Heart Disease and Diabetes

Heart disease continues to be the leading cause of death in the United States for both men and women. The good news is that it is often preventable. The link between diabetes and heart disease is well established. Diabetes is recognized as a major risk factor for heart disease. Having diabetes increases your risk of heart disease two to four times. So, why is this? What about having diabetes makes heart disease more likely?

Heart disease risk factors such as high cholesterol, high blood pressure, and smoking damage blood vessels. Blood vessels of people with diabetes appear to be even more susceptible to damage from these factors. It may be that poorly controlled blood glucose over time contributes to the increased risk of damage to blood vessels.

Your best defense against heart disease is well-controlled diabetes and establishing targets of care for heart disease and diabetes.

bowl of fruits including strawberries, grapes, oranges

Blood Glucose (Sugar) Levels

A target range for fasting, after meals and hemoglobin A1C levels (3-month average blood sugar) should be established with your health care provider. When blood glucose is high, it can increase cholesterol and make controlling blood pressure harder. Low blood sugar levels can also damage the heart, especially if you already have heart disease. Your body responds to low blood glucose by increasing heart rate.

You should always determine your personal blood sugar target levels with your health care provider. The following are general recommendations from the American Diabetes Association:

Fasting Blood Glucose checked 8 hours without food: 80-130 mg/dl
After Meal Blood Glucose checked 2 hours after eating: less than 180 mg/dl
A1C checked every 3 months if uncontrolled, or every 6 months if at goal: less than 7%

Blood Pressure

Uncontrolled blood pressure damages blood vessels. This increases the risk of having a stroke, heart failure, or a heart attack. Blood pressure should be checked at every office visit. Your health-care provider may recommend a type of medication called an ACE-inhibitor or ARB to help control blood pressure. Along with controlling blood sugar, these drugs also protect your kidneys.

A blood pressure goal for most people with diabetes and no additional risk factors: less than 140/90. The goal for people with diabetes plus at least one of the following risk factors: high cholesterol, smoking, history of premature heart disease in your family, obesity, and having protein in the urine: less than 130/80 mmHg.

illustration of distressed heart disease with heart rate monitor

Weight

Risk of heart disease increases in people who are overweight or obese. Your health-care provider assesses your weight status using body mass index (BMI). BMI compares your weight with your height. Losing and maintaining a 7% weight loss can decrease the risk of heart disease, especially for those with diabetes. Your registered dietitian can help with an individualized meal plan to help you meet and maintain your weight loss goals.

Cholesterol

Cholesterol build-up in your arteries can lead to a heart attack or stroke. We hear a lot about “good” and “bad” cholesterol levels. High- density lipoprotein (HDL) is known as “good” cholesterol and low -density lipoprotein (LDL) is known as “bad” cholesterol. An easy way to remember the difference is L for “lousy” cholesterol or H for “healthy” cholesterol. Eating less animal fat and more plant-based fats will lower LDL. Regular physical activity increases HDL. To decrease the risk of heart disease the goal is LDL below 100 mg/dl and HDL above 40 mg/dl for men and 50 mg/dl for women.

Physical Activity

Regular physical activity is beneficial in managing blood sugar, weight, and decreasing heart disease risk. Both physical activity and resistance training are important. Aim for 150 minutes a week. For some, additional monitoring and medication adjustment may be necessary to maintain safe blood glucose levels. Always discuss your exercise plan with your health-care provider.