Note: November is annual National Diabetes Awareness Month, and I’ve chosen the topic of heart health for my ‘soap box’ this year.
Last month I was invited, along with a handful of other online diabetes advocates, to visit the Dallas headquarters of the American Heart Association, the national nonprofit organization championing cardiac health. Of course were there to talk about heart disease – in particular, to brainstorm how to get millions of diabetics around the country to pay attention to their own elevated risk of having a heart attack or stroke.
Our session started with a simple statement on a white board: “Heart disease is one of the biggest – yet least discussed – health threats to people living with type 2 diabetes.” Our 10-person task force spent the better part of a day digging into this issue. I learned a lot, about both our risks and how they’re overshadowed by the realities of living with diabetes.
Did You Know…
First off, I was jarred to learn that cardiovascular (CVD, or heart) disease is actually the No. 1 killer of people with type 2 diabetes in this country. Heart attack and stroke are actually a bigger risk than all the other damaging consequences of diabetes put together, including blindness, kidney disease, amputations, etc.
To be precise, approximately 21 million Americans live with diabetes, and 90 to 95 percent of those are type 2. Among that group, at least 65% of deaths are due to CVD, such as heart attack or stroke.
This is bad news indeed – and by the way, smoking doubles your chance of developing heart disease and multiplies your chances of having a heart attack or stroke by two to four times.
Why We’re Not Paying Attention
So if we’re at such high risk, why is it that people with diabetes don’t think much about heart health?
Here are the main reasons we came up with:
1) Diabetes is overwhelming – both in the things you’re asked to do and the many risks/threats you hear about
2) Our day-to-day lives with diabetes are all about managing our glucose levels in a delicate balancing act between our food, exercise, and medications
3) When we think complications, we always think blindness, amputations, and dialysis
4) Doctors treating diabetes generally only talk about glucose control, not about heart health or heart risk (closely related to No. 3, above)
5) People don’t generally know their blood pressure and cholesterol numbers – and often don’t think they need to
Also, there tends to be a mentality of “it won’t happen to me…,” especially if you’re making an effort to otherwise “take care of your diabetes.” But the fact is that someone with a low A1C (average glucose level, indicating good diabetes control) can still be at very high risk for heart disease if their blood pressure and cholesterol levels are creeping up.
What We Can Do About It
At this point in the day, our white board was becoming quite crowded with unpleasant notes. But happily, there was good news too, which is that there are quite a few things you can do to improve your heart health, and each of them is equally beneficial for your diabetes and your overall well-being.
Not surprisingly, the actions to take fall into four familiar categories: Regular Screening, Food, Activity, and Medications. With an eye towards heart health, here are the details:
• Regular Screening
If you haven’t had your blood pressure and cholesterol levels checked recently, start now. It’s important to understand the numbers, and what you can do about them. Healthy blood pressure*, measured with an arm-cuff test, should be 130/80 or lower.
Your cholesterol is measured by a group of three blood tests: LDL (‘bad cholesterol’), HDL (‘good cholesterol’) and triglycerides, another type of fat in the bloodstream. Healthy results* for these tests are: LDL of 80 mg/dL or less, HDL of 45 or more, and triglyceride of under 150.
For a good tutorial on how to bring your numbers into range, allow me to recommend the book I co-authored with a doctor last year, titled “Know Your Numbers, Outlive Your Diabetes.”
You need to learn a little about the types of fat in your diet.
Good fats can both lower your LDL and increase your HDL. These are the monounsaturated or polyunsaturated fats found in fish, nuts, and some vegetables. Olive oil and canola oil are examples of good fats. Bad fats are the saturated fats found primarily in red meats and dairy products. Instead of these, opt for chicken, turkey, soy products, skim milk, and hard cheeses — rather than soft, high-fat varieties. The extremely bad fats are trans fats. Fat that has been “partially hydrogenated” has a worse effect on your cholesterol and heart health than any other kind.
One thing we noted is that people with diabetes are often so pre-occupied with low-carb foods to keep glucose levels down that they forget the importance of eating heart-healthy foods that are low in fat.
In fact, nature’s most effective method for heart health is exercise!
Clinical research shows that a moderate level of physical activity (several hours a week) can decrease the risk of a heart attack by over 50%. But you do have to do something that raises your heart rate to achieve this. Since your heart is a muscle, aerobic exercise can improve your heart’s strength, in a similar fashion to the way weight-lifting makes your biceps stronger.
For those who haven’t been active in the past, we encourage you to start simple by trying to walk more, take the stairs more often, or find some kind of exercise class or club you can visit several times a week.
If lifestyle changes aren’t enough to move the needle for you, there are an increasing number of medications available to help. These include statins for lowering cholesterol and ACE’s (Angiotensin Converting Enzyme inhibitors) and ARB’s (Angiotensin Receptor Blockers) for bringing down high blood pressure.
A recent Kaiser study showed that giving PWDs a combination of two low-cost generic drugs, along with a daily aspirin, “can slash their risk of hospitalization for heart attack or stroke by 60%.” The study participants were given lovastatin to lower cholesterol and lisinopril to lower blood pressure.
Other clinical research has shown that for every ten-point drop in the systolic blood pressure (the top number), there was almost a 20% decrease in the chance of stroke, and a 15% decrease in the chance of heart attack!
Finally, the folks at the American Heart Association kicked around some general calls-to-action, including the idea that people newly diagnosed with diabetes should be referred to a cardiologist (heart doctor) right off the bat. Who among us has ever seen one, unless we’ve already had a heart attack?
I know that trying to “live healthier” is much easier said than done. But I personally am over 40 and have a history of heart disease in my family. So I’m doing what I can to spread the word about getting active on your heart health before it acts up on you.
For more information on this AHA campaign, or to share your own story, please visit www.Iknowdiabetes.org.
* target test results in accordance with the current recommendation of the American Diabetes Association and other national organizations.