It’s not something you want to hear or read about, but the reality is that having diabetes means that your risk of heart disease is about twice as high as people who don’t have diabetes. According to the American Diabetes Association, two out of three people who have diabetes will die from heart disease or stroke (collectively called cardiovascular disease). Other heart-related complications can occur from having diabetes, such as heart attack, heart failure and peripheral arterial disease.
As grim as this may all seem, there’s a silver lining: many of the risk factors for heart disease are changeable. In other words, you can do something about them!
What’s not changeable
Before we delve into the steps you can take to lower your risk of heart disease, let’s review the risk factors that, like it or not, you can’t do too much about:
Age: Your risk of heart disease climbs as you get older.
Sex: Men have a higher risk of heart disease than women, but women’s risk increases after menopause.
Family history: They say you can’t choose your family. If heart disease runs in yours, your risk is automatically increased.
Race or ethnicity: According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for people of most ethnicities in the United States, including African Americans, whites and Hispanics.
What’s changeable
Luckily, you don’t need to feel powerless. There’s a lot that you can do around lifestyle to get and keep your heart and blood vessels healthy, and to greatly lessen the chance of having a heart attack or stroke. Let’s take a look.
Diabetes
All of the effort you put into managing your blood glucose levels can make a big difference in your heart health. High blood glucose levels can damage blood vessels and nerves that control your heart and blood vessels.
Action step: Know your “diabetes numbers.” That means finding out your A1C, blood pressure and cholesterol levels, as well as your goals. If any of your diabetes numbers aren’t at your target, talk with your health-care team about what you can do to get there. A healthy eating plan, weight loss, physical activity and medication are all ways to meet your goals.
Blood pressure
High blood pressure, or hypertension, is a major risk factor for heart disease. High blood pressure is when the pressure of the blood in your blood vessels is too high. If not controlled, serious damage to your heart, kidneys and brain can occur, including heart attack and stroke. For many people with diabetes, the blood pressure goal is less than 140/90 mmHg. But some people may have a lower goal, such as less than 130/80 mmHg. If you’ve been told that you have high blood pressure, talk with your doctor about medication to help you control high blood pressure, as well as checking your blood pressure at home with a home monitor.
Action steps: In addition to taking medication, there are a lot of lifestyle measures that you can take to help you get your blood pressure to a safe level. Cut back on using salt and eating high sodium foods (canned foods, fast foods, salty chips). Eat more fresh vegetables and fruit. Go easy with alcohol. Try to walk or do some form of physical activity every day. Aim to lose 5 percent of your body weight if you’re overweight.
Cholesterol and triglycerides
High levels of cholesterol and triglycerides in your blood can raise your risk of heart disease. LDL cholesterol (aka “bad” cholesterol) can buildup in your arteries, so the goal is to keep this low. HDL cholesterol, or “good” cholesterol, may protect against heart disease; the higher the HDL, the better. Triglycerides, a type of fat in the blood, can also raise the risk of heart attack or stroke if levels are too high (above 150). Medical care guidelines for people who have diabetes generally recommend that those ages 40 to 75 years, as well as people who have multiple risk factors, take a medication called a statin to lower their heart disease risk. Statins are not the only drug of choice, however, so again, it’s important to discuss medication use with your doctor.
Action steps: Focus on a heart-healthy diet. That means eating less saturated fat (found in red meat and whole-milk dairy products) and switching to healthier fats, such as olive oil, canola oil, fatty fish, avocados, nuts and seeds. Boost your intake of soluble fiber, which is found in beans, oatmeal, apples, pears and broccoli. Ramp up your physical activity and stop smoking to help raise your HDL cholesterol. Losing weight, if you need to, can also help improve your cholesterol levels.
Smoking
Smoking is a leading cause of heart disease and preventable deaths in the U.S. Smoking damages blood vessels and can narrow them, raising blood pressure and the chance of a blood clot forming. Of course, smoking can cause other serious health conditions, too, including cancer, lung diseases, a weakened immune system, cataracts, and erectile dysfunction. Pretty much every organ system in the body is affected by smoking. The good news is that quitting smoking leads to benefits almost right away.
Action steps: Stopping smoking can be hard, but there are ways for you to succeed. The first step to consider is to talk with your health-care team about the best way for you to stop. Self-help programs, counseling, nicotine replacement products, and medications are options to explore. Visit the website https://smokefree.gov for more ideas and support.
Overweight and obesity
Carrying extra weight is a major risk factor for heart disease, even if you have no other risk factors. In addition, if you carry most of your weight around your abdomen (think, “apple-shaped”), your risk is higher than if you carry your weight in your hips and thighs (“pear-shaped”). How do you know? Looking in the mirror is one way. Taking your waist measurement is another. You’re at high risk if you’re a woman and your waist is 35 inches or higher, or if you’re a man and your waist is 40 inches or higher. If you’ve tried to lose weight before, only to have regained it, you might feel discouraged and that it’s not worth it to try again. Don’t give up! And don’t think that you have to get down to an unrealistic weight, either. Losing even five percent of your weight can make a big difference in your health.
Action steps: Think about what worked for you in the past in terms of weight loss. Maybe a structured program helped you, or joining a support group. Tracking your food intake using a smartphone app, clearing your cupboards of unhealthy foods, or using a tool such as the plate method are other options. Think twice about trying a fad diet or purchasing expensive and potentially harmful supplements. They can be dangerous and likely won’t lead to lasting results. Not sure what’s best for you? Ask your doctor for a referral to a registered dietitian to get you started. And for some people, prescription medication or bariatric (weight-loss) surgery might be part of the solution.
Physical inactivity
In today’s busy world, it’s often hard to find time to go for a walk or get to the gym. But the inability to make time to be active is more harmful than you might think. Being physically inactive is a major risk factor for heart disease. A study published in the journal JAMA Network Open in 2018 revealed that, of 122,000 patients, those who had reduced cardiorespiratory fitness had an increased in “all-cause mortality,” which was comparable to or greater than other major risk factors such as diabetes and smoking. Not moving enough can lead to other health conditions, such as high blood pressure, high cholesterol, diabetes and obesity; in other words, physical inactivity is like a double whammy when it comes to heart disease risk.
Action steps: If you’re not a gym rat or the thought of going for a walk outdoors bores you to tears, you might be uncertain how to be active. Fortunately, there are a lot of options! First, get the OK to do activity from your doctor. Second, think about some types of activity that appeal to you and that you are able to do — swimming, dance classes, chair exercises or using exercise videos are a few suggestions. Third, plan your strategy. If you’re not used to being active, it won’t do much good (and may even do some harm) if you jump full force into exercise. Start out slowly and go easy. And map out when you’ll do it (before walk, on your lunch break, after dinner). Finally, get started! The hardest part is the first step, but keep going — you can do it!
Want to learn more about diabetes and heart health? Read “Taking Diabetes to Heart” and “Heart Health Fact or Fiction.”
