Cutting Cardiovascular Risks

Cardiovascular disease and diabetes often appear together. It isn’t entirely clear how the two diseases affect each other, but the most pertinent facts are clear enough.

Cutting Cardiovascular Risks

If you have diabetes, you’re two to four times more likely than the general population to have heart disease. In fact, heart attacks are what ultimately kill 80 percent of people with diabetes.

The risks are so high that, according to the American Diabetes Association (ADA), having diabetes puts you in the same danger zone as a person who has already had a heart attack-and is thus likely to have another. Heart attack is just one of several problems to watch out for when you have cardiovascular disease. Most of them come down to two basic conditions, both of which you can take steps to control.

Assessing Atherosclerosis

Cardiovascular is an umbrella term that includes both the heart (the cardio part) and the blood vessels (the vascular part). In a healthy person, a strong heart sends blood through the body via a network of smooth and elastic blood vessels. But problems arise when blood vessels become stiff, narrowed, or clogged-a condition known as atherosclerosis.

Atherosclerosis can occur in a number of ways related to diabetes. High blood sugar can slow blood circulation and promote the formation of clots. Being overweight (especially if you carry fat mostly in the abdomen) and having high levels of such blood fats as cholesterol and triglycerides (common with diabetes) can lead to obstructions in blood vessels. Depending on where they occur, these slowdowns in blood flow can trigger a number of different problems.

  • When arteries that feed the heart become obstructed, the heart can’t pump as efficiently as it should. Initially, this can cause chest pain from angina, a condition in which heart tissue is damaged from lack of nutrients. If a coronary artery becomes completely blocked, the result is a heart attack.
  • If blood flow slows down in the arteries that feed the brain, lack of oxygen can cause what’s known as cerebrovascular disease, in which areas of the brain become impaired. Often, the condition starts with temporary loss of brain function that can produce symptoms like slurred speech, weakness, and numbness. A total blockage can cause a stroke.
  • When blood flow to the arteries feeding the legs is impeded, a condition known as peripheral vascular disease develops. A partial blockage can cause temporary pain (called claudication) in the thighs, calves, or buttocks. A total blockage can cause gangrene, although this doesn’t happen often, because blood to the legs can usually bypass the clog using other arteries. Still, poor leg circulation, often combined with nerve damage, can lead to serious problems in the feet.

High Blood Pressure Havoc

High blood pressure can build up silently, just as diabetes can, and the two diseases often develop in tandem. If you have diabetes, you’re twice as likely to have high blood pressure than the average person is, and about 60 percent of people with type 2 diabetes do. Controlling high blood pressure is critical if you have diabetes because the damage it causes contributes not only to atherosclerosis but also to kidney and eye disease. All told, it has a hand in 35 to 75 percent of all complications that go along with diabetes.

You need a certain amount of blood pressure (the force that blood exerts against artery walls) for good circulation. But too much gradually weakens the heart by making it work harder and damages the lining of blood-vessel walls, making it easier for atherosclerosis to set in. High blood pressure can also weaken arteries in the brain and cause them to balloon, a condition called an aneurysm. The bursting of an aneurysm is potentially fatal.

According to the ADA, you should strive to keep your blood pressure down to at least 130/80 mm Hg if you have diabetes-and lower than that is even better.

Preventing Cardiovascular Disease

Some of the steps you’re already taking to control diabetes can also work wonders against heart and vascular problems. But you and your doctor may want to try other options as well-including drugs that attack a number of diabetes-related problems at once. Here are some of the most important steps to consider:

  • Keep up the good work. By exercising regularly and following your meal plan, you stand to lower your risk of cardiovascular complications. For example, eating more carbohydrates and fiber while consuming less saturated fat can reduce cholesterol in the blood and help you lose excess weight-a major contributor to high blood pressure. At the same time, exercise strengthens the heart, keeps blood vessels supple, and appears to lower blood pressure even if you’re not dropping pounds.
  • But go a little further. You may need to take your diet one step further by eating less salt. Over the years, researchers have debated whether salt really affects blood pressure. But one of the most conclusive studies to date-the 2001 Dietary Approaches to Stop Hypertension, or DASH II, study-showed that eating less than one teaspoon of salt a day could lower your stroke risk by 42 percent and your heart-disease risk by more than 20 percent. You can significantly cut your consumption by eating fewer processed foods and more fruits and vegetables.
  • Don’t smoke. There are plenty of reasons to give up smoking, but start with the fact that it doubles your risk of having a heart attack. In fact, smoking speeds up or exacerbates just about every process that contributes to cardiovascular disease: It reduces blood flow by making arteries stiffer and narrower, raises blood pressure, contributes to the formation of plaques that can lead to clogs, makes it easier for blood to clot around obstructions, and worsens pain from peripheral vascular disease.
  • Ask about aspirin. This anti-inflammatory has proven to be a power hitter in the battle against cardiovascular disease. In addition to relieving pain, aspirin makes the clot-forming particles in blood, called platelets, less able to stick together. As a result, taking aspirin every day can cut your risk of a heart attack by a whopping 60 percent. One recent study finds that taking one at bedtime can also reduce high blood pressure.

Check with your doctor about whether you should take low-dose aspirin (81 mg) or full-strength (325 mg)-or if aspirin is even appropriate for you. Many people find that it irritates or causes bleeding in the stomach, though taking coated tablets that dissolve in the small intestine can help you avoid these problems. Still, you should avoid aspirin if you have a stomach ulcer or liver disease. And talk to your doctor about how aspirin affects the performance of other medications you may be taking-including blood thinners and drugs for hypertension.

  • Check your ACE in the hole. You can choose from an array of drugs that fight high blood pressure, but two classes of medication appear to have special benefits for people with diabetes. ACE (angiotensin-converting enzyme) inhibitors work by blocking a process in which one hormone turns into another that constricts blood vessels. ACE inhibitors are popular for bringing down blood pressure because, compared with other blood-pressure medications, they have few side effects other than causing a persistent dry cough in a few patients. The bonus: Research shows that ACE inhibitors lower the risk of cardiovascular problems in people with diabetes even if they don’t have high blood pressure. And one study found that people taking the ACE inhibitor ramipril were 30 percent less likely to develop diabetes, suggesting that the drug improves insulin sensitivity.

The second class of drugs are called angiotensin II receptor blockers, or ARBs. They work similarly to ACE inhibitors but are less likely to cause that dry cough.

  • Seek help from statins. People with diabetes often have high cholesterol, a risk factor for heart attacks. But many of them aren’t reaping the benefit of cholesterol-lowering drugs called statins. Talk to your doctor.
  • Turn to tea. Certain foods appear to have an especially powerful protective effect against cardiovascular damage. One of these is tea, which numerous studies have linked with better heart health. In one of the most recent studies, heavy tea drinkers (who averaged two or more cups a day) had a 44 percent lower death rate after a heart attack than people who didn’t drink tea; moderate tea drinkers had a 28 percent lower death rate. Tea’s protective effect is thought to come from its bounty of flavonoids, antioxidant compounds found in both black and green tea that appear to prevent cholesterol from clogging arteries, discourage blood from clotting, and keep blood vessels supple.
  • Get your fill of fish. Another food with potent heart-protecting power is fish-or, more specifically, oils they contain known as omega-3 fatty acids. These oils can make blood less prone to clotting, lower triglyceride levels, and reduce blood-vessel inflammation, which can promote plaque buildup. In one study published in 2002, women who ate five or more servings of fish per week reduced their risk of coronary artery disease by more than a third, and their risk of having a heart attack by half over a 16-year period. Another study published at the same time found that men without heart disease who ate several servings of fish per week were 81 percent less likely to die suddenly. Fish that are particularly rich in omega-3s include cold-water varieties like salmon, trout, mackerel, and tuna.
  • Aim for antioxidants. Antioxidant nutrients like vitamins C and E counteract a process called oxidation, in which unstable molecules produced by the body’s use of oxygen damage healthy tissue. Among their benefits, antioxidants make cholesterol less likely to stick to artery walls. Vitamin C is found in such foods as citrus fruits, red and green bell peppers, broccoli, and tomatoes. You can get vitamin E in peanuts, sunflower seeds, wheat germ, and vegetable oils.

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