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A dangerous duo: Diabetes and heart disease

Many people with diabetes are unaware of the increased dangers they face from heart disease. But minding the "ABCs of diabetes" can help keep heart disease at bay.

Diabetes can affect the entire body, putting people at risk for complications all the way from their eyes down to their feet. But all too often, people who have diabetes don't recognize one of the most serious potential complications—heart disease.

People with diabetes are two to four times more likely to die of heart disease and one and a half times more likely to have a stroke, according to the American Diabetes Association (ADA). What's more, many people with diabetes are unaware of their increased cardiovascular disease risk.

"It is much more likely that [someone who has diabetes] will be disabled as the result of heart disease or stroke than disabled because of blindness or an amputation or the need for dialysis," says John B. Buse, MD, PhD, a past president of the ADA.

Learning your ABCs

"Diabetes and cardiovascular disease are sort of two sides to the same coin," says Dr. Buse, an endocrinologist who specializes in diabetes treatment.

Just as a high percentage of people with diabetes have heart disease, a high percentage of people who have heart disease have diabetes. And many factors can lead to or worsen both diseases.

That's where the ADA's "ABCs of diabetes" comes in. Each letter stands for a healthy reminder:

A is for the A1C test, which measures a person's average blood sugar over the past three months. It should be less than 7 and needs to be checked at least twice a year.

B is for blood pressure. Both diabetes and high blood pressure increase the risk of heart attack, stroke, and eye and kidney disease, according to the ADA. This makes blood pressure control especially important for people who have diabetes. Work with your healthcare provider to keep track of your blood pressure and make sure it's in a healthy range.

C is for cholesterol, especially the bad cholesterol, or LDL (low-density lipoprotein). Generally, the lower your LDL the better. Your cholesterol needs to be checked at least every five years.

Managing these factors helps keep your heart and blood vessels healthy despite diabetes.

Living your ABCs

To meet your ABC recommendations, you might want to enlist the help of a couple more letters from the diabetes alphabet.

"Some people have suggested there should be a 'D' and 'E' for diet and exercise," Dr. Buse says. "Diet and exercise are the cornerstones of therapy."

When it comes to diet, start by eating more fiber. Choose whole grains, fruits, vegetables and beans. Eat less fat and salt.

When it comes to exercise, try to get a little each day.

"What we'd like people to do is engage in moderate physical activity, such as a brisk walk, for at least 30 minutes for at least five days a week," Dr. Buse says.

Other ways to meet your ABC recommendations include:

  • Stay at a healthy weight. If you're overweight, set an initial goal of dropping 5 to 10 percent of your body weight.
  • If you smoke, stop. Your doctor can suggest strategies to help.
  • Talk to your doctor about taking a daily aspirin.
  • Keep up with all of your prescription medications.

For people with diabetes, medications often include a cholesterol-lowering statin drug. The ADA recommends that all people who have diabetes take a statin.

"Since basically everybody with diabetes can die of a heart attack, you can make the argument that everybody should be on a statin," Dr. Buse says. It's "not so much whether they should be on it, but when."

As easy as ABC

With all the pills, injections and monitoring procedures, controlling just the blood sugar aspect of diabetes can be incredibly complicated, Dr. Buse says. And when you add the changes needed to help prevent heart disease, it may seem overwhelming.

But just as saying your ABCs became easier with a little practice when you were a child, managing your diabetes will become easier with a bit of time and your doctor's help.

The healthy changes you need to make as an adult are relatively simple, Dr. Buse says. Your doctor can help you find "multiple, easy ways to lower the risk of heart attack or stroke."

reviewed 7/8/2019

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