CVD Risk Management in Diabetes

Cardiovascular disease, or CVD, is the most common cause of death in people with diabetes, and diabetics are more prone to “silent” heart attacks where they don’t have the typical symptoms of chest pain and shortness of breath. For this reason, doctors focus strongly on CVD risk management in diabetes to prevent heart disease and lower the risk of heart attacks.

CVD Risk Management in Diabetes Begins with Controlling Blood Pressure

Hypertension is twice as common in people with diabetes as it is in non-diabetics and having both diabetes and hypertension together significantly increases the risk of heart disease and heart attack. In fact, according to the journal Diabetes Care, diabetics have a six-fold increased risk of heart attack. Obviously, it’s important to control blood pressure levels in diabetics, and doctors usually have lower target ranges for blood pressure in diabetics because of their higher risk of heart disease. Treatment is usually started when systolic blood pressure climbs above 130 mmHg or diastolic blood pressure is 80 mmHg or above.

Lifestyle changes play an important role in reducing blood pressure and CVD risk management in diabetes. Exercise, a heart-healthy diet and not smoking lowers blood pressure and reduces the risk of heart disease. When diabetics need medications to control their blood pressure, they usually require more than one to achieve acceptable blood pressure control.

One of the best medications for controlling hypertension and CVD risk in diabetes is a group of medications called ACE inhibitors or a similar class called ARBs. This class of medications may be used alone or in combination with a diuretic. ACE inhibitors not only lower blood pressure, they also slow down the progression of diabetic kidney disease. They also lower the risk of heart attack in diabetics who have heart disease.

In some cases, an additional anti-hypertensive medication may be needed to lower a diabetic’s blood pressure to the target level. This might include a beta-blocker or a calcium channel blocker, although beta-blockers are used with caution since they can mask the symptoms of hypoglycemia and worsen insulin resistance.

CVD Risk Management in Diabetes: Optimizing Lipid Levels

Diabetics often have abnormal lipid levels including a high LDL, low HDL and elevated triglycerides. Correcting these problems is an important goal of CVD risk management in diabetes. Most sources now recommend that all diabetics at high risk for cardiovascular disease should take a statin regardless of their LDL level.

For diabetics who have a low HDL, doctors sometimes combine a statin with niacin, although some people have difficulty tolerating niacin because of flushing and itching. High triglycerides are also common in diabetics and are a risk factor for heart disease. Omega-3 fatty acid supplements reduce triglyceride levels but people who fail to respond or who can’t take omega-3s may need a prescription medication.

Diabetics often have abnormal lipid levels including a high LDL, low HDL and elevated triglycerides. Correcting these problems is an important goal of CVD risk management in diabetes. Most sources now recommend that all diabetics at high risk for cardiovascular disease take a statin regardless of their LDL level.

For diabetics who have a low HDL, doctors sometimes combine a stain with niacin, although some people have difficulty tolerating niacin because of flushing and itching. High triglycerides are also common in diabetics and are a risk factor for heart disease. Omega-3 fatty acid supplements reduce triglyceride levels but people who fail to respond or who can’t take omega-3s may need a prescription medication, usually a fibrate.

Lifestyle Factors are Critical

Management of CVD risk in diabetes always starts with lifestyle factors. Eating a Mediterranean-style diet, exercising and keeping blood sugars under good control goes far in reducing the risk of heart disease. Medications are not a substitute for making healthy diet and lifestyle choices.

The Bottom Line

Management of CVD risk in diabetes requires optimizing blood pressures, lipid levels and controlling blood sugar levels. Talk to your doctor about the best way to do this in your particular case.

References

Diabetes Care. 2005; 28: Supplement 1.

Diabetes Essentials. Foruth Edition. 2009.