A strong link between diabetes and heart disease is now well established. Women with diabetes have an even greater risk of heart disease compared with those of similar age who do not have diabetes. In fact, cardiovascular disease leading to heart attack or stroke is by far the leading cause of death in both men and women with diabetes. Another major component of cardiovascular disease is poor circulation in the legs, which contributes to a greatly increased risk of foot ulcers and amputations.

If you have diabetes, heart disease can be a serious concern. In fact, cardiovascular disease leading to heart attack or stroke is by far the leading cause of death in both men and women with diabetes, says Dr. Ganda, a board-certified specialist in Internal Medicine, Endocrinology and Metabolism and a professor of medicine at Harvard Medical School.

"The good news is that there are steps to take to reduce your risk for heart disease if you have diabetes." 

Om Ganda, MD
Medical Director of the Lipid Clinic
  1. Control your weight. One of the most important things you can do if you have diabetes is maintain a healthy weight. Pay special attention to excess weight found “around the waist area,” as it can make you more insulin-resistant. Insulin resistance can make you more susceptible to heart disease. If you are overweight, talk to a registered dietitian about healthy ways to lose weight.
  2. Get regular physical activity. There is a significant body of research that proves the myriad cardiovascular benefits of regular physical activity (that goes beyond weight loss). Start off slowly, and build a plan that works well for you and meets your needs. Regular physical activity makes your heart stronger, enabling it to pump more blood with less effort. Less effort means the force on your arteries decreases. By becoming more active, the systolic blood pressure – the top number in a blood pressure reading – can be lowered an average of 4 to 9 millimeters of mercury. Even if your blood pressure is normal, routine physical activity can help it from rising as you age. Joslin offers one-on-one consultations with clinical exercise physiologists that are covered by many insurance providers. These sessions are considered diabetes education—not training sessions—and can start you on the path toward physical fitness.
  3. Don’t smoke. If you already do, make plans to begin a smoking cessation program. "Nicotine narrows and restricts blood vessels; diabetes will also do the same thing to your blood vessels. You can't change having diabetes, but you can stop damage caused by nicotine," says Dr. Ganda.
  4. Maintain optimal control over glucose. Tight control can prevent many complications from diabetes and also protects your heart. Aim for an A1C average close to 7%, without risking hypoglycemia (low blood glucose). Seniors may have a more relaxed AIC goal.
  5. Lower your LDL cholesterol (the "bad" type). Both the American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal of less than 100 mg/dl. Dr. Ganda recommends eating fiber-rich foods, such as fruits, vegetables, steel cut oats, and whole grains. Statin drugs are often necessary in people with diabetes to achieve this goal. High triglycerides (another type of fat in blood), can often be managed by glucose control, regular exercise, and modifying what you eat. Routine use of omega-3 fatty acids (fish oil) supplements is not necessary, according to current guidelines. It is best to add at least 2 servings (3.5 oz. each) of fatty fish per week (these include albacore tuna, salmon, mackerel, herring, lake trout, and sardines in sardine oil) to achieve the need for omega-3 fats. 
  1. Control your blood pressure. All people with diabetes should aim for a blood pressure reading of less than 130/80, advises Dr. Ganda. Limit your daily sodium (salt) intake to <2,300 mg. Too much sodium causes the blood vessels to constrict, which can drive up blood pressure. 
  1. Aspirin. Aspirin for the prevention of heart disease is a complicated subject and should be addressed with your doctor, who will base his/her decision on your age and your personal medical history. In the event that aspirin is indicated, the recommended dose for cardiovascular disease reduction is 75 to 162 mg daily. Taking a daily multivitamin (avoid megadoses) may also be beneficial to those with diabetes. 

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