by Julie J. Martin, MS Until recently, controlling blood glucose was considered the single most important step in treating diabetes. However, new studies indicate that, because diabetes can cause damage to the heart and blood vessels, controlling cardiovascular disease (CVD) risk factors is equally important. This is especially true for women, as diabetes has greater adverse effects on them than it does on men. For example, the risk of heart disease and blindness from diabetes is higher for women than men. Diabetes and Heart Disease Risk DiabetesMore than 18 million Americans are affected by diabetes, a serious, chronic condition associated with numerous health complications. Diabetes is easy to diagnose by testing blood glucose levels, but one-third of diabetics don't know they have the disease. Although there is no cure, early detection, appropriate treatment, education, and a healthy lifestyle can help you avoid or delay diabetes-related complications. Cardiovascular Disease (CVD)CVD is the leading cause of death in the US and the primary reason for heart attack and stroke. It is also the most common complication associated with diabetes. Diabetics are two to four times more likely than the general population to have CVD, and they experience heart attacks earlier in life. According to the American Diabetes Association (ADA), 80% of people with diabetes will develop cardiovascular disease, and 65% will die from it.
Women Are at Increased RiskWomen are at special risk, and they account for over half of people with diabetes. A recent study examined the impact of diabetes on death from all causes in women by using data from the Nurses Health Study. Established in 1976, this study followed over 120,000 registered nurses for 20 years. It concluded that women with diabetes appear to lose their usual female advantage regarding heart disease, and are more likely to have high blood pressure and high cholesterol than non-diabetic women. Controlling Risk Factors: Getting Appropriate TreatmentCoronary artery disease (a form of CVD) occurs when there is a gradual buildup of plaques in blood vessels that supply blood to your heart. Over time the plaques narrow or block the arteries, limiting blood supply to the heart. Controlling risk factors that lead to CVD, many of which are shared by diabetes, will likely improve both conditions. Blood GlucoseHigh blood glucose levels can damage your heart and blood vessels and lead to CVD. Therefore, it is important to regularly monitor and control your blood glucose levels. CholesterolCholesterol is a substance that is an important component of cell membranes as well as a building block necessary in the production of many hormones. However, abnormally high levels of cholesterol contribute to formation of fatty deposits (plaques) within the walls of blood vessels, which in turn lead to development of coronary artery disease. Cholesterol is transported through the bloodstream by high-density lipoproteins (HDL), low density lipoproteins (LDL), and very low density lipoproteins (VLDL). LDL is frequently called bad cholesterol as it promotes accumulation of cholesterol in the walls of your arteries. Diabetes tends to make the LDL particles more likely to stick to and damage artery walls. HDL cholesterol is sometimes referred to as "good" cholesterol. It helps clear excess cholesterol from your body. Its level is raised mostly by regular exercise.
A recent report by the American College of Physicians recommends that anyone with diabetes, who also has known CVD or risk factors for CVD, take medication, specifically statins, to control cholesterol, even if cholesterol levels are currently normal. Blood PressureNarrow blood vessels are one reason for high blood pressure (eg, hypertension), a condition shared by nearly three-quarters of adults with diabetes. Because high blood pressure can make some of the complications of diabetes worse, the ADA recently recommended aggressive treatment of hypertension for people with diabetes. The primary groups of medications recommended to treat high blood pressure in diabetics are angiotensin converting enzyme inhibitors (ACE-inhibitors) or angiotensin receptor blockers (ARBs) which may provide addition protection for the cardiovascular system and the kidneys beyond simply reducing the blood pressure. Controlling Risk Factors: Lifestyle ModificationsIn addition to using medication to control cholesterol, blood pressure, and blood glucose levels, modifying certain lifestyle factors is essential for reducing the complications associated with diabetes and improving your length and quality of life. Eat a Healthy DietWork with your doctor to devise an eating plan that you can follow. Include foods that are low in saturated fat and cholesterol, and high in fiber; consume salt and alcohol in moderation; choose fats that help lower cholesterol; and eat five servings of fruits and vegetables every day. A healthy diet can help manage your CVD risk by lowering your blood pressure, cholesterol, and blood glucose levels.
Another study using data from the Nurses Health Study examined dietary fat and cholesterol and the risk of CVD among women with diabetes. Between 1976 and 1996, women with diabetes were periodically sent dietary questionnaires. Analyses showed that diets higher in saturated fat and cholesterol were associated with higher risk for CVD, and that healthy fats conferred protective heart benefits. Increase Physical ActivityBeing physically active every day for 30 minutes or more will have broad health benefits. Find ways to incorporate extra movement into your daywalk briskly for 30 minutes, take the stairs instead of the elevator, or park a little farther away from your destination than usual. Start slowly and build up your strength and endurance. Being physically active can be very enjoyable, and its good for your health! Lose WeightEating a healthy diet, reducing your calorie intake, and increasing your physical activity will all help you lose weight if needed. Weight loss and increased activity can also increase your healthy HDLs. Try to Quit SmokingIf you are thinking about quitting, there are many smoking cessation programs and support groups which can help you. The benefits of quitting are both immediate and long-lasting. ConclusionEducate yourself about diabetes and how you can control it. There are many sources of information and organizations dedicated to managing and preventing this disease. Work closely with your health care team to monitor your health and help you address your individual health issues.
American Association of Diabetes Educators
American Diabetes Association
American Heart Association
National Diabetes Education Program
Canadian Cardiovascular Society
Canadian Diabetes Association
Gilbert, Susan. 2004. Looking beyond sugar to the heart . New York Times. Sunday, June 6. Special Section: Womens health.
Howard BV, Cowan LD, Go O, et al. Adverse effects of diabetes on multiple cardiovascular disease risk factors in women: the Strong Heart Study . Diabetes Care . 2004; 21 (8).
Hu FB, Stampfer MJ, Solomon CG, et al. The impact of diabetes mellitus on mortality from all causes and coronary heart disease in women. Archives of Internal Medicine. 2001; 161 (14): 1717-1723.
National Diabetes Information Clearinghouse. 2003. Prevent diabetes problems: Keep your heart and blood vessels healthy. National Institutes of Diabetes and Digestive and Kidney Diseases, September.
Tanasescu M, Cho E, Manson JE, et al. Dietary fat and cholesterol and the risk of cardiovascular disease among women with type 2 diabetes . American Journal of Clinical Nutrition. 2004; 79 (6).
Sandeep V and Haywood RA. Pharmacologic lipid-lowering therapy in type 2 diabetes mellitus. Annals of Internal Medicine. 2004; 140 (8). Websters New World Medical Dictionary. 2000. IDG Books Worldwide, Inc. Foster City, CA.Last reviewed May 2008 by Craig Clark, DO, FACC, FAHA, FASEPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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