How to Protect Your Heart If You Have Diabetes

You’ve probably heard that diabetes is a major risk factor for cardiovascular disease.

How major?

According to the American Diabetes Association (ADA), adults with diabetes are almost twice as likely to have a heart attack or stroke as those without diabetes. Regular exercise and healthy eating go a long way toward making sure your heart is in good shape. But your doctor may also recommend medication to help lower your risk.

Here’s what you need to know about the medications most often prescribed to treat several common contributors to heart disease.

Treating high blood pressure
Blood pressure is the force of blood flow inside your arteries (blood vessels). If your blood exerts too much force on those vessels, your heart has to work harder than it should, putting you at increased risk for heart attack, stroke, eye problems, and kidney disease. As many as two in three adults with diabetes have high blood pressure, also called hypertension. If you have diabetes, the ADA recommends having your blood pressure checked at every routine doctor’s visit.

Your healthcare team will use two numbers to describe your results—for instance, 120/80 mm HG. The first number—known as “systolic” pressure—refers to the pressure your blood exerts as it pushes through your blood vessels when your heart beats. The second number—“diastolic” pressure—refers to the pressure between heartbeats, when the vessels relax. For most adults the ADA recommends the following:

• If you have diabetes and are at a higher risk of cardiovascular disease, keep your blood pressure below 130/80 mm Hg if possible. 
• If you are at lower risk for cardiovascular disease, you should shoot for lower than 140/90 mmHg.
• If you are pregnant and have diabetes and pre-existing high blood pressure, it’s suggested you stay in the 110-135/85 mmHg range.

Your HCP may treat hypertension with lifestyle changes and medication. There are several kinds of blood pressure drugs, though not all of them are equally good for people with diabetes. Some raise blood glucose levels or mask some of the symptoms of low blood glucose (hypoglycemia). And you may need one or more to reach your blood pressure goals.

• ACE inhibitors. Shorthand for angiotensin-converting enzyme inhibitors, ACE inhibitors are recommended for most people who have diabetes, high blood pressure, and kidney disease. Drugs in this category—which include captopril and enalapril—work by keeping your blood vessels relaxed. Specifically, they prevent a hormone called angiotensin from forming in your body and narrowing your blood vessels.
• ARBs. Angiotensin II receptor blockers (ARBs) also lower blood pressure by keeping your blood vessels open and relaxed. Like ACE inhibitors, ARBs have been proven to slow down or even halt the progression of kidney disease by maintaining blood pressure control. The ADA recommends one of these two hypertension meds if you have diabetes and kidney disease. (You should not be on both at the same time, as it can cause kidney issues.)
• Calcium channel blockers. These medicines help the blood vessels relax by keeping calcium out of the cells of your blood vessels and heart. If you have diabetes but don’t have kidney disease and are looking to prevent cardiovascular disease, your doctor may prescribe a calcium channel blocker instead of, or in addition to, an ACE inhibitor or ARB.
• Diuretics. So-called "water pills" help rid your body of extra water and sodium through urine. That reduces the amount of fluid flowing through your arteries, which eases the pressure on them. If you’re pregnant, diuretics are not usually recommended for blood pressure control.

Lowering high cholesterol
We’ve all heard about the perils of cholesterol, a type of fat produced by your liver and found in your blood. It’s important to understand the difference between the "good" kind and the "bad."

Low-density lipoproteins—also known as LDL, or the "bad" cholesterol—can build up and clog your blood vessels. That buildup is called plaque. If you have too much LDL, you’re at greater risk of a heart attack or stroke.

High-density lipoproteins—also called HDL and referred to as the "good" cholesterol—helps remove the LDL from your blood vessels.

People with diabetes are typically advised to make lifestyle changes to help lower their cholesterol and are also prescribed a statin to reduce their LDL levels. With rare exceptions, the ADA recommends that adults with diabetes take a statin.

Depending on how you respond to statins, your doctor may also prescribe an additional LDL-lowering medication. Your dose will depend on whether you have additional risk factors for cardiovascular disease.

Should you take aspirin?
Just because aspirin is available without a prescription doesn’t mean it’s harmless. The ADA recommends taking a low-dose aspirin every day to help maintain a healthy heart if:

• You’re between the ages of 50 and 69 and have diabetes
• You have at least one of the following: a family history of heart disease, high blood pressure or high cholesterol levels, dyslipidemia, chronic kidney disease/albuminuria, or you are a smoker
• You don’t have an increased risk of bleeding

If you’re not sure whether an aspirin should be part of your daily regimen, talk to your healthcare provider.

The link between diabetes and cardiovascular disease may seem overwhelming. But with the right guidance from your doctor and the appropriate medications, you can reduce your risk of heart problems.