Our expert is Simeon Margolis, M.D., Ph.D.
Keep cholesterol and triglycerides on target to help safeguard your heart
Having diabetes means that your risk of developing cardiovascular disease, which can lead to a stroke or heart attack, is two to four times higher than it is for the general population. While controlling your blood sugar is essential for overall health if you have diabetes, it may have little effect on your likelihood of developing heart disease.
What will lower your risk is maintaining a healthy blood pressure (less than 140/80 mm Hg, ideally) and keeping your lipidsfatty substances in your blood such as cholesterol and triglyceridesat desirable levels. Here's what you can do to keep your levels looking good:
Hit Your Targets
Elevated levels of triglycerides and low levels of HDL ("good") cholesterol are common in people with diabetes. They, along with LDL cholesterol, lead to atherosclerosis, a buildup of plaque in the arteries that can result in heart disease and strokes. If you have diabetes, aim for an LDL cholesterol level of less than 100 mg/dL. Aim for LDL cholesterol levels as low as 70 mg/dL if you have additional risk factors for heart disease, such as high blood pressure.
Triglycerides should be below 150 mg/dL. If yours are very highover 500 mg/dLgetting them to that level may not be realistic; instead, your goal should be to lower them as much as possible to prevent an attach of pancreatitis (an inflammation of the pancreas that can cause pain in the upper abdomen).
Choose the Right Fats
Eat a diet low in saturated fats, which are primarily found in red meat and dairy products. Avoid trans fats, found in many margarines and packaged snack foods. Trans fats raise LDL cholesterol and lower HDL cholesterol. Lean meats such as turkey and low-fat or nonfat dairy products are better choices. (Maintaining a healthy weight, exercising and quitting smoking also benefit lipid levels.)
Ask about Medication
If your LDL cholesterol is over 100 mg/dL, you may be a candidate for a statin drug. Statins can decrease LDL cholesterol by 25 to 50 percent and cut the risk of heart attack and stroke. They can reduce the need for procedures such as angioplasty or coronary artery bypass surgery by 25 percent.
Your doctor may add another cholesterol-lowering agent (colesevelam, which blocks the intestinal absorption of bile acids, or ezetimibe, which blocks the absorption of cholesterol from the intestine). If your triglycerides are still above 200 mg/dL, adding a drug such as a fenofibrate can lower triglycerides by 25 to 50 percent. One study showed that adding a fenofibrate to a statin significantly reduced cardiac events in diabetes patients who had elevated levels of triglycerides and low HDL cholesterol.
Should You Take Niacin?
Many studies have shown that low HDL cholesterol is associated with an increased risk of heart attacks and strokes. HDL cholesterol levels are difficult to raise substantially through lifestyle measures such as dietary changes, weight loss and exercise. Prescription niacin (Niaspan) is sometimes added to statin treatment to raise HDL cholesterol levels. While niacin can increase HDL cholesterol levels by 20 to 30 percent, clinical trials that raised HDL cholesterol with niacin have failed to show this approach lowers the risk of heart disease. So, you might consider talking about pros and cons with your doctor if he or she prescribes niacin to raise your HDL cholesterol.
From our sister publication, Diabetes Focus Fall 2012