed for diabetics whose blood pressure is elevated.
Written by: Simeon Margolis, M.D., Ph.D. From our sister publication, Diabetes Focus (Summer 2011)