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Clinical Overview
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Diabetes, Heart Disease, and Stroke

Clinical Overview
Reviewed by Michael Fuller, MD

What are the risk factors for heart disease and stroke in people with diabetes?

Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.

You can’t change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:

  • Having central obesity. People who have central obesity carry extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that creates deposits on the inside of blood vessel walls.

  • Having abnormal blood fat (cholesterol) levels.

    – LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries, which are the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked, causing heart disease.

    – Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.

    – HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

  • Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

  • Smoking. Smoking doubles your risk of heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

    What can I do to prevent or delay heart disease and stroke?

    Even if you are at high risk for heart disease and stroke, there are things you can do to keep your heart and blood vessels healthy:

  • Make sure that your diet is “heart-healthy.” Meet with a registered dietitian to plan a diet that meets these goals:

    1) Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.

    2) Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.

    3) Keep the cholesterol in your diet below 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.

    4) Keep the amount of trans fat in your diet to a minimum. Trans fat is a type of fat that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarine have trans fat. Check for trans fat in the Nutrition Facts section on the food package.

  • Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven’t been physically active recently, see your doctor for a checkup before you start an exercise program.

  • Reach and maintain a healthy body weight. If you are overweight, begin a weight loss program. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than one to two pounds a week.

  • If you smoke, quit. Your doctor can help you find ways to quit smoking.

  • Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

  • Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.

    Last updated: Dec-19-07

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