Controlling Heart Disease Risk Factors With Diabetes

If you have diabetes or metabolic syndrome, it is very likely that you have several significant risk factors for heart disease. In addition to the endothelial dysfunction that is caused by elevated blood sugars, people with these conditions are often overweight, sedentary, hypertensive, and have elevated blood lipids. If they also smoke, their risk for developing coronary artery disease (CAD) is extraordinarily high.

• Read how diabetes and metabolic syndrome contribute to heart disease.

Special Considerations For Controlling Risk Factors In Diabetes

Whether you have problems with blood sugar or not, if you have any of the major risk factors for heart disease, you need to do whatever you can to reduce your risk.

• Read about heart disease risk factors and how to control them.

But diabetics very often have a greater burden of risk factors than non-diabetics. For the most part, this is because type II diabetes and the metabolic syndrome are both are associated with being overweight, sedentary, and hypertensive.

Controlling cardiac risk factors is important in everybody. But if you have diabetes or metabolic syndrome, there are some special considerations you need to keep in mind regarding risk factors.

Hypertension

High blood pressure is the rule rather than the exception in people with type II diabetes or metabolic syndrome. And while hypertension is an important risk factor in everybody, it is especially important in diabetes.

Cardiovascular risk is significantly improved in diabetics if the blood pressure can be reduced to below 140/90 mmHg, and most experts suggest aiming for a blood pressure below 130/80 mmHg, if that can be accomplished without producing significant side effects from blood pressure medication.

• Read about hypertension and its treatment.

Cholesterol

For any given level of LDL cholesterol, the risk of developing CAD is higher in diabetics than in non-diabetics. For this reason, most experts are today recommending that diabetics receive a statin drug, with the goal of reducing LDL cholesterol levels to below 100 mg/dL.

• Read about cholesterol and its treatment.

Smoking

While smoking tobacco is a terrible risk factor in anyone, it is especially risky for diabetics to smoke. In diabetics, smoking makes it more difficult to control blood sugar, makes diabetic kidney disease more likely, and accelerates diabetic neuropathy (a disorder of the nerves, manifested most commonly by loss of sensation in the extremities, and which often leads to foot ulcers or possibly amputation). Smoking also makes the endothelial dysfunction seen with diabetes worse, and thus accelerates atherosclerosis.

It is critical that, especially if you have diabetes, you do not smoke.

• Read about smoking and the heart.

Diabetic Kidney Disease

Diabetics who develop associated kidney disease are at a much higher risk for cardiac problems. The presence of microalbuminuria (protein in the urine) is the earliest manifestation of diabetic kidney disease, and almost doubles the subsequent risk of stroke or heart attack. The progression of diabetic kidney disease can be slowed by the treatment of hypertension and good control of blood glucose.

• Read about diabetic kidney disease.

Exercise

People with diabetes who exercise regularly have reduced cardiac risk. Those who walk for at least two hours per week (or perform equivalent physical exercise) have a significantly reduced cardiovascular mortality, compared to diabetics who are sedentary.

• Read about exercise and heart disease.

Lack of Alcohol Intake

Diabetics who consume light or moderate alcohol (up to one or two drinks per day) have been shown to have a significantly lower risk of death from CAD than those who do not drink at all. Drinking more alcohol than that, however, increases mortality rates higher than for non-drinkers. Because of this "narrow therapeutic window," and the fact that alcohol for many people is quite addictive, most doctors do not actively recommend that their non-drinking diabetic patients take up drinking.

_Sources:

_{Grundy, SM, Benjamin, IJ, Burke, GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999; 100:1134.}

_{Kannel, WB, McGee, DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59:8.}

_{Booth, GL, Kapral, MK, Fung, K, et al. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet 2006; 368:29.}