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Diabetes Special Report

Looking Out for Number One: Diabetes and Cardiovascular Disease

Many people with diabetes do not realize that their number one potential health threat is not retinopathy or neuropathy, but cardiovascular disease. Why is cardiovascular disease so common in people with diabetes? Read on …

Coronary heart disease and stroke -- the two predominant types of cardiovascular disease -- claim the lives of almost two thirds of people with diabetes. That's two to four times higher than the rate in the general population. In fact, as many as 80% of people with type 2 diabetes develop macrovascular disease, defined as narrowing and/or blockages in large arteries which can lead to angina (chest pain), heart attacks, strokes, aortic aneurysms, and peripheral arterial disease (poor blood flow to the legs and feet). In addition, nearly half of people with diabetes over age 65 develop heart failure, a life-threatening condition that occurs when the heart muscle weakens and can no longer pump enough blood to meet the body's needs.

Why is cardiovascular disease so common in people with diabetes? To begin with, people with diabetes typically have other major risk factors for heart and blood vessel trouble, such as obesity and hypertension. In addition, they also often have elevated triglycerides that can cause larger amounts of an aggressive form of low-density lipoprotein (LDL, or "bad") cholesterol -- that is, small, dense particles that are more likely to form plaques that clog arteries and cut off blood flow to the heart.

What's more, excessive insulin levels characteristic of diabetes not only raise triglycerides but also lower beneficial high-density lipoprotein (HDL) cholesterol, further promoting plaque formation. Another possible factor may be that high blood glucose levels can injure the inner artery wall. This damage could trigger a complex series of cellular changes, eventually leading to plaque deposits that reduce blood flow and can cause a heart attack or stroke. And finally, not only does diabetes promote plaque development in the artery walls, diabetes also increases the risk of blood clot formation.

Taking steps to control your blood pressure, cholesterol, and other risk factors is the first line for maintaining a healthy heart and blood vessels. The evidence is overwhelming that lowering blood pressure and cholesterol as well as quitting smoking can reduce the incidence of cardiovascular disease in those with diabetes.

The blood pressure battle. If you have diabetes, you should keep your blood pressure below 130/80 mm Hg -- that's lower than the 140/90 mm Hg or less recommended for the general population. Research shows that the best drugs to accomplish this are an ACE inhibitor or angiotensin II receptor blocker and a diuretic. Keeping your blood pressure from rising will also help ward off other diabetes complications, such as vision loss and kidney failure.

The cholesterol connection. Your doctor will want to see your LDL cholesterol at least below 100 mg/dL and possibly below 70 mg/dL. You should also try to maintain triglyceride levels below 150 mg/dL and to boost HDL cholesterol. Men should aim for an HDL cholesterol of 45 mg/dL or higher, while women benefit from 55 mg/dL and up. Statin drugs are the most effective medications for controlling total and LDL cholesterol. In fact, if you have diabetes and are over age 40, you should be taking a statin even if your LDL cholesterol levels are less than 100 mg/dL.

The action of aspirin. Anyone with diabetes over age 40 should consider taking a daily aspirin. Aspirin prevents the aggregation or clumping of disk-shaped platelets in the blood from forming clots that can block blood flow to the heart or the brain.

Glucose control. Protecting yourself against cardiovascular disease also requires keeping your blood glucose levels in balance. The American Diabetes Association (ADA) recommends maintaining HbA1c levels of less than 7%, which is equivalent to an average blood glucose level of about 170 mg/dL or less.

Posted in Diabetes on February 4, 2010

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