Over time, high blood glucose levels can damage your blood vessels and the nerves that control them, so people living with diabetes have an increased risk of heart disease and stroke, explains Clyde Yancy, M.D., chief of cardiology at Northwestern and a spokesperson for the American Heart Association. But even when you have diabetes, heart disease isn't inevitable, and there's a lot you can do to lower your odds, says Yancy. Focus on these four areas for a healthier heart.
You probably already know your A1C and what your goal range should be. But you should keep an eye on your blood pressure and cholesterol numbers too. The American Diabetes Association (ADA) recommends that most people with diabetes aim for a blood pressure of under 140/90 mmHg, but you and your doctor might decide that a lower target of 130/80 or 120/80 mmHg is right for you. Tamanna Singh, M.D., a cardiologist at the Cleveland Clinic, recommends that PWDs with a higher risk of coronary artery disease aim for a blood pressure under 130/80 mmHg.
The American Heart Association recommends keeping triglycerides under 150 mg/dL and aiming to keep HDL cholesterol (the good kind) at 40 mg/dL or above for men and 50 mg/dL or above for women. The ADA recommends getting your cholesterol levels checked at least every five years if you're under 40, and annually for those over 40 and for people taking a statin.
Focusing on increasing heart-healthy fats and lowering saturated fat and sodium can help reduce your risk of heart disease and stroke. A great way to do this is to focus on eating more plant-based foods like fruits, veggies, whole grains, legumes, nuts, and heart-healthy oils like olive and canola oil, and eating fewer highly processed foods. This style of eating not only protects you against heart disease, it also can help you manage your diabetes, particularly when you stick within a calorie range that doesn't lead to weight gain, says Jeffrey Mechanick, M.D., a diabetes specialist and medical director of the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart in New York City.
You don't have to be a gourmet chef to tweak your eating style. Simple, small changes such as eating tuna or salmon twice a week, snacking on a small handful of nuts every day, and keeping an eye on your salt intake can go a long way. Another smart tweak is to add more produce to your meals—the ADA recommends aiming for 8 to 10 servings per day for heart health. Consider adding some shredded carrots or zucchini to your pasta sauce, or replacing some of the ground meat in burgers or meatloaf with cooked chopped mushrooms. Want more guidance? Try following either the Mediterranean Diet or the DASH diet, both of which have been shown to lower the risk of heart disease.
Pictured recipe: Pork Paprikash with Cauliflower "Rice"
Staying active improves insulin sensitivity, lowers blood sugar, and boosts overall heart health by keeping your blood vessels flexible and strong. This means not only aiming for regular exercise, but also trying to move more throughout your day. A good goal for most people is 150 minutes per week of moderate exercise that raises your heart rate, like brisk walking (roughly 30 minutes a day, 5 times a week), plus aiming to get up and move for at least 3 minutes every 30 minutes, to avoid prolonged sitting. If you can't squeeze in a full half-hour of exercise at once, it's fine to divide it into 10- or 15-minute chunks of activity.
The more often your blood sugar is in a healthy range, the lower your risk of developing heart disease, stresses Evan Sisson, Pharm.D., a certified diabetes educator and professor at VCU School of Pharmacy in Richmond, Virginia. Consistently taking your diabetes medications will help reduce your overall heart disease risk, because it helps you manage your blood glucose levels. But you may also require other heart drugs. If your blood pressure is 140/90 mmHg or above, the ADA recommends starting blood pressure medication, and if it's 160/100 mmHg or higher, they recommend taking two blood-pressure-lowering meds. If you're 40 or older, the ADA recommends taking a cholesterol-lowering medication such as a statin, especially if you have risk factors for heart disease such as high blood pressure, elevated cholesterol, chronic kidney disease, or tobacco use.
PWDs of any age who have a history of cardiovascular disease should be taking a statin, says Singh. It's a good idea to regularly review your medication regime with your doctor, because there may be new medications available that are more effective—or less expensive—than the ones you're currently on.