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9 ways to protect your heart when diabetes threatens it

Diabetes and heart disease were once thought to be entirely unrelated disorders. New thinking suggests that they may actually spring from the same underlying cause — chronic, systemwide inflammation — or at least be influenced by it. This intertwining is a bad thing, since developing diabetes usually means developing heart disease as well. It also has a silver lining: Protecting yourself against one of these chronic conditions works against the other, too.

More than one million Americans are diagnosed with type 2 diabetes each year. Traditionally, up to 80% of people with diabetes develop some form of cardiovascular disease, from heart attack and stroke to peripheral artery disease and heart failure.

The connection between the two diseases isn’t ironclad. The American Heart Association and the American Diabetes Association have joined forces to fight both heart disease and diabetes. Their latest effort focuses on helping people with diabetes whose hearts seem healthy keep them that way.

As you scan the table below, notice that almost every recommendation is good for diabetes as well as heart disease. The complete guidelines are available at health.harvard.edu/112.

Strategy

Goal

Getting there

Know your risk

Knowledge is power. Calculate your risk of heart disease, or ask your doctor to do it.

The Framingham calculator is a general heart disease–risk estimator. Specific ones for people with diabetes have been developed by two diabetes groups. All are available online at health.harvard.edu/113.

Exercise

Aim for at least 150 minutes a week of moderate exercise (like walking) or 90 minutes of vigorous exercise.

If you do just one thing on this list, choose exercise. It is a key to controlling blood sugar, strengthens the heart and lungs, improves blood pressure, corrects out-of-whack cholesterol, and has other beneficial effects.

Weight

If your weight is in the healthy range, work to keep it there. If you are overweight, try to lose 5%–7% of your weight over the next 12 months.

Cutting out just one 12-ounce can of sugared soda a day (150 calories) is enough to help you lose a pound a month.

Diet

  • Cut back on unhealthy fats: Lower saturated fat and keep trans fat intake as close to zero as possible.
  • Add more unsaturated fats from fish, grains, and vegetable oils.
  • Include at least 30 grams of fiber a day.
  • Watch the salt — reduce your intake to under 2,500 milligrams a day.
  • Choose whole grains and other slowly digested carbohydrates.

The foods you eat can help you control blood sugar and protect your arteries. The main strategy is to get more fruits, vegetables, beans, whole grains, fish, and vegetable oils (especially olive oil), and less fast food, salty or fried food, and rapidly digested carbohydrates.

Blood pressure

A healthy blood pressure is 120/80 or below. If you have high blood pressure, aim for a systolic pressure of 130 or lower and a diastolic pressure of 80 or lower.

Measure your blood pressure often; home monitors are a good investment.

Cholesterol

Aim for these levels:

  • LDL under 100 mg/dL
  • HDL above 40 mg/dL
  • Triglycerides under 150 mg/dL.

A healthful diet and exercise can do a lot to reverse risky lipid levels. A cholesterol-lowering statin can help protect against heart attack and stroke even when LDL levels are near the recommended goal. Niacin or a fibrate can improve HDL and triglyceride levels.

Smoking

If you smoke, try to stop. Avoid secondhand smoke whenever possible.

The most effective quitting strategy includes talk therapy plus nicotine replacement therapy along with drugs such as bupropion (generic, Wellbutrin, Zyban) or varenicline (Chantix).

Blood sugar control

Aim for hemoglobin A1c to be at least under 7% and, ideally, as close to 6% as possible without causing bouts of low blood sugar.

Managing carbohydrate intake and switching to whole grains can help ease the blood sugar roller coaster. Exercise is vitally important. Use medications such as metformin, thiazolidinediones, and insulin as needed.

Antiplatelet agents

Take a low-dose aspirin (75–162 milligrams) every day unless your doctor tells you not to.

Aspirin prevents platelets from latching onto each other, an early step in clot formation. Preventing clots helps prevent heart attack and stroke.

 

May 2007 update

Create an exercise or fitness plan you can live with
Click to enlarge

Exercise: A Program You Can Live With

Not sure how to start an exercise regimen? Exercise: A Program You Can Live With will help guide you through starting and maintaining an exercise program that suits your abilities and lifestyle. You’ll find answers to your questions on how much and what kind of physical activity you need, as well as advice on fitness products currently in the marketplace. Read more

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