Preventing Cardiovascular Disease

Control diabetes -- and keep your heart healthy -- with these tips.

From Stopping Diabetes in Its Tracks

Keep It Up -- and Go Further!

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 beyond what you're already doing 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 Stopping 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. Americans on average get 8 to 10 times more salt than they need. You can significantly cut your consumption by eating fewer processed foods and more naturally low-salt whole foods like 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 through the arteries by making them even 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 lowdose 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.
  
  

More Healthy-Heart Tips

• Check your ACE in the hole. You can choose from an array of drugs that fight high blood pressure, but one class of medications appears to have special benefits to people with diabetes. Called ACE (angiotensin-converting enzyme) inhibitors, they 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. (Newer drugs called angiotensin II receptor blockers eliminate that problem). 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. What's more, a study published in 2000 found that people taking the ACE inhibitor ramipril were 30 percent less likely to develop diabetes, suggesting that the drug improves insulin sensitivity.
  
  
• 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. If you thought you weren't a candidate for statins, think again. The National Cholesterol Education Program recently revised its cholesterol guidelines, so 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.
  
  
• Supplement with folic acid. This B vitamin has been shown to lower levels of homocysteine, a substance linked to cardiovascular disease risk. A multivitamin should do the trick.